Abstract

Research Article

“Iliosacral bridging” - A new alternative minimal invasive fixation of unstable pelvic ring fractures

Siekmann H*, Becherer L, Neef R, Kunath T and Florian Radetzki

Published: 20 November, 2018 | Volume 2 - Issue 2 | Pages: 039-046

Introduction: Fractures of both the anterior and posterior pelvic ring are common injuries in polytrauma and the elderly that extend beyond those of simple low-impact trauma. While conventional X-rays predominantly show the ventral aspect of the injury, computed tomography often detect additional fractures of the sacrum. A large number of these fractures are B-injuries by AO, mainly compression fractures at an advanced age. In addition, the prevalence of pelvic insufficiency fractures caused by osteoporosis rather than subsequent to an obvious trauma is increasing, with such an injury often associated with pain that impairs mobilization. The standard sacroiliac screw fixation is often characterized by loosening and thus failure of the osteosynthesis especially in osteoporotic bone of elderly patients.

Method: A new alternative surgical minimal invasive technique, the “iliosacral bridging”, stabilizes the fractures of the sacrum with an internal fixation from S1 pedicle of the uninjured side to the ilium on the affected side. The combination of this internal fixation with the standard single sacroiliac screw on the injured side allows an immediate full weight bearing and pain free mobilization. We present a case series of 8 patients.

Results: The clinical and radiological analysis analogous to the pelvic-outcome-score brought forward that 2 patients showed an excellent and 2 patient a good result. The other 4 patients achieved sufficient results.

Conclusions: The “iliosacral bridging” we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries

Read Full Article HTML DOI: 10.29328/journal.ascr.1001022 Cite this Article Read Full Article PDF

Keywords:

Pelvis; Pelvic ring; Osteoporotic fracture; Insufficiency fracture; Classification; Treatment; Osteosynthesis; Iliosacral bridging; Transsacral bar; Iliolumbar fixation; Sacroiliac screw

References

  1. Gilliland MD, Ward RE, Barton RM, Miller PW, Duke JH. Factors affecting mortality in pelvic fractures. J Trauma 1982; 22: 691-693. Ref.: https://goo.gl/MkAo1t
  2. Keller JM, Sciadini MF, Sinclair E, O'Toole RV. Geriatric trauma demographics, injuries, and mortality. J Orthop Trauma. 2012; 26: e161-e165. Ref.: https://goo.gl/2tmKuj
  3. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury. 2013; 44: 1733-1744. Ref.: https://goo.gl/6Jo4xn
  4. Sullivan MP, Baldwin KD, Donegan DJ, Mehta S, Ahn J. Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis. Orthopedics. 2014; 37: 151-157. Ref.: https://goo.gl/27u3TS
  5. Frick H, Leonhardt H, Starck D. Taschenlehrbuch der gesamten Anatomie I. Allgemeine Anatomie. Spezielle Anatomie I. Extremitäten, Rumpfwand, Kopf, Hals. Mit Schlüssel zum Gegenstandskatalog. 4. Auflage ed. Stuttgart: Thieme 1992;
  6. Galbraith JG, Butler JS, Blake SP, Kelleher G. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED. Am J Emerg Med 2011; 29: 359-356. Ref.: https://goo.gl/95dD72
  7. White JH, Hague C, Nicolaou S, Gee R, Marchinkow LO, et al. Imaging of sacral fractures. Clin Radiol 2003; 58: 914-921. Ref.: https://goo.gl/EXMwzq
  8. Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. AJR Am J Roentgenol. 2008; 191: 995-1001. Ref.: https://goo.gl/iNyzzz
  9. Ahovuo JA, Kiuru MJ, Visuri T. Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol. 2004; 14: 500-505. Ref.: https://goo.gl/j3WRZK
  10. Pohlemann T, Gansslen A, Tscherne H. [Fracture of the sacrum]. Unfallchirurg. 2000; 103: 769-786.
  11. Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988; 227: 67-81. Ref.: https://goo.gl/oFzSa6
  12. Koo H, Leveridge M, Thompson C, Zdero R, Bhandari M, et al. Interobserver reliability of the young-burgess and tile classification systems for fractures of the pelvic ring. J Orthop Trauma. 2008; 22: 379-384. Ref.: https://goo.gl/FdTrAh
  13. Tile M. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams & Wilkins. 1995;
  14. Giannoudis PV, Tzioupis CC, Pape HC, Roberts CS. Percutaneous fixation of the pelvic ring: an update. J Bone Joint Surg Br. 2007; 89: 145-154. Ref.: https://goo.gl/ugZ9fC
  15. Grubor P, Milicevic S, Biscevic M, Tanjga R. Selection of treatment method for pelvic ring fractures. Med Arh. 2011; 65: 278-282. Ref.: https://goo.gl/fg9Fpp
  16. Mendel T, Noser H, Wohlrab D, Stock K, Radetzki F. The lateral sacral triangle--a decision support for secure transverse sacroiliac screw insertion. Injury. 2011; 42: 1164-1170. Ref.: https://goo.gl/BYkYk2
  17. Babayev M, Lachmann E, Nagler W. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil. 2002; 79: 404-409. Ref.: https://goo.gl/5BaEo9
  18. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res. 1989; (242): 83-97. Ref.: https://goo.gl/pyS5f9
  19. Mears SC, Sutter EG, Wall SJ, Rose DM, Belkoff SM. Biomechanical comparison of three methods of sacral fracture fixation in osteoporotic bone. Spine (Phila Pa 1976) 2010; 35: E392-E395. Ref.: https://goo.gl/BL36ZJ
  20. Routt ML, Jr., Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996; 10: 171-177. Ref.: https://goo.gl/yE2LAc
  21. Carlson DA, Scheid DK, Maar DC, Baele JR, Kaehr DM. Safe placement of S1 and S2 iliosacral screws: the "vestibule" concept. J Orthop Trauma. 2000; 14: 264-269. Ref.: https://goo.gl/rfuBAW
  22. Tosounidis T, Kanakaris N, Nikolaou V, Tan B, Giannoudis PV. Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable? Int Orthop. 2012; 36: 2553-2558. Ref.: https://goo.gl/YUACk3
  23. van Zwienen CM, van den Bosch EW, Snijders CJ, Kleinrensink GJ, van Vugt AB. Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma. 2004; 18: 589-595. Ref.: https://goo.gl/uFxqzv
  24. Wahnert D, Raschke MJ, Fuchs T. Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum: a new method using modified implants. Int Orthop. 2013; 37: 1147-1150. Ref.: https://goo.gl/huSi7G
  25. Yu BS, Yang ZK, Li ZM, Zeng LW, Wang LB, et al. Which is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell. J Spinal Disord Tech. 2011; 24: E49-E56. Ref.: https://goo.gl/LLbNyp
  26. Frey ME, DePalma MJ, Cifu DX, Bhagia SM, Carne W, et al. Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J. 2008; 28: 367-373. Ref.: https://goo.gl/3nKGW6
  27. Shah RV. Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases. Spine J. 2012; 12: 113-120. Ref.: https://goo.gl/Jv47Pq
  28. Trouvin AP, Alcaix D, Somon T, Zarnitsky C. Analgesic effect of sacroplasty in osteoporotic sacral fractures: a study of six cases. Joint Bone Spine. 2012; 79: 500-503. Ref.: https://goo.gl/HvHbBp
  29. Bastian JD, Keel MJ, Heini PF, Seidel U, Benneker LM. Complications related to cement leakage in sacroplasty. Acta Orthop Belg. 2012; 78:100-105. Ref.: https://goo.gl/PyCKdW
  30. Pohlemann T, Weigel B, Maghsudi M. Praxisbuch Unfallchirurgie. 2nd ed. Berlin, Heidelberg, NY: Springer. 2011;
  31. Schildhauer TA, Josten C, Muhr G. riangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma.1998; 12: 307-314. Ref.: https://goo.gl/V7LZw9
  32. Schildhauer TA, McCulloch P, Chapman JR, Mann FA. Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations. J Spinal Disord Tech. 2002; 15: 199-205. Ref.: https://goo.gl/wx7gXb
  33. Ebraheim NA, Lin D, Xu R, Stanescu S, Yeasting RA. Computed tomographic evaluation of the internal structure of the lateral sacral mass in the upper sacra. Orthopedics.1999; 22: 1137-1140. Ref.: https://goo.gl/vof6rG

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