gms | German Medical Science

Objectives: Percutaneous iliosacral screw fixation offers a minimal invasive and safe fixation method for the majority of posterior pelvic ring fractures. In osteoporotic fractures, loosening of the screws is frequently observed which may result in inadequate fracture fixation and could lead to revision operations.

Biomechanical studies have shown that augmentation of screws with bone cement provides better hold in osteoporotic bone. The use of cannulated fenestrated screws allows for radiological control of hazardous leakage with contrast fluids and subsequent in-screw cement augmentation after definitive placement of the screw. In contrast to cement application before definitive screw placement this technique may help minimising potential complications.

The aim of this study is to report on the initial experiences with a new cannulated fenestrated screw system.

Methods: We prospectively followed all consecutive patients with fragility fractures of the pelvis (FFP) treated with percutaneous iliosacral cannulated fenestrated screws (ISG Schraube, Medid) and cement augmentation (TraumaCem V+, DePuy Snythes) in our department. Weight bearing as tolerated was allowed 24 hours after screw placement to permit full cement hardening. Clinical and radiological follow up was standardised.

Basic patient characteristics, radiological findings, operative methods, mobility status, and pain levels were collected and statistically analysed.

Result: Eight patients with FFP were treated with a total number of 13 iliosacral screws. The average age of the patients was 76 years (range 50–98 years). All screws were placed on the level of the 1st sacral body. In average, 1.70ml bone cement was applied per screw.

Postoperative CT scan showed no screw malpositioning. In one patient, cement leakage to the spinal canal was detected although the intraoperative leakage test with contrast fluid was found to be negative. The respective patient remained without any neurological symptoms. All patients reported significant improvement of pain levels postoperatively. No screw loosening was detected during follow-up.

Discussion: Percutaneous iliosacral fixation of FFP using cannulated fenestrated screws with in-screw cement augmentation is associated with a low complication rate. It leads to a significant pain reduction and allows for early mobilisation of patients without risk of screw loosening. Further studies, including larger numbers of patients, are needed to fully evaluate the safety and benefit of the technique.