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In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Minimal invasive screw fixation is common for treating posterior pelvic ring pathologies, but lack of bone quality may cause anchorage problems. The aim of this study was to report in detail a new technique combining iliosacral screw fixation with in-screw cement augmentation (ISFICA).

Description of technique

The patient was put under general anesthesia and placed in the supine position. A K-wire was inserted under inlet–outlet view to guide the fully threaded screw. The screw placement followed in adequate position. Cement was applied through a bone filler device, inserted at the screwdriver. The immediate control of cement distribution, accurate screw placement and potential leakage were obtained via intraoperative CT scan.

Patients and methods

Twenty consecutive patients treated with ISFICA were included in this study. The mean age was 74.4 years (range 48–98). Screw placement, possible cement leakage and screw positioning were evaluated via intraoperative CT scan. Postoperative neurologic deficits, pain reduction and immediate postoperative mobilization were clinically evaluated.

Results

Twenty-six screws were implanted. All patients were postoperatively, instantly mobilized with reduced pain. No neurologic deficits were apparent postoperatively. No cement leakage occurred. One breach of the iliac cortical bone was noted due to severe osteoporosis.

One screw migration was seen after 1 year and two patients showed iliosacral joint arthropathy, which led to screw removal.

Conclusion

ISFICA is a very promising technique in terms of safety, precision and initial postoperative outcome. Long-term outcomes such as lasting mechanical stability or pain reduction and screw loosening despite cement augmentation should be investigated in further studies with larger patient numbers.

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Author notes

    Authors and Affiliations

    1. Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

      M. A. König, S. Hediger, J. W. Schmitt, T. Jentzsch, K. Sprengel & C. M. L. Werner

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    1. M. A. König
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    2. S. Hediger
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    3. J. W. Schmitt
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    4. T. Jentzsch
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    5. K. Sprengel
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    6. C. M. L. Werner
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    Correspondence to C. M. L. Werner.

    Ethics declarations

    This study was performed with ethical requirements, with ethical approval obtained at the “Kantonale Ethikkommission Zürch”: KEK 2014-0557.

    Conflict of interest

    M. A. König, S. Hediger, J. W. Schmitt, T. Jentzsch, K. Sprengel and CML Werner declare that they have no conflict of interest.

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    M. A. König and S. Hediger equally contributed to this work.

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    König, M.A., Hediger, S., Schmitt, J.W. et al. In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J Trauma Emerg Surg 44, 203–210 (2018). https://doi.org/10.1007/s00068-016-0681-6

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    • DOI: https://doi.org/10.1007/s00068-016-0681-6

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