scholarly journals Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

2010 ◽  
Vol 131 (6) ◽  
pp. 809-813 ◽  
Author(s):  
Georg Osterhoff ◽  
Christian Ossendorf ◽  
Guido A. Wanner ◽  
Hans-Peter Simmen ◽  
Clément M. L. Werner
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Perioperative Complications ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Injuries ◽  
Iliosacral Screw Fixation

scholarly journals Comparison of Lumbopelvic Fixation and Iliosacral Screw Fixation for the Treatment of Bilateral Sacral Fractures

2021 ◽  
Author(s):  
Katharina E. Wenning ◽  
Emre Yilmaz ◽  
Thomas A. Schildhauer ◽  
Martin F. Hoffmann
Keyword(s):  
Operative Time ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Weight Bearing ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Sacral Fractures ◽  
Lumbopelvic Fixation ◽  
Pelvic Ring Injuries ◽  
Iliosacral Screw Fixation

Abstract Background: Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose: The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications, and postoperative mobilization. The secondary aim was to determine if demographics influence surgical treatment.Methods: Over a 4-year period (2016-2019) 188 consecutive patients with pelvic ring injuries were treated at one academic level-1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. 77 patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma, and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight-bearing was used as outcome variable. Follow-up was at least 6 months postoperatively.Results: Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Thereof, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p=0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (165 min vs. 73 min; respectively, p<0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p=0.008) but were all weight-bearing as tolerated when discharged (p<0.001). Conclusion: Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight-bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

scholarly journals Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Katharina E. Wenning ◽  
Emre Yilmaz ◽  
Thomas A. Schildhauer ◽  
Martin F. Hoffmann
Keyword(s):  
Operative Time ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Weight Bearing ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Sacral Fractures ◽  
Lumbopelvic Fixation ◽  
Pelvic Ring Injuries ◽  
Iliosacral Screw Fixation

Abstract Background Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications and postoperative mobilization. The secondary aim was to determine whether demographics influence surgical treatment. Methods Over a 4-year period (2016–2019), 188 consecutive patients with pelvic ring injuries were treated at one academic level 1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. Seventy-seven patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight bearing was used as outcome variable. Follow-up was at least 6 months postoperatively. Results Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Therefore, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p = 0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (73 min vs. 165 min; respectively, p < 0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p = 0.008) but were all weight bearing as tolerated when discharged (p < 0.001). Conclusion Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

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