Biomechanical analysis of stiffness and fracture displacement after using PMMA-augmented sacroiliac screw fixation for sacrum fractures

2017 ◽  
Vol 62 (4) ◽  
pp. 421-428 ◽  
Author(s):  
Andreas Höch ◽  
Richard Schimpf ◽  
Niels Hammer ◽  
Stefan Schleifenbaum ◽  
Michael Werner ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Cement Augmentation ◽  
Biomechanical Analysis ◽  
Human Donor ◽  
Sacroiliac Screw ◽  
Fracture Stabilization ◽  
Sacroiliac Screw Fixation

AbstractCement augmentation of pedicle screws is the gold standard for the stabilization of osteoporotic fractures of the spine. In-screw cement augmentation, in which cement is injected through the cannula, is another option for fracture stabilization of fragility fractures of the sacrum. However, biomechanical superiority of this technique compared to conventional sacroiliac screw fixation has not been tested. The present study compares the stability of cement-augmented and non-cement-augmented sacroiliac screw fixation in osteoporotic sacrum fractures under cyclic loading. Eight human donor pelvises with intact ligaments and 5

scholarly journals Is cement-augmented sacroiliac screw fixation with partially threaded screws superior to that with fully threaded screws concerning compression and pull-out force in fragility fractures of the sacrum? – a biomechanical analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Juliana Hack ◽  
Maiwand Safi ◽  
Martin Bäumlein ◽  
Julia Lenz ◽  
Christopher Bliemel ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Fragility Fractures ◽  
Cement Augmentation ◽  
Osteoporotic Bone ◽  
Sacroiliac Screw ◽  
Pull Out ◽  
Sacroiliac Screw Fixation ◽  
Group A ◽  
Group B ◽  
Screw Group

Abstract Background Providing a stable osteosynthesis in fragility fractures of the pelvis can be challenging. Cement augmentation increases screw fixation in osteoporotic bone. Generating interfragmentary compression by using a lag screw also improves the stability. However, it is not known if interfragmentary compression can be achieved in osteoporotic sacral bone by cement augmentation of lag screws. The purpose of this study was to compare cement-augmented sacroiliac screw osteosynthesis using partially versus fully threaded screws in osteoporotic hemipelvises concerning compression of fracture gap and pull-out force. Methods Nine fresh-frozen human cadaveric pelvises with osteoporosis were used. In all specimens, one side was treated with an augmented fully threaded screw (group A), and the other side with an augmented partially threaded screw (group B) after generating a vertical osteotomy on both sides of each sacrum. Afterwards, first a compression test with fracture gap measurement after tightening of the screws was performed, followed by an axial pull-out test measuring the maximum pull-out force of the screws. Results The fracture gap was significantly wider in group A (mean: 1.90 mm; SD: 1.64) than in group B (mean: 0.91 mm; SD: 1.03; p = 0.028). Pull-out force was higher in group A (mean: 1696 N; SD: 1452) than in group B (mean: 1616 N; SD: 824), but this difference was not statistically significant (p = 0.767). Conclusions Cement augmentation of partially threaded screws in sacroiliac screw fixation allows narrowing of the fracture gap even in osteoporotic bone, while resistance against pull-out force is not significantly lower in partially threaded screws compared to fully threaded screws.

scholarly journals Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

2016 ◽  
Vol 474 (11) ◽  
pp. 2522-2530 ◽  
Author(s):  
Georg Osterhoff ◽  
Andrew E. Dodd ◽  
Florence Unno ◽  
Angus Wong ◽  
Shahram Amiri ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Cement Augmentation ◽  
Sacroiliac Screw ◽  
Sacroiliac Screw Fixation

Sacroiliac Screw Fixation for Tile B Fractures

2003 ◽  
Vol 55 (5) ◽  
pp. 962-965 ◽  
Author(s):  
Eric W. van den Bosch ◽  
C. M. A. van Zwienen ◽  
G. A. Hoek van Dijke ◽  
C. J. Snijders ◽  
Arie B. van Vugt
Keyword(s):  
Screw Fixation ◽  
Sacroiliac Screw ◽  
Sacroiliac Screw Fixation

COMPARISON OF X-RAY AND CT METHODS FOR ASSESSING SACRAL SHAPE VARIANTS AND IDENTIFYING A SECURE SACROILIAC SCREW FIXATION CORRIDOR

2019 ◽  
Vol 22 (03n04) ◽  
pp. 1950007
Author(s):  
Florian Radetzki ◽  
Felix Goehre ◽  
Stefan Schwan ◽  
Andreas Wienke ◽  
Lars Jansch ◽  
...  
Keyword(s):  
Predictive Value ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Invasive Technique ◽  
Posterior Pelvic Ring ◽  
Predictive Values ◽  
X Ray ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Sacroiliac Screw Fixation

Sacroiliac screw fixation is the only minimally invasive technique for stabilizing unstable posterior pelvic ring fractures. X-ray/CT methods identify sacral shape variants, which influence screw fixation feasibility at sacral segment S1. As no reliability analysis was previously published, this study analyzed four X-ray/CT-based screw corridor evaluation methods. CT datasets of 80 human pelvises (♂[Formula: see text][Formula: see text], ♀[Formula: see text][Formula: see text], [Formula: see text] years, [Formula: see text][Formula: see text]cm, [Formula: see text][Formula: see text]kg) were used. CTs were post-processed using Amira 5.2 software to generate 3D models and analyzed for S1 transverse 7.3[Formula: see text]mm screw corridors using a C++ program. CT-slices and radiograph-like images were generated per each classification’s requirements. Five surgeons independently assessed sacral shape and transverse screw insertion feasibility. Sensitivity, specificity, and positive/negative predictive values were calculated. C++ analysis indicated feasible screw insertion in 66 cases (82%). Sensitivities were 86% (Mendel), 75% (Routt), 74% (Carlson), and 67% (Kim). Specificities were 73% (Mendel) and 79% (Kim). Mean positive predictive value spanned from 54.6% (Mendel) to 26.2% (Carlson); negative predictive value spanned from 94.5% (Kim) to 90.4% (Carlson). No significant differences existed between surgeons. Mendel’s classification provides reliable and reproducible assessment via the lateral sacral triangle, without additional CTs like Carlson or Routt or the subjectivity of Kim’s method.

scholarly journals Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation—A 15-Year Retrospective Analysis on over 640 Screws

2020 ◽  
Vol 9 (8) ◽  
pp. 2660 ◽  
Author(s):  
René Hartensuer ◽  
Moritz F. Lodde ◽  
Jonas Keller ◽  
Maria Eveslage ◽  
Josef Stolberg-Stolberg ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Case Series ◽  
Fragility Fractures ◽  
Epidemiological Data ◽  
Neurological Impairment ◽  
Complication Rates ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Complication Risk ◽  
Screw Misplacement

Background: Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. Methods: The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. Results: Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. Conclusions: The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.

scholarly journals Adjacent-segment disease after thoracic pedicle screw fixation

2018 ◽  
Vol 28 (3) ◽  
pp. 280-286 ◽  
Author(s):  
Nitin Agarwal ◽  
Robert F. Heary ◽  
Prateek Agarwal
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Spine Deformity ◽  
Fracture Stabilization ◽  
Thoracic Pedicle Screw

OBJECTIVEPedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine.METHODSSelect references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors’ experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined.RESULTSDefinitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months.CONCLUSIONSThis long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis

2012 ◽  
Vol 16 (6) ◽  
pp. 585-593 ◽  
Author(s):  
Ben B. Pradhan ◽  
Alexander W. L. Turner ◽  
Michael A. Zatushevsky ◽  
G. Bryan Cornwall ◽  
Sean S. Rajaee ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinous Process ◽  
Pedicle Screws ◽  
Axial Rotation ◽  
Pedicle Screw Fixation ◽  
Biomechanical Analysis ◽  
Instrumented Fusion ◽  
Lumbar Spinal ◽  
Flexion And Extension

Object Traditional posterior pedicle screw fixation is well established as the standard for spinal stabilization following posterior or posterolateral lumbar fusion. In patients with lumbar spinal stenosis requiring segmental posterior instrumented fusion and decompression, interlaminar lumbar instrumented fusion (ILIF) is a potentially less invasive alternative with reduced morbidity and includes direct decompression assisted by an interlaminar allograft spacer stabilized by a spinous process plate. To date, there has been no biomechanical study on this technique. In the present study the biomechanical properties of the ILIF construct were evaluated using an in vitro cadaveric biomechanical analysis, and the results are presented in comparison with other posterior fixation techniques. Methods Eight L1–5 cadaveric specimens were subjected to nondestructive multidirectional testing. After testing the intact spine, the following conditions were evaluated at L3–4: bilateral pedicle screws, bilateral laminotomy, ILIF, partial laminectomy, partial laminectomy plus unilateral pedicle screws, and partial laminectomy plus bilateral screws. Intervertebral motions were measured at the index and adjacent levels. Results Bilateral pedicle screws without any destabilization provided the most rigid construct. In flexion and extension, ILIF resulted in significantly less motion than the intact spine (p < 0.05) and no significant difference from the laminectomy with bilateral pedicle screws (p = 0.76). In lateral bending, there was no statistical difference between ILIF and laminectomy with unilateral pedicle screws (p = 0.11); however, the bilateral screw constructs were more rigid (p < 0.05). Under axial rotation, ILIF was not statistically different from laminectomy with unilateral or bilateral pedicle screws or from the intact spine (p > 0.05). Intervertebral motions adjacent to ILIF were typically lower than those adjacent to laminectomy with bilateral pedicle screws. Conclusions Stability of the ILIF construct was not statistically different from bilateral pedicle screw fixation following laminectomy in the flexion and extension and axial rotation directions, while adjacent segment motions were decreased. The ILIF construct may allow surgeons to perform a minimally invasive, single-approach posterior decompression and instrumented fusion without the added morbidity of traditional pedicle screw fixation and posterolateral fusion.

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