Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants

Abstract

Pelvis ring fractures of geriatric patients are currently a serious problem in orthopedic and trauma surgery. One controversy that remains is the insufficiency fracture of the sacrum with treatment options ranging from conservative to operative. We modified standard 7.3-mm screws with additional perforations at the tip to allow cement injection trough the screw to improve implant anchorage. We describe a new method of treatment of sacral insufficiency fractures. We use modified cannulated 7.3-mm screws (Synthes) with additional perforations at the screw tip. This allows the implant augmentation after proper implant positioning and contrast medium instillation for leakage detection. All patients (12 female) treated this way, are allowed to weight bear as tolerated immediately after surgery. The pain level (measured by the visual analog scale--VAS) was significantly reduced due to surgery (mean 8.2 pre-operatively, mean 2.6 postoperatively), the pain medication could be reduced rapidly. The described procedure for the treatment of sacral insufficiency fractures has the potential to increase the safety of cement injection into the sacrum because of the possibility of contrast agent instillation prior to cement injection. Furthermore, the amount of cement can be reduced and additional stability can be attained due to iliosacral screw osteosynthesis compared to sacroplasty.