Compressive effect and collapse behavior of three different transsacral implants in sacral fragility fractures - a retrospective analysis of 106 cases.

Abstract

The aim of this study were the retrospective evaluation of the compressive effect and complication rates of transsacral stabilization of osteoporosis-associated sacral fragility fractures in 106 patients using three different implants (6.0mm sacral bar, n = 32; 7.3mm screw, n = 26; 7.5mm ISG-Rod System, n = 48) with regard to the image morphological and clinical-perioperative outcome. For this purpose, the sacral width was determined preoperatively and postoperatively using multiplanar CT reconstructions and correlated with the measured bone density (HU). The results were compared with each other on an implant-specific basis. A significant compressive effect was found for all implants (6.0mm sacral bar 7.1 ± 3.4mm, 7.3mm screw 6.9 ± 1.8mm, 7.5mm ISG-Rod System 8 ± 2.4mm). No implant-specific difference in compression could be detected. Overall, the washers broke into the iliac cortex in 9% of cases. The subgroups did not differ significantly in this respect (6.0mm sacral bar: 4 [13%], 7.3mm screw 1 [1%], 7.5mm ISG-Rod System (5 [10%], p = 0.581). A correlation between the degree of osteoporosis and the compressive effect could not be demonstrated. Significant implant-specific differences were found in the incision-suture time, with only ø0:39 ± 0:13h required for implantation of the 7.5mm ISG Rod System (6.0mm sacral bar: ø1:09 ± 0:22h, 7.3mm screw: ø0:55 ± 0:20h). The fluoroscopy time was significantly lower with the 7.3mm screw (ø0:57 ± 0:23min) and the 7.5mm ISG Rod System (ø0:42 ± 00:17min) than with the 6.0mm sacral bar (ø1:36 ± 0:46min). A significant compressive effect was demonstrated with all three implants. No implant-specific complications or surgical site complications were identified in either the overall cohort or the subgroups. The 7.5mm ISG Rod System shows advantages with regard to the duration of surgery and fluoroscopy.