Abstract
Background and Objectives: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). Materials and Methods: Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. Results: Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, p = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), p ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, p = 0.79. Conclusions: In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone.
Highlights
During the recent two decades the incidence of pelvic ring fractures and the amount of their surgical treatment procedures increased significantly [1]
Weight bearing mobilization and pain reduction are theofgoals and fixation of theFull weight bearing posterior part is the primary goal in stabilization the of the treatment fragility fractures of the pelvis [6,7]
The anterior pelvic ring was addressed with a supra-acetabular external fixator
Summary
During the recent two decades the incidence of pelvic ring fractures and the amount of their surgical treatment procedures increased significantly [1]. Fractures resulting from low-energy trauma or physiological stress are classified as fragility fracture of the pelvis (FFP) [3]. Letournel’s golden rule postulates that the reduction and fixation of the weight bearing posterior part is the primary goal in stabilization of the Medicina 2021, 57, x FOR PEER REVIEW pelvic ring [4,5]. Weight bearing mobilization and pain reduction are theofgoals and fixation of theFull weight bearing posterior part is the primary goal in stabilization the of the treatment fragility fractures of the pelvis [6,7]. Several treatment optionswith for posterior sacroiliac screw are is widely accepted as standard of carefractures treatment pelvic ring(SI). 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. Results: Fracture displacement after 500 cycles was lowest in Group 3
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