Cement-augmented sacroiliac screw fixation with cannulated versus perforated screws – A biomechanical study in an osteoporotic hemipelvis model

Hack, Juliana; Krüger, Antonio; Masaeli, Adrian; Aigner, René; Ruchholtz, Steffen; Oberkircher, Ludwig

doi:10.1016/j.injury.2018.06.012

Cited by 14 publications

(6 citation statements)

References 28 publications

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“…However, failure rates of sacroiliac screws occurred in 14% to 17% of patients [37,38]. Accordingly, cement augmentation of sacroiliac screws at the level of the body of S1 vertebra was proposed to increase the anchorage between the bone and the implant and was a matter of preclinical research [15][16][17][18][19][20]. In addition, a 25% reduced time from surgery to discharge was noted following cement augmentation [23].…”

Section: Discussionmentioning

confidence: 99%

“…However, a diminished screw purchase of sacroiliac screws as a monocortical screw device in cancellous, osteoporotic bone is a concern [13,14]. Therefore, cement augmentation of sacroiliac screws at the level of the body of S1 vertebra was proposed to increase the anchorage between bone and implant and was a matter of preclinical research [15][16][17][18][19][20]. However, neither an advantage with regard to cyclic loading, nor a distinct clinical benefit of sacroiliac screw augmentation was evident in recent systematic reviews [21,22] whereas shortened length of hospital stay and a reduced risk for general complications was noted in sacroiliac screws augmented with bone cement [23].…”

Section: Introductionmentioning

confidence: 99%

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The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective

Albers

Kastner

Gueorguiev

et al. 2022

Eur J Trauma Emerg Surg

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Purpose To compare construct stability of cement augmented sacroiliac screws using two different cementation sites in a biomechanical fragility fracture model of the pelvis. Methods A fracture model with an incomplete fracture of the sacral ala and complete fracture of the anterior pelvic ring mimicking a FFP IIB fragility fracture of the pelvis was established in five fresh frozen human cadaveric pelvises. Sacral fracture stabilization was achieved with bilateral 7.3 mm fully threaded sacroiliac screws. Cement augmentation was performed at the tip of the screw (body of S1; Group A) on one side, and at the midshaft of the screw (sacral ala; Group B) on the contralateral side. Biomechanical testing was conducted separately on both sides comprising cyclic loading of axial forces transferred through the tested hemipelvis from L5 to the ipsilateral acetabulum. Combined angular displacement in flexion and internal rotation (“gap angle”), angular displacement of the ilium in relation to the screw (“screw tilt ilium”), and screw tip cutout were evaluated. Results Relative interfragmentary movements were associated with significantly higher values in group A versus group B for “gap angle” (2.4° vs. 1.4°; p < 0.001), and for “screw tilt ilium” (3.3° vs. 1.4°; p < 0.001), respectively. No significant difference was indicated for screw tip cutout between the two groups (0.6 mm [Group A] vs. 0.8 mm [Group B]; p = 0.376). Conclusion The present study demonstrated less fragment and screw displacements in a FFP IIB fracture model under physiologic cyclic loading by cement augmentation of sacroiliac screws at the level of the lateral mass compared to the center of vertebral body of S1.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective

Albers

Kastner

Gueorguiev

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…In numerous xation devices, sacroiliac screws have been applied by clinicians, because of their advantages of minimal invasiveness, a short learning curve and easy placement. Hence, instead of being phased out, these screws have been greatly developed in recent years, with advancements ranging from simple single sacroiliac screw xation to percutaneous cement sacroiliac screw xation [19][20][21] and the recent emergence of lengthening sacroiliac screws through the bilateral sacroiliac joint [22] . Despite the development of sacroiliac screws, many problems caused by the sacroiliac screw itself cannot be changed, such as screw fracture, insu cient internal control force, poor stability, and important neurovascular injury in the screw placement process.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional Digital Anatomical Measurement of Modified Sacroiliac Screws

Wang

Zhao

Jiang

et al. 2022

Preprint

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Purpose To rebuild a model of the pelvis and effectively simulate the trajectory of modified sacroiliac screws, we measured the parameters of each screw and screw channel and assessed the safety and feasibility of the parameters in adults.Method and materials One hundred (50 males and 50 females) normal adult pelvic CT (computed tomography) images were randomly selected and imported into Mimics software to rebuild the three-dimensional pelvis model. In these models, each ideal channel of modified screws was simulated, and then we obtained the precise parameters of screws and channels using Mimics and Three-matic software.Results The results of the comparison (right vs. left) showed that there were no significant differences in any of the angles, radius or M1SI parameters (the first modified sacroiliac). However, one parameter (BS) of M2SI (the second modified sacroiliac), two parameters (AP and BS) of M3SI (the third modified sacroiliac), and three parameters (AP、BS、L) of M4SI (the fourth modified sacroiliac) were statistically significant (P < 0.05). The result of comparison (between genders) showed that there were no significant differences in M1SI and M2SI; in contrast, the radius, length and the α angle of M3SI and M4SI were significantly different between genders (P < 0.05), and the radius of M4SI required special attention. If the radius of the limiting screw channel was >3.50 mm, 52 cases (52%, 24 males and 28 females) could not complete the M4SI screw placement among 100 samples. If the radius of the limiting screw channel was >3.0 mm, a total of 10 cases (10%, 2 males and 8 females) could not complete the M4SI screw placement.Conclusion Through the measurement of 100 healthy adult real three-dimensional pelvic models, we obtained the parameters of each modified sacroiliac screw and measured the three angles of each screw based on international coordinates for the first time, which can instruct clinical application.

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“…In addition, our study found that the failure of the SIS model is accompanied by a greater reduction in screw torque (i.e., screw loosening). Several studies have shown that usage of cement‐augmented sacroiliac screws can improve the stability of SIS fixation 34–36 . In another biomechanic study, Zderic et al found that the addition of a 2.7 mm screw to the washer of the sacroiliac screw (screw‐in‐screw fixation) can also enhance the stability of the SIS fixation 37 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that usage of cement-augmented sacroiliac screws can improve the stability of SIS fixation. [34][35][36] In another biomechanic study, Zderic et al found that the addition of a 2.7 mm screw to the washer of the sacroiliac screw (screw-in-screw fixation) can also enhance the stability of the SIS fixation. 37 Zhao et al have found that dual-level sacroiliac screws (S1 + S2) are more stable than single-level ones (S1 or S2) in the treatment of Denis type II sacral fractures.…”

Section: Torque Reduction Ratementioning

confidence: 99%

Biomechanical investigation of S2 alar‐iliac screw and S1 pedicle screw fixation in the treatment of Denis type II sacral fractures

Zheng

Liu

Xiang

et al. 2022

Journal Orthopaedic Research

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Although S2 alar-iliac screw technique has been widely used in spinal surgery, its applicability to pelvic fractures is largely unknown. This study aimed to evaluate the biomechanical stability of S2 alar-iliac screw and S1 pedicle screw fixation in the treatment of Denis II sacral fractures. Twenty-eight artificial pelvic fracture models were treated with unilateral lumbopelvic fixation, sacroiliac screw fixation, S2 alar-iliac screw and S1 pedicle screw fixation, and S2 alar-iliac screw and contralateral S1 pedicle screw fixation (Groups 1-4, respectively; N = 7 per group). Each model was cyclically tested under increasing axial compression. Optical motion-tracking was used to assess relative displacement and gap angle, and the number of failure cycles. Relative displacement was significantly smaller in Group 3 than in Groups 1 (p = 0.004) and 4 (p < 0.001) but not significantly different between Groups 3 and 2 (p = 0.290). The gap angle in Group 3 was significantly smaller than that in Group 1 (p = 0.009) on the sagittal plane but significantly larger than that in Group 4 (p = 0.006) on the horizontal plane. A number of failure cycles was significantly higher in Group 3 than in Groups 1 (p = 0.002) and 4 (p = 0.004) but not significantly different between Groups 3 and 2 (p = 0.910). From a biomechanical perspective, S2 alar-iliac screw and S1 pedicle screw fixation can provide good stability in the treatment of Denis II sacral fractures.

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Cement-augmented sacroiliac screw fixation with cannulated versus perforated screws – A biomechanical study in an osteoporotic hemipelvis model

Cited by 14 publications

References 28 publications

The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective

The ideal site of cement application in cement augmented sacroiliac screw fixation: the biomechanical perspective

Three-dimensional Digital Anatomical Measurement of Modified Sacroiliac Screws

Biomechanical investigation of S2 alar‐iliac screw and S1 pedicle screw fixation in the treatment of Denis type II sacral fractures

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