Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature

Rommens, Pol Maria; Ossendorf, Christian; Pairon, Philip; Dietz, Sven-Oliver; Wagner, Daniel; Hofmann, Alexander

doi:10.1007/s00776-014-0653-9

Cited by 117 publications

(103 citation statements)

References 29 publications

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“…The fluoroscopy frequency was 8.49 AE 2.37 (range, [4][5][6][7][8][9][10][11][12][13][14][15] times in the TiRobot group and 18.67 AE 4.18 (range, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] times in the traditional group. The t test value is 46.105 and the P value is 0.000; there was statistically significant difference between the two groups (P < 0.05); the fluoroscopy frequency in the TiRobot group was less than in the traditional group.…”

Section: Fluoroscopy Frequencymentioning

confidence: 99%

“…The incidence of unstable posterior pelvic ring injury was 17%-30% 5 . After the rescue treatment, the surgical treatment had a significant effect on the functional recovery of pelvic fracture patients 6 . However, pelvic fractures are difficult to treat.…”

mentioning

confidence: 99%

“…However, reasonable surgical methods should be selected for different types of pelvic fractures 13 . Previous surgical methods involved techniques using sacrum rods, anterior plates, posterior plates, and sacroiliac screws 6,[14][15][16][17][18][19][20][21] . The sacrum bar is largely disused due to its poor biomechanics 14 .…”

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confidence: 99%

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Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

Long

Gao³

et al. 2019

Orthopaedic Surgery

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Objectives To analyze the curative effect of TiRobot surgical robotic navigation and location system‐assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot. Methods A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X‐ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow‐up, the Majeed function system was used to evaluate the function. Results All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5–6.3 months) and 4.56 ± 0.78 months (range, 3.4–6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow‐up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups. Conclusion Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.

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Section: Fluoroscopy Frequencymentioning

confidence: 99%

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confidence: 99%

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Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

Long

Gao³

et al. 2019

Orthopaedic Surgery

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“…Sacral fractures are commonly treated with closed reduction and sacroiliac (SI) screws; however, screw loosening with backing out occurs in the elderly due to decreased screw purchase in osteoporotic bone . Therefore, trans‐sacral implants can be used in fragility fractures . In contrast to SI screws, their holding power does not depend on the cancellous bone mass within the sacrum, but on the cortex of the iliac bone .…”

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confidence: 99%

Critical dimensions of trans‐sacral corridors assessed by 3D CT models: Relevance for implant positioning in fractures of the sacrum

Wagner

Kamer

Sawaguchi

et al. 2017

Journal Orthopaedic Research

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Trans-sacral implants can be used alternatively to sacro-iliac screws in the treatment of osteoporosis-associated fragility fractures of the pelvis and the sacrum. We investigated trans-sacral corridor dimensions, the number of individuals amenable to trans-sacral fixation, as well as the osseous boundaries and shape of the S1 corridor. 3D models were reconstructed from pelvic CT scans from 92 Europeans and 64 Japanese. A corridor of <12 mm was considered critical for trans-sacral implant positioning, and <8 mm as impossible. A statistical model of trans-sacral corridor S1 was computed. The limiting cranio-caudal diameter was 11.6 mm (±5.4) for S1 and 14 mm (±2.4) for S2. Trans-sacral implant positioning was critical in 52% of cases for S1, and in 21% for S2. The S1 corridor was impossible in 26%, with no impossible corridor in S2. Antero-superiorly, the S1 corridor was limited not only by the sacrum but in 40% by the iliac fossa. The statistical model demonstrated a consistent oval shape of the trans-section of corridor S1. Considering the variable in size and shape of trans-sacral corridors in S1, a thorough anatomical knowledge and preoperative planning are mandatory using trans-sacral implants. In critical cases, S2 is a veritable alternative. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2577-2584, 2017.

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“…This, upon reversion, means that more than 80% of patients with FFP had a posterior pelvic ring injury. It therefore is recommended that every patient with an FFP receives a pelvic CT-scan so that the severity of the injury is not underestimated (19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Rommens¹,

Wagner²,

Hofmann³

2017

chr

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RezumatIncidenţa fracturilor de fragilitate ale pelvisului creşte rapid. Caracteristicile acestor fracturi sunt diferite de întreruperile de inel pelvin la adulţi. Fracturile de fragilitate pelviene sunt consecinţa unei traume de mică energie la pacienţi cu scădere importantă a densităţii minerale osoase. Ca urmare a unui model persistent de alterare a distribuţiei masei osoase la nivelul sacrumului, apar alte morfologii de fracturi osoase decât în cazul adulţilor tineri. Simptomul principal este durerea imobilizantă la nivel lombar, fesier, în regiunile inghinală şi/sau a simfizei pubiene. Imaginile radiologice convenţionale şi computerul tomograf vor revela prezenţa şi localizarea fracturilor la nivelul inelului pelvin anterior şi posterior. O nouă clasificare cuprinzătoare distinge 4 categorii de instabilitate. Primul criteriu este cel mai important, deoarece indică şi tipul de tratament preferenţial. Cel de-al doilea criteriu, care determină subtipurile celor patru categorii, este localizarea instabilităţii la nivelul inelului pelvin posterior. Acest criteriu indică tipul de procedură chirurgicală ce trebuie efectuată. Atunci când este ales tratamentul chirurgical, procedura aleasă ar trebui să fie cât mai puţin invazivă cu putinţă. Au fost dezvoltate diverse tehnici percutane sau de fixare mai puţin invazivă a inelului pelvin posterior. Sunt prezentate avantajele şi limitările acestora -sacroplastie, osteosinteză ileosacrată cu şurub, plasare de ciment, fixare internă transiliacă, osteosinteză transsacrată, fixare lombopelvină. Fracturile inelului pelvin anterior necesită de

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Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature

Cited by 117 publications

References 29 publications

Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures

Critical dimensions of trans‐sacral corridors assessed by 3D CT models: Relevance for implant positioning in fractures of the sacrum

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

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