Mid-term outcome of bilateral fragility fractures of the sacrum after bisegmental transsacral stabilization versus spinopelvic fixation

Abstract

Aims Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). Methods A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the 12-Item Short Form Survey 12 (SF-12). Fracture healing was assessed by CT. The primary outcome parameter of functional recovery was the per-day step count; the secondary parameter was the subjective outcome assessed by questionnaires. Results Overall, no baseline differences were observed between the BTS and SP cohorts. In total, 58 (BTS = 19; SP = 39) and 37 patients (BTS = 14; SP = 23) could be recruited at TP1 and TP2, respectively. Mean steps per day at TP1 were median 308 (248 to 434) in the BTS group and 254 (196 to 446) in the SP group. At TP2, median steps per day were 3,759 (2,551 to 3,926) in the BTS group and 3,191 (2,872 to 3,679) in the SP group, each with no significant difference. A significant improvement was observed in each group (p < 0.001) between timepoints. BTS patients obtained better results than SP patients in ODI (p < 0.030), MS (p = 0.007), and SF-12 physical status (p = 0.006). In all cases, CT showed sufficient fracture healing of the posterior ring. Conclusion Both groups showed significant outcome improvement and sufficient fracture healing. Both techniques can be recommended for BFFS, although BTS was superior with respect to subjective outcome. Step-count tracking represents a reliable method to evaluate the mobility level. Cite this article: Bone Joint J 2021;103-B(3):462–468.

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

“…Although our study indicated equal use of spinopelvic fixation 6 and sacroiliac screws/transsacral implant fixation 38 , 39 for posterior bilateral displaced sacral fractures (FFP IVb), discriminating radiological factors were not found. Significant pain reduction without complications after operative treatment using percutaneous transiliac-transsacral screws or bilateral sacroiliac screws in the upper sacral segment has been reported 38 , 40 , 41 . Interestingly, even unilateral injuries were recommended bilateral stabilization, probably to avoid fracture progression 35 , 42 .…”

OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures

“…Although this decision meant sacrificing the ability of the CS to describe a transverse fracture component of the sacrum, such as interconnecting bilateral fracture lines, in detail (such a case is summarized with OF4), this sacrifice was deemed acceptable because the impact of the missing information on the decision to pursue conservative versus surgical treatment is unclear. Furthermore, efforts to construct a CS capable of providing categories clearly aligned with surgical procedures to address each fracture type are limited by the lack of evidence for widely varying surgical treatment strategies for OFP [ 10 , 19 – 21 ].…”

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation

“…The general consensus is that conservative treatment with demand-oriented pain therapy is the first-line therapeutic approach [4]. If conservative therapy fails, surgical fracture stabilization as a second-line therapeutic step is a promising approach [5].…”

“…The literature describes a variety of different surgical stabilisation procedures for the treatment of BFFS. In addition to the classic sacroiliac screw fixation with [7] and without [1] cement augmentation, transsacral stabilization [5,8] using extra-long screws or sacral bars and sacroplasty [9,10] is used as minimally invasive procedures. Spinopelvic fixation using open or percutaneous techniques [5] has also been described.…”

“…In addition to the classic sacroiliac screw fixation with [7] and without [1] cement augmentation, transsacral stabilization [5,8] using extra-long screws or sacral bars and sacroplasty [9,10] is used as minimally invasive procedures. Spinopelvic fixation using open or percutaneous techniques [5] has also been described. The chosen osteosynthesis approach must be able to bear full weight immediately to ensure the fastest possible mobilisation of the geriatric patient.…”