Percutaneous Transiliac–Transsacral Screw Fixation of Sacral Fragility Fractures Improves Pain, Ambulation, and Rate of Disposition to Home

Walker, J. Brock; Mitchell, Sean M.; Karr, Sean; Lowe, Jason; Jones, Clifford B.

doi:10.1097/bot.0000000000001243

Cited by 33 publications

(49 citation statements)

References 15 publications

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“…These range from full open operative xation interventions, to percutaneous hardware insertion, to percutaneous injection of polymethylmethacrylate. [26][27][28] Walker and colleagues 29 recently used percutaneous transiliactranssacral screws in 8 patients with sacral fragility lateral compression type 1 pelvic injuries and reported statistically signi cant improvements in pain scores and the proportion discharged home compared to their nonstandardized control group.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality following pelvic ramus fractures in an older Atlantic Canadian cohort

Hamilton

Harnett

Stone

et al. 2019

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Background: Pelvic ramus fractures in older patients are associated with substantial morbidity and mortality. There is a paucity of literature on fractures of the pelvis in this age group. The purpose of this study was to report mortality rates following such injuries. In addition, we aimed to describe and quantify the important resultant morbidity in this vulnerable population. Methods: We performed a retrospective chart review of all low-energy pelvic ramus fractures in patients more than age 60 years that occurred between January 2000 and December 2005. Data on survival, hospital length of stay, ambulatory status and place of residence were recorded. For comparison, we calculated the mortality rate for a surrogate age-and sex-matched group using Statistics Canada survival data for use as an uninjured control group. Results: We identi ed 43 patients (32 women [74%]; mean age 79.4 yr) with isolated low-energy pelvic ramus fractures over the study period. The 1-and 5-year mortality rates were 16.3% (95% con dence interval [CI] 7.8%-30.3%) and 58.1% (95% CI 43.3%-71.6%), respectively, both signi cantly higher than the point estimates for the control group (6.6% and 31.3%, respectively). Following injury, 14/39 patients (36%) permanently required increased ambulatory aids, and 8 (20%) required a permanent increase in everyday level of care. Conclusion: The results suggest that there may be increased mortality and morbidity following low-energy pattern pelvic ramus fractures in an older population compared to age-and sex-matched uninjured control subjects. Contexte : Les fractures du bassin chez les personnes âgées sont associées à une morbidité et une mortalité substantielles. La littérature sur les fractures du bassin dans ce groupe d'âge est peu abondante. Le but de cette étude était donc de faire état des taux de mortalité suite à de telles blessures. Nous avons aussi voulu décrire et quanti er l'importante morbidité qui en résulte chez cette population vulnérable.

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Section: Discussionmentioning

confidence: 99%

Morbidity and mortality following pelvic ramus fractures in an older Atlantic Canadian cohort

Hamilton

Harnett

Stone

et al. 2019

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“…This trend is similar to Walker et al, which found that 100% of operatively fixed elderly sacral fracture patients (U-type and LC1 fractures types) could ambulate discharge, as demonstrated on measured walking test (mean distance: 95ft). 12 In comparison to nonoperative treated patients, these outcomes were significantly improved (72% ambulating, mean distance: 35ft; p 0.03). However, a key differentiator of Walker et al is that some patients (37.5%) had regained ambulatory status prior to surgery, compared to none (0%) in the current study.…”

Section: Discussionmentioning

confidence: 86%

“…As a result, the literature has seen an emergence of evidence characterizing the utility of surgical fixation in treating sacral fractures within the aging population. [9][10][11][12] Outcomes suggest that surgical fixation in these patients can afford immediate ambulation (mean distance post-operative Day 1: 114.4 feet), as well as a high rate of return to independent living (73-75%). [10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] Outcomes suggest that surgical fixation in these patients can afford immediate ambulation (mean distance post-operative Day 1: 114.4 feet), as well as a high rate of return to independent living (73-75%). [10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome. [9][10][11][12] It is unclear whether such variables as baseline function (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] However, while this evidence has been encouraging and effective in establishing the utility of surgical fixation in the elderly population, especially in comparison to non-operative treatment, it has yet to explore many factors that may influence outcome. [9][10][11][12] It is unclear whether such variables as baseline function (i.e. ambulation status, place of residence), time-tosurgery, concomitant injury, and fracture mechanism (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Fixation of Sacral Fractures in the Elderly Population: Are There Predictors of Outcome? An Analysis of Return to Ambulation and Residential Living Status

Ferry

Kim

Ostrander³

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Recent literature suggests that surgical fixation of elderly sacral fractures may reduce time to mobilization and ultimately self-sufficiency. However, it is unclear if predictors of success exist in this subpopulation. The objective of this study was to characterize relative change in ambulation and residential living statuses (pre-injury vs. post-surgery) of elderly patients who received surgical fixation of sacral fractures, as well as determine whether or not demographics and injury characteristics influence these findings. Methods: Fifty-four elderly patients (≥60 years old) receiving percutaneous screw fixation of sacral fractures were retrospectively reviewed. All fractures were traumatic in nature; insufficiency fractures were excluded. Patient and surgical demographic data, as well as 1-year mortality status, was reported. Primary study endpoints included relative change in patient ambulation and residential living statuses (pre-injury to post-surgery). Statistical analyses were performed to assess relative change in ambulation/living status from pre-injury to post-surgery and to determine if predictors of outcome existed. Results: Of the 54 patients who met inclusion criteria, 4 expired prior to discharge, 2 expired post-discharge, and 4 were lost to follow-up. Of those patients discharged, 95.7% regained some form of ambulation at last follow-up (mean: 22.4 ± 18.9 weeks). Of patients living independent pre-injury, 94.9% would eventually return to independent home living. Neither time-to-surgery, concomitant orthopaedic injury, Charlson Comorbidity Index, or injury mechanism were predictors of final ambulation or residential status (p ≥ 0.07). Mortality at 1-year was 11.1%. Discussion: Operative fixation supported a high rate of return to pre-injury ambulation and residential living status. However, there did not appear to be measures predictive of final functional status. Further efforts with larger, prospective cohorts are warranted.

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Specifics of Surgical Management: Pelvis

Nwankwo

Westrick

Altman

et al. 2022

Senior Trauma Patients

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Percutaneous Transiliac–Transsacral Screw Fixation of Sacral Fragility Fractures Improves Pain, Ambulation, and Rate of Disposition to Home

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 33 publications

References 15 publications

Morbidity and mortality following pelvic ramus fractures in an older Atlantic Canadian cohort

Morbidity and mortality following pelvic ramus fractures in an older Atlantic Canadian cohort

Surgical Fixation of Sacral Fractures in the Elderly Population: Are There Predictors of Outcome? An Analysis of Return to Ambulation and Residential Living Status

Specifics of Surgical Management: Pelvis

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