Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation

Oberkircher, Ludwig; Masaeli, Adrian; Bliemel, Christopher; Debus, Florian; Ruchholtz, Steffen; Krüger, Antonio

doi:10.1016/j.spinee.2015.08.016

Cited by 41 publications

(27 citation statements)

References 31 publications

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“…Oberkirchner et al were the first to biomechanically evaluate the primary stability of cement augmented sacroiliac screws. Using cadaveric sacra, they demonstrated significant superior screw anchorage of cement augmented screws in a pull‐out test .…”

Section: Discussionmentioning

confidence: 97%

“…However, this particular method of cement augmentation in sacroiliac screws has only sparsely been biomechanically evaluated so far . Specifically, it is still unclear to which extent sacroiliac screw augmentation biomechanically improves the stability compared to a non‐augmented screw under physiological stress, and whether adverse events such as implant failure by screw loosening and particularly unscrewing, can be prevented by cement augmentation.…”

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confidence: 99%

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Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

et al. 2016

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Operative treatment of sacral insufficiency fractures is frequently being complicated by osteopenic bone properties. Cement augmentation of implanted sacroiliac screws may lead to superior construct stability and prevent mechanical complications. A novel hemi-pelvis test model with dissected symphysis was developed. Five fresh-frozen cadaveric pelvises were vertically osteotomized at the sacrum on both sides and fixed with sacroiliac screws in both corridors of the first sacral vertebral body. One side was randomly augmented with bone cement. Cyclic testing consisting of torsional loading (±2.5 Nm) combined with progressively increasing axial loading (+50 N compression, -10 N traction, ±0,01 N/cycle) was performed until failure; simulated physiological loads derived from inverse dynamic calculations. The fixation was analyzed fluoroscopically quantifying screw migrations and assessing failure mechanisms. Failure modes were cut-out, pull-out, screw-out, and washer penetration. Motion at fracture site was analyzed via optical motion tracking. Unscrewing was provoked four times with non-augmented and twice with augmented screws. When focusing on the sacral region only, cement augmentation significantly improved screw fixation in terms of increased number of cycles to failure (p = 0.043). However, when considering overall construct stability, there was no significant difference between augmented and non-augmented state due to washer penetration at the iliac bone. The generated hemi-pelvis model was found to be valid due to the reproduction of the clinically observed failure mode (unscrewing). Unscrewing was not fully prevented by cement augmentation. Augmentation effects stability at the screw tip, but particularly in porotic bone, failure may shift to the next weak point. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1485-1493, 2017.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

et al. 2016

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“…Placement of two iliosacral screws achieves higher biomechanical stability than just one, and, similarly, longer screws achieve a higher stability than shorter ones [86,87]. Clinically, screws often fail by loosening or unscrewing [85] due to reduced bone quality [81] which can be effectively addressed by using cannulated screws and bone cement to augment the fixation site [88,89]. Bone cement is also an option for isolated and incomplete compression fractures [83] in which the cement is injected via a needle accessing the sacrum via the sacrum ala.…”

Section: Pelvis Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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“…Special care should be taken to avoid cement leakage into the sacral canal, the neuroforamina or through the anterior sacral cortex. Biomechanical studies have shown that stability of iliosacral screw fixation in FFP is significantly higher with cement augmentation than without (44,45). Clinical experience is still small, but results are promising (42,43).…”

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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Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation

Cited by 41 publications

References 31 publications

Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model

Biomechanics of Osteoporotic Fracture Fixation

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

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