Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis

Abstract

Background: Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of the pelvis is expanding and its results are promising. Methods: We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures. Results: The mean time to surgery was 8.6 + 2.4 days, and the mean intraoperative blood loss was 94.1 + 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 + 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 + 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 + 0.50. There were no cases of 30-day and 1-year mortality. Conclusion: 3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

“…Similar to other studies we found a mean age of about 79 (60-99) years with a predominance of women, which constituted 90% of our collective [16,[30][31][32][33][34][35][36].…”

“…Hopf et al found a complication rate of 20% which is equal to the findings in our population [ 16 ]. In other studies complication rates from zero to 41% are described [ 16 , 30 , 32 – 36 , 42 , 55 , 56 ] (Table 1 ).…”

“…We found five studies regarding fragility fractures of the pelvis which assessed operation times. Sanders 3), depending on whether the procedure was planned in advance or intra-operatively [30,32,34,35,37]. Percutaneous screw insertion is typically associated with considerable fluoroscopy use, although there have only been a few studies that fully assessed radiation doses in FFP.…”

“…Sanders et al recorded operation times of 26.6 min, Höch et al of 27 min per screw with 33 of the 34 patients needing additional ventral fixation, the total operation time was not assessed. Eckhardt et al recorded operation times of 79 min, König et al of 45.25 min, Wong et al described mean operation times of 93.7 min (SD 32.4) and 133 min (SD 38.3), depending on whether the procedure was planned in advance or intra-operatively [ 30 , 32 , 34 , 35 , 37 ]. Percutaneous screw insertion is typically associated with considerable fluoroscopy use, although there have only been a few studies that fully assessed radiation doses in FFP.…”

“…In the follow-up examination we found a pain level of 2.35. Other studies reported VAS at follow-up varying from 0.36 to 3.4 [ 16 , 32 – 36 , 56 ]. Comparison of pain level at discharge (1.98) and in the follow up (2.4) in our collective to the findings in the Hopf paper (1.73 at discharge) shows no statistically relevant differences.…”