Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients

• Published in: Injury 2015-08, Vol.46 (8), p.1631-1636
• Main Authors: Hopf, Johannes Christof, Krieglstein, Christian F, Müller, Lars P, Koslowsky, Thomas C
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bone Screws; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures, Bone - complications; Fractures, Bone - physiopathology; Fractures, Bone - surgery; Humans; Ilium - surgery; Male; Orthopedics; Osteoporotic pelvic ring fractures; Pain, Postoperative - prevention & control; Pelvic Bones - injuries; Percutaneous iliosacral screw fixation; Practice Guidelines as Topic; Retrospective Studies; Sacroiliac Joint - physiopathology; Sacroiliac Joint - surgery; Sacrum - surgery
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2015.04.036

Abstract Introduction Osteoporotic posterior ring fractures of the pelvis are common injuries in the elderly, but the treatment of these fractures still remains controversial. Percutaneous iliosacral screw fixation is one surgical option if conservative treatment cannot provide sufficient pain reduction. The aim of this study is to provide short-term results of elderly patients with percutaneous screw fixation. Methods 30 patients with posterior ring fractures were treated between 12/2009 and 01/2014 with percutaneous iliosacral screw fixation. Patients’ mean age was 78.4 years. Concerning short-term outcome, we focused on initial pain level and postoperative pain reduction together with intra- and postoperative complications. Results The average hospital stay was 23.7 days, with surgical treatment performed after an average of 9.2 days. 90% of our patients were female. All 30 patients had a lower level of pain at discharge compared with admission or immediately prior to surgery. The difference in pain level at admission compared with the pain level upon discharge showed a mean reduction from 6.8 to 1.8 with a statistically significant change ( P ≤ 0.001). 24 of 30 patients had no registered complications, one screw malpositioning with postoperative nerve irritation occurred. Discussion Conventional percutaneous iliosacral screw fixation is a successful operative treatment for elderly patients with persistent lower back pain after unstable posterior ring fractures of the pelvis. Intra- and postoperative complications are rare, so this treatment can be regarded as a safe procedure. Level of evidence IV (retrospective study).