Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study
<i>Background and Objectives</i>: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/12/1368 |
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| author | Moritz F. Lodde J. Christoph Katthagen Clemens O. Schopper Ivan Zderic R. Geoff Richards Boyko Gueorguiev Michael J. Raschke René Hartensuer |
| author_facet | Moritz F. Lodde J. Christoph Katthagen Clemens O. Schopper Ivan Zderic R. Geoff Richards Boyko Gueorguiev Michael J. Raschke René Hartensuer |
| author_sort | Moritz F. Lodde |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). <i>Materials and Methods</i>: Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. <i>Results</i>: Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, <i>p</i> = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), <i>p</i> ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, <i>p</i> = 0.79. <i>Conclusions</i>: In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone. |
| first_indexed | 2024-03-10T03:36:23Z |
| format | Article |
| id | doaj.art-9b2ca6d4f7d64e8c9cdad106424f1739 |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T03:36:23Z |
| publishDate | 2021-12-01 |
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| series | Medicina |
| spelling | doaj.art-9b2ca6d4f7d64e8c9cdad106424f17392023-11-23T09:29:03ZengMDPI AGMedicina1010-660X1648-91442021-12-015712136810.3390/medicina57121368Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical StudyMoritz F. Lodde0J. Christoph Katthagen1Clemens O. Schopper2Ivan Zderic3R. Geoff Richards4Boyko Gueorguiev5Michael J. Raschke6René Hartensuer7AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, SwitzerlandDepartment for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, GermanyAO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, SwitzerlandAO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, SwitzerlandAO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, SwitzerlandAO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, SwitzerlandDepartment for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, GermanyDepartment for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany<i>Background and Objectives</i>: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). <i>Materials and Methods</i>: Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. <i>Results</i>: Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, <i>p</i> = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), <i>p</i> ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, <i>p</i> = 0.79. <i>Conclusions</i>: In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone.https://www.mdpi.com/1648-9144/57/12/1368SI screwcement augmentationunstable pelvic ring fracturebiomechanics |
| spellingShingle | Moritz F. Lodde J. Christoph Katthagen Clemens O. Schopper Ivan Zderic R. Geoff Richards Boyko Gueorguiev Michael J. Raschke René Hartensuer Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study Medicina SI screw cement augmentation unstable pelvic ring fracture biomechanics |
| title | Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study |
| title_full | Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study |
| title_fullStr | Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study |
| title_full_unstemmed | Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study |
| title_short | Does Cement Augmentation of the Sacroiliac Screw Lead to Superior Biomechanical Results for Fixation of the Posterior Pelvic Ring? A Biomechanical Study |
| title_sort | does cement augmentation of the sacroiliac screw lead to superior biomechanical results for fixation of the posterior pelvic ring a biomechanical study |
| topic | SI screw cement augmentation unstable pelvic ring fracture biomechanics |
| url | https://www.mdpi.com/1648-9144/57/12/1368 |
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