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Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly

Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden...

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Autores principales: Kress, Hannah, Klein, Roman, Pohlemann, Tim, Wölfl, Christoph Georg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9227275/
https://www.ncbi.nlm.nih.gov/pubmed/35744073
http://dx.doi.org/10.3390/medicina58060809
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author Kress, Hannah
Klein, Roman
Pohlemann, Tim
Wölfl, Christoph Georg
author_facet Kress, Hannah
Klein, Roman
Pohlemann, Tim
Wölfl, Christoph Georg
author_sort Kress, Hannah
collection PubMed
description Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3–7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0–60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved.
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spelling pubmed-92272752022-06-25 Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly Kress, Hannah Klein, Roman Pohlemann, Tim Wölfl, Christoph Georg Medicina (Kaunas) Article Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3–7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0–60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved. MDPI 2022-06-15 /pmc/articles/PMC9227275/ /pubmed/35744073 http://dx.doi.org/10.3390/medicina58060809 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kress, Hannah
Klein, Roman
Pohlemann, Tim
Wölfl, Christoph Georg
Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title_full Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title_fullStr Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title_full_unstemmed Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title_short Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly
title_sort sacroiliac screw placement with ease: ct-guided pelvic fracture osteosynthesis in the elderly
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9227275/
https://www.ncbi.nlm.nih.gov/pubmed/35744073
http://dx.doi.org/10.3390/medicina58060809
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