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Controlled Clinical Trial
. 2023 Apr;49(2):1001-1010.
doi: 10.1007/s00068-022-02123-6. Epub 2022 Oct 18.

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation

Thomas Mendel  1   2   3 , Bernhard W Ullrich  4   5   6 , Philipp Schenk  7   6 , Gunther Olaf Hofmann  4   5   6 , Felix Goehre  7   6 , Stefan Schwan  6   8 , Florian Brakopp  4   6 , Friederike Klauke  4   5   6
Affiliations
Controlled Clinical Trial

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation

Thomas Mendel et al. Eur J Trauma Emerg Surg. 2023 Apr.

Abstract

Purpose: Pelvic fragility fractures have steadily risen over the past decades. The primary treatment goal is the fastest possible mobilisation. If conservative therapy fails, surgical fixation is a promising approach. This study compares the outcome of bisegmental transsacral stabilisation (BTS) and spinopelvic fixation (SP) as minimally invasive techniques for bilateral fragility fractures of the sacrum (BFFS).

Methods: We performed a prospective, non-randomised, case-controlled study. Patients were included if they remained bedridden due to pain despite conservative treatment. Group assignment depended on sacral anatomy and fracture type. The outcome was estimated by blood loss calculation, cut-seam time, fluoroscopy time, complications, duration of stay at the intensive/intermediate care unit (ICU/IMC), and total inpatient stay. The mobility level at discharge was recorded.

Results: Seventy-three patients were included (SP: 49, BTS: 24). There was no difference in blood loss (BTS: 461 ± 628 mL, SP: 509 ± 354 mL). BTS showed a significantly lower cut-seam time (72 ± 23 min) than SP (94 ± 27 min). Fluoroscopy time did not differ (BTS: 111 ± 61 s vs. 103 ± 45 s). Thirteen percent of BTS and 16% of SP patients required ICU/IMC stay (BTS: 0.6 ± 1.8 days, SP: 0.5 ± 1.5 days) during inpatient stay (BTS: 9 ± 4 days, SP: 8 ± 3 days). Fourteen patients suffered from urinary tract infections (BTS: 8%; SP: 25%). In-patient mortality was low (BTS: 4.2%, SP: 4.1%). At discharge, the BTS group was almost back to the initial mobility level. In SP patients, mobility was significantly lower than before complaints (p = 0.004).

Conclusion: Both methods allow early mobilization of BFFS patients. Blood loss can be kept low. Hence, transfusion requirement is correspondingly low. The IMC/ICU and the total inpatient stay are lower than reported in the literature. Both BTS and SP can be recommended as safe and low-complication methods for use in BFFS patients. BTS is superior to SP with respect to surgery duration and level of mobility at discharge.

Keywords: Bilateral fragility fracture of the sacrum; Bisegmental transsacral stabilization; Blood loss; Complications; Fragility fracture of the pelvis; Geriatric; Short-term outcome; Spinopelvic fixation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a and b X-ray pelvic overview (a) and intraoperative image (b) of a bisegmental transsacral screw fixation
Fig. 2
Fig. 2
a and b X-ray pelvic overview (a) and intraoperative image (b) of a spinopelvic fixation
Fig. 3
Fig. 3
Graph showing comparison of BVloss in the BTS and SP group
Fig. 4
Fig. 4
a and b Graph showing significant differences of a cut-seam time and b fluoroscopy time between both groups
Fig. 5
Fig. 5
Postoperative inpatient length of stay of both groups with/without the need for treatment in an ICU/IMC ward. Bars represent the postoperative days for the individual patients (dark grey—ICU/IMC, light grey—normal ward). The error bars show the mean and standard deviation within the cohort. The rhombus symbolises a patient’s death
Fig. 6
Fig. 6
Comparison of mobility level of SP and BTS groups related to examination time points
See this image and copyright information in PMC

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