Novel within ring fixation using iliac screws and an iliosacral screw locking system technique for fragility fracture of the pelvis

Abstract

Background: Surgical indications for fragility fracture of the pelvis (FFP) have been reconsidered recently, and the indications to perform surgery have increased. However, the optimal surgical method to obtain sufficiently strong fixation in elderly patients with minimal invasiveness is not yet clear. In this report, we present the case of a patient with FFP who was treated with a novel posterior within ring fixation technique using a combination of iliac screws and an implant that locks the original iliosacral (IS) screw in the sacrum.

Case description: A 90-year-old man was diagnosed with FFP (Rommens classification: Type IIc) and hospitalized for conservative treatment. However, 6 weeks after the injury, pain reappeared in his right buttock and computed tomography showed additional fractures of the right subpubic branch and right sacrum (Rommens classification: Type IVb). The fracture was considered to have progressed from being stable to unstable, and surgical treatment was planned. To obtain strong fixation with minimal invasion, we performed posterior fixation using E.Spine Tanit (Euros, France) compact posterior thoracolumbar instrumentation, an implant that combines an IS screw with a sacral anchoring system. The patient started walking unaided 2 weeks after the surgery, suggesting a good outcome of this surgical approach to FFP.

Conclusion: We performed posterior fixation surgery for a patient with an unstable FFP that recurred and progressed after conservative treatment. We have achieved good results using a minimally invasive, strong, and within ring fixation technique.

Keywords: Fragility fracture of pelvis; Iliosacral screw; Pelvic fracture; Rommens classification; Spinopelvic fixation; Within ring fixation.

Figure 1:

Plain radiographs (a) and computed tomography showing fractures of the sacrum (b) and pubis (c). The patient was diagnosed with a fragility fracture of the pelvis (Rommens classification: Type IIc).

Figure 2:

Plain radiographs (a) and computed tomography (b,c) 2 weeks after discharge, showing additional fractures of the right subpubic branch and right sacrum (Rommens classification: Type IVb).

Figure 3:

Postoperative scar.

Figure 4:

Representative images for the within ring fixation technique using E.Spine Tanit. An Intraoperative image(a) and postoperative radiographs(b,c).

Figure 5:

Screw trajectory(red arrows) and skin incision(red lines) of each techniques.

Figure 6:

(a-e) Representative images for the within ring fixation technique using E. Spine Tanit.