Related Experiment Video
Updated: May 17, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Comparing different minimally invasive screw osteosyntheses methods for the stabilization of the sacral fractures
Martin Naisan1, Andreas Kramer2, Stefan Kindel2
1Wirbelsäulenzentrum St.-Josefs Hospital, Wiesbaden, Germany.
Background Context:
Percutaneous screw osteosynthesis is the gold standard for managing sacral fragility fractures in geriatric patients with immobilizing pain. However, comparative evidence regarding the optimal type, length, or insertion position of sacroiliac screws remains limited.
Purpose:
This study aimed to compare outcomes between long transsacral screws bridging both sacroiliac joints and short sacroiliac screws.
Study Design/Setting:
Retrospective cohort single-center study.
Patient Sample:
Geriatric patients treated with percutaneous sacroiliac screws for sacral fragility fractures.
Outcome Measures:
Primary outcome: screw loosening at 3-, 6-, and 12-month follow-ups.
Secondary Outcomes:
surgical duration, postoperative pain, mobility improvement, and hospital stay length.
Methods:
Data from 122 patients (median age 81, 84 % female) treated between 2018 and 2021 were analyzed. Patients were categorized into three groups [1]: two long transsacral screws [2], a combination of one long and two short screws, and[3] four short sacroiliac screws. Fracture characteristics, FFP classification, and risk factors for screw loosening were evaluated.
Results:
Fractures were bilateral in 73 %, with FFP classifications of type 2 (48 %), type 3 (12 %), and type 4 (40 %). Anterior pelvic fractures were present in 63 %, comminuted fractures in 34 %, and H-type fractures in 29 %. Loosening rates were 17 % in the long-screw group, 6 % in the combination group, and 4 % in the short-screw group. Surgical duration was shortest for long screws (mean 52.6 min) compared to the combination (61.8 min) and short-screw (83.4 min) groups. Pain scores decreased below 5 in 88 % of patients at 3 months and 92 % at 12 months. Screw length was a significant risk factor for loosening (p = 0.04).
Conclusions:
Long transsacral screws offer minimally invasive fixation with reduced surgical duration but higher loosening rates. Osteosynthesis with four short sacroiliac screws demonstrates superior long-term stability, making it a promising option for sacral fragility fractures.
