Mortality After Iliosacral Screw Fixation for Osteoporotic Pelvic Ring Fractures

Fragility fractures of the posterior pelvic ring are associated with osteoporosis and are becoming more common with demographic change. Known limitations of conservative therapy include a significant loss of autonomy and high mortality. Surgical stabilisation using percutaneous sacroiliac (SI) or trans-iliac trans-sacral (TITS) screws, has been established to increase mobility, but long-term results have not yet been studied.

138 patients with percutaneous SI and TITS screw fixation of the posterior pelvic ring in osteoporotic fragility fractures were followed up for more than a year postoperatively in this retrospective study. Thereby, all patients were operated in the conventional supine position in a hybrid operating room consisting of a fixed, robot-assisted 3D flat-panel detector and a navigation system.

34 patients were male and 104 female. The mean age was 77.6 ± 9 years. 26 patients were ASA 1 + 2, 93 patients ASA 3 and 19 patients ASA 4. 80 fractures were classified as FFP 2, 23 FFP 3 and 35 FFP 4. Time to surgery was 127.5 ± 113.2 hours. Hospitalisation lasted an average of 15.7 ± 8.5 days. At the time of discharge, 68.8% of the patients had regained their original mobility, while 31.2% remained limited. The home situation remained unchanged in 73.9% of the patients, worsened in 26.1% and improved in 2.8%. 90.6% of the screw fixations showed no signs of loosening. In 9.4%, loosening could not be ruled out radiologically, but a surgical revision was not necessary. The 1-year mortality rate was 10.1%.

Percutaneous navigated screw fixation of the posterior pelvic ring in fragility fractures is a simple, safe, minimally invasive and precise method with good clinical results in terms of rapid recovery with early mobilization of patients to maintain autonomy and reduce mortality. Further clinical studies with controlled cohorts and a large number of patients with long follow-up periods should be carried out to compare the procedure with other methods. In particular, the question of an additional standardized treatment of the anterior pelvic ring in unstable dislocated fragility fractures should be investigated.