Image-guided percutaneous screw fixation in pathological fractures of the roof of the acetabulum

To evaluate whether percutaneous cemented screw fixation improves the ability to walk of patients with pathological fractures of the acetabulum roof.

In this retrospective single-center study, interventions performed with image-based guidance using either fluoroscopic or Cone Beam Computed Tomography (CBCT) control, or Four-Dimensional Computed Tomography (4DCT) control, to treat pathological fracture of the acetabulum roof with a percutaneous screwing technique were analyzed. Walking was measured on a 4-level scale: not walking, walking with 2 crutches, walking with a crutch, and walking unassisted. Results were analyzed using a non-parametric Wilcoxon test for paired series. Secondary outcomes were also assessed, such as weight-bearing, postoperative complications, and pain.

A total of 19 consecutive patients (mean age 66.8 years, mostly American Society of Anesthesiologists score 3) receiving a percutaneous cemented screw fixation of the roof of the acetabulum intervention between December 2014 and February 2025 were included. The cancers involved were mainly prostate cancer, followed by lung and breast cancer. The study shows a significant improvement in patients' walking ability (p = 0.0029) and weight-bearing capacity (p = 0.039) when comparing patients' situation before and after the intervention. The intervention also improved pain level in 17 out of 19 patients.

Percutaneous fixation of pathological fractures of the acetabulum roof by cemented screws, guided by imaging, is an approach that significantly improves walking.