Minimally invasive stabilization of fragility fractures of the pelvis with transsacral bar and retrograde transpubic screw

Objective Stabilization of fragility fractures of the pelvis (FFP) using a minimally invasive technique. Insertion of a transsacral rod into the transsacral corridor of S1. Insertion of a retrograde transpubic screw through the superior branch of the pubic bone. Indications Uni- or bilateral displaced fragility fractures of the sacrum or sacroiliac joint. Nondisplaced fractures of the sacrum or sacroiliac joint in case of nonsuccessful conservative treatment. Uni- or bilateral fractures of the superior branch of the pubic bone, which are present in combination with a posterior pelvic instability. Contraindications Fragility fractures of the pelvis, which can be successfully treated conservatively. Absence of transsacral corridor in sacral body S1. Major displacement, nonreducible fractures of the superior branch of the pubic bone. Soft tissue infection at insertion site of implants. Surgical technique The transsacral bar is inserted under fluoroscopic control from ilium to ilium through the transsacral corridor of the sacral body S1. The retrograde transpubic screw is inserted from the pubic tubercle through the superior branch of the pubic bone past the acetabulum into the body of the ilium. Postoperative management An early mobilization with weight bearing of both lower extremities as tolerated by the patient is allowed. Conventional radiographs for control of the position of the implants and fractures are taken after mobilization Results In all, 64 patients with FFP type II, FFP type III or FFP type IV were stabilized with a transacral bar osteosynthesis in the posterior pelvis. In 32 patients (50%), additional sacroiliac screws were inserted. In 29 patients (45.3%) the transsacral bar osteosynthesis was combined with a transpubic retrograde screw. Median length of hospital stay was 17.5 days. In all, 20 patients (31.3%) suffered general, 10 patients (15.6%) suffered surgery-related complications, and 41 patients (64.1%) were mobile in the room or on the ward at discharge. One-year mortality was 10.9%. The values of the SF-8 Physical and Mental Component Scores, Parker Mobility Score and Numeric Rating Scale were moderate, yet comparable with the values of patients of the same age.