Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

Ulrich Josef Albert Spiegl; Klaus J. Schnake; Bernhard Ullrich; Max J. Scheyerer; Georg Osterhoff; Holger Siekmann

doi:10.1055/a-1498-2975

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2023; 161(02): 143-153
DOI: 10.1055/a-1498-2975

Review/Übersicht

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

Article in several languages: English | deutsch

Ulrich Josef Albert Spiegl

¹Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Leipzig, Germany

,

Klaus J. Schnake

²Zentrum für Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St Marien gGmbH, Erlangen, Germany

³Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Klinikum Nürnberg, Nürnberg

,

Bernhard Ullrich

⁴Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Germany

,

Max J. Scheyerer

⁵Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln, Germany

,

Georg Osterhoff

¹Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Leipzig, Germany

,

Holger Siekmann

⁶Unfallchirurgie, AMEOS Klinikum Sankt Salvator Halberstadt GmbH, Germany

› Author Affiliations

Abstract

An increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

Key words

posterior pelvis - sacral fracture - minimally invasive stabilization - insufficiency fracture - fragility

Full Text

References

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