In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up

Background: The incidence of pelvic ring fractures in the elderly significantly increased. Because of persistent pain and immobilization associated with this injury, surgical treatment is recommended. To minimise comorbidities and surgical risk, percutaneous techniques are becoming more relevant. In-screw cement augmentation of sacroiliac screw fixation is a promising procedure; however, clinical follow-up data remain scarce. This study investigated the safety and possible complications of the procedure along with a 1-year follow-up. Methods: Thirty-four patients (treated with 43 screws) were prospectively included. Data on patients' age and sex, the mechanism of accident, fracture pattern, duration of hospital stay, surgery and adverse events were recorded. Data were obtained postoperatively on the reduction of pain and complications, such as infection, cement leakage and neurological deficits, and at 1-year follow-up on pain, quality of life according to the 12-Item Short Form Survey and mobility. Implant failure was defined as retraction or dislocation of screws and was also documented. Results: Screw-related complications occurred with 2 of 43 screws. None of these complications were related to cement augmentation. In-hospital adverse events occurred in 6 of 34 patients. Postoperative pain, measured by the visual analogue scale, was significantly reduced from 6.7 +/- 1.4 preoperatively to 2.7 +/- 1.0 postoperatively (p < 0.001). Although patients complained of pain at the 1-year follow-up, they reported a significant decline compared with pain at admission (3.4 +/- 2.3; p < 0.001). Results on the quality of life were comparable with those for the age-and gender matched German population. All patients were mobile, and no implant failure was detected. Conclusions: The results indicate that in-screw augmented sacroiliac screw fixation for fragility fractures of the pelvis is a safe technique. Pain was significantly reduced immediately after surgery compared to the preoperative state. Furthermore, significant pain reduction after one year compared to the preoperative state and quality of life was comparable to the age-and gender-matched German population. Thus, we recommend in-screw augmentation for screw fixation for sacral fragility fractures of the pelvis following failed conservative treatment.