Thomas Mendel1,2,3, Bernhard W Ullrich4,5,6, Philipp Schenk7,6, Gunther Olaf Hofmann4,5,6, Felix Goehre7,6, Stefan Schwan6,8, Florian Brakopp4,6, Friederike Klauke4,5,6. 1. Department of Trauma and Reconstruction Surgery, BG Klinikum Bergmannstrost Halle, Merseburger Strasse 165, 06120, Halle, Germany. dr.th.mendel@gmail.com. 2. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany. dr.th.mendel@gmail.com. 3. Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany. dr.th.mendel@gmail.com. 4. Department of Trauma and Reconstruction Surgery, BG Klinikum Bergmannstrost Halle, Merseburger Strasse 165, 06120, Halle, Germany. 5. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany. 6. Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany. 7. Research Executive Department, BG Klinikum Bergmannstrost Halle, Halle, Germany. 8. Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Halle, Germany.
Abstract
PURPOSE: Pelvic fragility fractures have steadily risen over the past decades. The primary treatment goal is the fastest possible mobilisation. If conservative therapy fails, surgical fixation is a promising approach. This study compares the outcome of bisegmental transsacral stabilisation (BTS) and spinopelvic fixation (SP) as minimally invasive techniques for bilateral fragility fractures of the sacrum (BFFS). METHODS: We performed a prospective, non-randomised, case-controlled study. Patients were included if they remained bedridden due to pain despite conservative treatment. Group assignment depended on sacral anatomy and fracture type. The outcome was estimated by blood loss calculation, cut-seam time, fluoroscopy time, complications, duration of stay at the intensive/intermediate care unit (ICU/IMC), and total inpatient stay. The mobility level at discharge was recorded. RESULTS: Seventy-three patients were included (SP: 49, BTS: 24). There was no difference in blood loss (BTS: 461 ± 628 mL, SP: 509 ± 354 mL). BTS showed a significantly lower cut-seam time (72 ± 23 min) than SP (94 ± 27 min). Fluoroscopy time did not differ (BTS: 111 ± 61 s vs. 103 ± 45 s). Thirteen percent of BTS and 16% of SP patients required ICU/IMC stay (BTS: 0.6 ± 1.8 days, SP: 0.5 ± 1.5 days) during inpatient stay (BTS: 9 ± 4 days, SP: 8 ± 3 days). Fourteen patients suffered from urinary tract infections (BTS: 8%; SP: 25%). In-patient mortality was low (BTS: 4.2%, SP: 4.1%). At discharge, the BTS group was almost back to the initial mobility level. In SP patients, mobility was significantly lower than before complaints (p = 0.004). CONCLUSION: Both methods allow early mobilization of BFFS patients. Blood loss can be kept low. Hence, transfusion requirement is correspondingly low. The IMC/ICU and the total inpatient stay are lower than reported in the literature. Both BTS and SP can be recommended as safe and low-complication methods for use in BFFS patients. BTS is superior to SP with respect to surgery duration and level of mobility at discharge.
PURPOSE: Pelvic fragility fractures have steadily risen over the past decades. The primary treatment goal is the fastest possible mobilisation. If conservative therapy fails, surgical fixation is a promising approach. This study compares the outcome of bisegmental transsacral stabilisation (BTS) and spinopelvic fixation (SP) as minimally invasive techniques for bilateral fragility fractures of the sacrum (BFFS). METHODS: We performed a prospective, non-randomised, case-controlled study. Patients were included if they remained bedridden due to pain despite conservative treatment. Group assignment depended on sacral anatomy and fracture type. The outcome was estimated by blood loss calculation, cut-seam time, fluoroscopy time, complications, duration of stay at the intensive/intermediate care unit (ICU/IMC), and total inpatient stay. The mobility level at discharge was recorded. RESULTS: Seventy-three patients were included (SP: 49, BTS: 24). There was no difference in blood loss (BTS: 461 ± 628 mL, SP: 509 ± 354 mL). BTS showed a significantly lower cut-seam time (72 ± 23 min) than SP (94 ± 27 min). Fluoroscopy time did not differ (BTS: 111 ± 61 s vs. 103 ± 45 s). Thirteen percent of BTS and 16% of SP patients required ICU/IMC stay (BTS: 0.6 ± 1.8 days, SP: 0.5 ± 1.5 days) during inpatient stay (BTS: 9 ± 4 days, SP: 8 ± 3 days). Fourteen patients suffered from urinary tract infections (BTS: 8%; SP: 25%). In-patient mortality was low (BTS: 4.2%, SP: 4.1%). At discharge, the BTS group was almost back to the initial mobility level. In SP patients, mobility was significantly lower than before complaints (p = 0.004). CONCLUSION: Both methods allow early mobilization of BFFS patients. Blood loss can be kept low. Hence, transfusion requirement is correspondingly low. The IMC/ICU and the total inpatient stay are lower than reported in the literature. Both BTS and SP can be recommended as safe and low-complication methods for use in BFFS patients. BTS is superior to SP with respect to surgery duration and level of mobility at discharge.
Authors: Geraldine L Nanninga; Kevin de Leur; Martien J M Panneman; Maarten van der Elst; Klaas A Hartholt Journal: Age Ageing Date: 2014-01-12 Impact factor: 10.668
Authors: Thomas Mendel; Bernhard Wilhelm Ullrich; Gunther Olaf Hofmann; Philipp Schenk; Felix Goehre; Stefan Schwan; Friederike Klauke Journal: Eur J Trauma Emerg Surg Date: 2020-09-02 Impact factor: 3.693