Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and
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ORIGINAL PAPER
Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results Yuhei Nakayama 1 & Takashi Suzuki 1 & Akifumi Honda 1 & Shinnosuke Yamashita 1 & Kentaro Matsui 1 & Keisuke Ishii 1 & Taketo Kurozumi 1 & Yoshinobu Watanabe 1 & Hirotaka Kawano 2 Received: 17 April 2020 / Accepted: 11 June 2020 # SICOT aisbl 2020
Abstract Purpose Fragility fractures of the pelvis (FFPs) type IIIa in the Rommens classification include unilateral iliac fractures as well as pubic rami fractures. We devised a new, less-invasive fixation technique to achieve increased stability for FFPs type IIIa. The aim of this study was to describe this procedure and report the preliminary clinical results. Methods A total of 14 geriatric patients (> 60 years old) who sustained FFP type IIIa caused by low-energy trauma were surgically treated with interdigitating screw fixation including a trans-pubic screw in a retrograde manner and two trans-iliac screws from the anterior inferior iliac spine toward the posterior inferior iliac spine. All iliac fractures were displaced with external rotation, and closed reduction was performed. Percutaneous screw fixation, in which fully threaded screws were in contact with each other, provided stable fixation allowing early mobilization. Results A median decrease in pain levels by post-operative day two was 4.5 compared with pre-operatively using a numerical rating scale. While full weight-bearing was allowed from four weeks post-operatively in the initial five patients, immediate full weight-bearing was instructed as tolerated for the subsequent nine patients. No complications were encountered during the perioperative period. At the final follow-up, all fractures were united without fixation loss, screw dislodgment, or hardware failure. Conclusions This procedure of closed reduction and interdigitating screw fixation for FFP type IIIa appears to represent a safe, reliable technique. Our experience suggests that interdigitating fixation for FFP type IIIa is effective for relieving pain and promoting early mobilization in elderly patients. Keywords Fragility fracture . Pelvis . Percutaneous screw fixation . Interdigitation
Introduction With the rapid aging of populations around the world, the incidence of geriatric pelvic fractures has been increasing dramatically in many countries [1]. Most of these patients have some degree of osteoporosis and sustain the pelvic fractures due to low-energy trauma [2]. Furthermore, almost 60% of geriatric fracture patients reportedly have one or more comorbidities [3].
* Takashi Suzuki [email protected] 1
Trauma and Reconstruction Center, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan
2
Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan
Rommens et al. reported that these fractures, which they termed “fragility fractures of the pelvis” (FFPs), should be considered under a new classificatio
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