There are currently no guideline recommendations for the correct timing of surgical treatment in fractures of the posterior pelvic ring, as discussed in the article. To this end, large prospective studies should be conducted. Our treatment algorithm (1) was developed on the basis of our clinical experience and was intended to be merely a suggestion. Where conservative treatment fails, “early” minimally invasive treatment is certainly the preferred option. CT-guided osteosynthesis is obviously important in this setting. As our main focus was on raising awareness of pelvic fractures in elderly people, as such fractures are often underestimated, the restrictions on word count did not permit us to discuss all operative approaches in detail. CT-guided or navigated osteosynthesis is used in many hospitals for iliosacral fixation; it has also been described in studies. A recently published multicenter study did not show any advantage relating to the position of the screw (2). Cement augmentation of the iliosacral joint screw should not be confused with sacroplasty, which consists of cement application only into the area of the fracture. If the screw in the sacral vertebra is augmented with cement, the cement at the distal end of the screw must not be applied into the fracture gap, as this would hamper fracture healing. A prospective study showed good clinical and radiological results for the cement augmented iliosacral joint screw (3). The biomechanical study discussed in the contribution by Reuther showed no substantial advantage of cement augmentation for a load of only 10 000 cycles. However, we already confirmed a significant advantage for cement augmentation as regards primary stability (4). Prospective randomized studies of this are lacking. The recommendations in the article can therefore be based only on the existing literature with low-level evidence and on the authors’ clinical experience—as we pointed out several times on our article.
On behalf of the authors
PD Dr. med. Ludwig Oberkircher
Zentrum für Orthopädie und Unfallchirurgie
Universitätsklinikum Gießen und Marburg, Standort Marburg
Conflict of interest statement
All authors declare that no conflict of interest exists.
|1.||Oberkircher L, Ruchholtz S, Rommens PM, Hofmann A, Bücking B, Krüger A: Osteoporotic pelvic fractures. Dtsch Arztebl Int 2018; 115: 70–80 VOLLTEXT|
|2.||Verbeek J, Hermans E, van Vugt A, Frölke JP: Correct positioning of percutaneous iliosacral screws with computer-navigated versus fluoroscopically guided surgery in traumatic pelvic ring fractures. J Orthop Trauma 2016; 30: 331–5 CrossRef CrossRef|
|3.||Höch A, Pieroh P, Henkelmann R, Josten C, Böhme J: In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up. BMC Surg 2017; 17: 1–8 CrossRef MEDLINE PubMed Central|
|4.||Oberkircher L, Masaeli A, Bliemel C, Debus F, Ruchholtz S, Krüger A: Commentary on the primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation. Spine J 2016; 16: 233–4 CrossRef MEDLINE|