CT-Guided Pelvic Osteosynthesis
The authors deserve thanks for addressing pelvic fractures in elderly people, which is an underestimated problem, although the associated immobility results in substantial mortality and morbidity. They were correct to point out the need for computed tomography (CT) or magnetic resonance imaging for diagnostic purposes (1). They did, however, omit to point out the importance of CT guidance for osteosynthesis. As a result, the erroneous assumption may arise that conservative treatment is the method of choice—in spite of the fact that they emphasized the need for rapid mobilization in posterior pelvic ring fractures. If patients are to be mobilized early, one should not wait for 1–2 weeks and inflict strong analgesics on elderly people. 27 years ago, the first description of CT-guided screw fixation of an iliosacral fracture was reported (2). In 2014, I published the largest series of sacral osteosynthesis procedures to date, in which primarily very old persons received minimally invasive treatment in the CT room under local anesthesia without relevant complications (3). General anesthesia with the associated high risk of postoperative cognitive dysfunction is no longer required for screw fixation. Doctors no longer have to decide between Scylla (operating room) and Charybdis (potentially fatal complications as a result of waiting).
Furthermore, it is beyond me why the authors of a CME article, which supposedly reflects state of the art approaches, mention the application of cement to prevent loosening of the screws. There are no valid studies that cement “augmentation” will prevent loosening of the screws (4). Immediate pain reduction is the result of screw fixation itself, without any risk of complications.
PD Dr. med. Gerd Reuther
Facharzt für Radiologie, Saalfeld/Saale
|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.||Nelson DW, Duwelius PJ: CT-guided fixation of sacral fractures and sacroiliac joint disruptions. Radiology 1991; 180: 527–32 CrossRef MEDLINE|
|3.||Reuther G, Röhner U, Will T, et al.: CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT. Rofo 2014; 186: 1134–9 CrossRef MEDLINE|
|4.||Höch A, Schimpf R, Hammer N, et al.: Biomechanical analysis of stiffness and fracture displacement after using PMMA-augmented sacroiliac screw fixation for sacrum fractures. Biomed Tech (Berl) 2017; 62: 421–8 CrossRef MEDLINE|