Felix Karl Ludwig Klingebiel (Zurich / CH), Octavia Klee (Zurich / CH), Yannik Kalbas (Zurich / CH), Michel Paul Johan Teuben (Zurich / CH), Anhua Loong (Beijing / CN), Henrik Teuber (Zurich / CH), Yannis Hoch (Zurich / CH), Valentin Neuhaus (Zurich / CH), Ladislav Mica (Zurich / CH), Hans-Christoph Pape (Zurich / CH), Roman Pfeifer (Zurich / CH)
Abstract text (incl. references and figure legends)
Introduction
Percutaneous sacroiliac screw fixation (SI) of unstable pelvic ring fractures with Rescue Screws is an established treatment to promptly stabilize the posterior pelvic ring and haemodynamic status. This intervention is performed under challenging conditions and might therefore be associated with complications. The aim of our study was to compare Rescue Screws with elective SI-screw fixations.
Material&Methods
A retrospective study of trauma patients with acute pelvic ring injuries at a level one trauma center was performed. Patients ≥15 years, treated with sacroiliac/transsacral screw fixation were included. Rescue Screws were defined as immediate surgical stabilization after admission to trauma bay. Patients were stratified according to treatment strategy (RS: Rescue Screws; EL: elective screw placement). Outcome: screw breakage, loosening, malpositioning and reoperations.
Results
252 patients were included between 11/2014 and 08/2021. 48 patients (43±18 years) were treated with Rescue Screws; 204 patients (61±20 years) received EL. The RS-group was more frequently polytraumatized (p<0.001) than the EL-group (89.6% vs. 46.1%) with a higher overall ISS (30±12 vs. 17±10). Unstable pelvic ring fractures were diagnosed more often (p<0.001) in the RS-group (91.7% vs. 48.0%) as well as concomitant shock (37.5% vs. 3.4%). The RS-group was more likely to develop implant complications (25.0% vs. 10.8%, p=0.018). There was no difference regarding reoperations before (p=0.986) or after (p=0.110) fracture consolidation.
Conclusions
Treatment of unstable pelvic ring fractures with Rescue Screws appears as a feasible treatment option for unstable pelvic ring situations at risk. Despite a higher overall risk of implant complications, Rescue Screws are not associated with elevated revision rates, which indicates a minor clinical relevance of these findings. Further studies are needed to compare Rescue Screws to other emergency interventions (e.g. C-Clamp).
References
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