Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation.

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.