Abstract
Cement augmentation of pedicle screws is the gold standard for the stabilization of osteoporotic fractures of the spine. In-screw cement augmentation, in which cement is injected through the cannula, is another option for fracture stabilization of fragility fractures of the sacrum. However, biomechanical superiority of this technique compared to conventional sacroiliac screw fixation has not been tested. The present study compares the stability of cement-augmented and non-cement-augmented sacroiliac screw fixation in osteoporotic sacrum fractures under cyclic loading. Eight human donor pelvises with intact ligaments and 5th lumbar vertebra were dissected. A vertical shear fracture was created as a combination of a sacrum fracture and cutting of the symphysis. Both sides were tested in a single-limb-stance setup with 10,000 loading cycles applied. Stiffness of the pelvis and displacement of the fracture were measured using a hydraulic testing machine and a 3D image correlation system. The augmented screw fixation failed in two of eight pelvises, and the non-augmented screws failed in three of eight pelvises. CT scans showed no leakage of cement. In-screw polymethylmethacrylate (PMMA) augmentation showed no advantage based on measured displacement of the sacrum fractures or stiffness for sacroiliac screw fixation of fragility fractures of the sacrum.
Acknowledgments
We thank Toni Wendler for his support in data processing. Furthermore, we want to thank Jocelyn Todd from our Center for Musculoskeletal Research for her excellent proofreading as a native speaker. We would also like to thank Robbie McPhee for his help with the drawings. Königsee Implants (Allendorf, Germany).
Conflict of interest statement: The institution of the authors received financial and material funding from Königsee Implants (Allendorf, Germany). Dr. Jörg Böhme has currently an advisory contract with Königsee Implants (Allendorf, Germany). There were no further financial and/or personal relationships of any author or other people or organizations that would inappropriately influence their work.
Ethical review committee statement: While alive, the donors gave their informed and written consent for the post-mortem donation of their bodies for teaching and research purposes. Being part of the body donor program regulated by the Saxonian Death and Funeral Act of 1994 (third section, paragraph 18 item 8), institutional approval for the use of the post-mortem tissues of human body donors was obtained from the Institute of Anatomy, University of Leipzig. The authors declare that all experiments have been conducted according to the principles of the Declaration of Helsinki.
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