Discussion
pelvic fractures, axial stiffness, fracture, pubic ramus fractures, osteosynthesis, osteoporotic, dislocation, associated loss of fracture, pain, fractures, TITS, implant failure, lumbopelvic
SCREW LOOSENING, DEGENERATIVE
This study compared the biomechanical stability of anterior and posterior pelvic ring fractures after osteosynthesis with TITS or SI screws in an osteoporotic human cadaveric model. Axial stiffness as well as implant failure showed no significant differences in the cohorts. This suggests that both surgical procedures are initially adequate to stabilize an osteoporotic pelvic ring fracture. However, initial axial stiffness is not prognostic for durability of osteosynthesis after loading, a criterion of utmost relevance in osteoporotic bone. Complicated healing processes in the sense of screw loosening and screw dislocation with associated loss of fracture fixation, especially with sacroiliac screws, have been documented in the literature [To provide the best possible treatment for osteoporotic pelvic ring fractures, it was first necessary to determine the fracture morphology of these injuries. Scheyerer et al. were able to demonstrate a posterior pelvic ring lesion in elderly patients with pubic ramus fractures in over 96.8% [There is currently no scientifically based guideline for osteoporotic pelvic ring fracture treatment, even though there is a broad consensus in the community on a surgical approach. In a retrospective study, Walker et al. demonstrated the advantages of surgical management over conservatively managed osteoporotic pelvic fractures. Thus, patients in the surgically managed cohort benefited from a reduction in pain, better mobilization, as well as discharge to home, as opposed to a nursing facility [Numerous osteosynthesis techniques have been developed and discussed in the past for stabilization of osteoporotic and non-osteoporotic pelvic ring fractures. Nowadays, a variety of osteosynthetic options are available to us: transiliac and other plate osteosynthesis procedures of the posterior and anterior pelvic rings, sacroiliac screws, sacral bars, lumbopelvic fixation, and triangular osteosynthesis as a combination of the different methods [With regard to the biomechanical aspects of the various osteosynthesis modalities and fracture types, Peng et al. were able to show in their study that in H- and U-type fractures the common methods such as lumbopelvic support and bilateral triangular stabilization achieve a stable result. However, TITS screw osteosynthesis was shown to be the most stable in all aspects studied [To improve screw fixation, Suero et al. showed in their biomechanical study better results for augmented sacroiliac screws and TITS screw fixation compared to non-augmented short screws [This study has several limitations. As in most biomechanical studies, the small group size does not allow definitive conclusions about any statistical significances. Moreover, it is in the nature of biomechanical studies that they can be translated into reality theoretically, but only to a limited extent practically. Degenerative pre-existing conditions could alter the outcome outside the test setup. Additional pulling and compressive forces from surrounding muscles allow only limited clinical relevance. Fixation of the anterior pelvic ring may provide better stability. In further biomechanical studies, the additional stabilization of the anterior pelvic ring in combination with a transiliacal–transsacral screw should be investigated.