• Dirk Wähnert, Michale J Raschke, and Thomas Fuchs.
• Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Alber-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
• Int Orthop. 2013 Jun 1;37(6):1147-50.

PurposePelvis ring fractures of geriatric patients are currently a serious problem in orthopedic and trauma surgery. One controversy that remains is the insufficiency fracture of the sacrum with treatment options ranging from conservative to operative. We modified standard 7.3-mm screws with additional perforations at the tip to allow cement injection trough the screw to improve implant anchorage.MethodWe describe a new method of treatment of sacral insufficiency fractures. We use modified cannulated 7.3-mm screws (Synthes) with additional perforations at the screw tip. This allows the implant augmentation after proper implant positioning and contrast medium instillation for leakage detection.ResultsAll patients (12 female) treated this way, are allowed to weight bear as tolerated immediately after surgery. The pain level (measured by the visual analog scale--VAS) was significantly reduced due to surgery (mean 8.2 pre-operatively, mean 2.6 postoperatively), the pain medication could be reduced rapidly.ConclusionThe described procedure for the treatment of sacral insufficiency fractures has the potential to increase the safety of cement injection into the sacrum because of the possibility of contrast agent instillation prior to cement injection. Furthermore, the amount of cement can be reduced and additional stability can be attained due to iliosacral screw osteosynthesis compared to sacroplasty.

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