Percutaneous sacroiliac screw fixation in fragility fractures of the pelvis: Comparison of two different augmentation techniques

Published:October 08, 2022DOI:



      Fragility fractures of the pelvis (FFP) are becoming increasingly common. Percutaneous sacroiliac screw fixation is an accepted and safe treatment method for FFP. Augmentation is an option to optimize fixation strength of the screws. This study aims to compare patient mobility and the occurrence of complications after operative treatment of FFP utilizing two different augmentation techniques.


      All patients who received augmented sacroiliac screws for the treatment of FFPs between 01.01.2017 and 31.12.2018 at one of the two participating hospitals were included. The operative techniques only differed with regards to the augmentation method used. At the one hospital cannulated screws were used. Definitive screw placement followed augmentation. At the other hospital cannulated and fenestrated screws were used, permitting definitive screw placement prior to augmentation.


      In total, 59 patients were included. The NRS score for pain was significantly lower after surgery. Preoperative mobility levels could be maintained or improved in 2/3 of the patients. There were no fatal complications. Two revision surgeries were performed because of screw misplacement. There were no significant differences between the two augmentation techniques in terms of complications.


      Both augmentation techniques have a low complication rate and are safe methods to maintain patients’ mobility level. The authors advocate early consideration of surgical treatment for patients with FFP. Augmentation can be considered a safe addition when performing percutaneous sacroiliac screw fixation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kannus P.
        • Palvanen M.
        • Niemi S.
        • Parkkari J.
        • Järvinen M.
        Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium.
        Osteoporos Int. 2000; 11: 443-448
        • Rommens P.M.
        • Wagner D.
        • Hofmann A.
        Surgical management of osteoporotic pelvic fractures: a new challenge.
        Eur J Trauma Emerg Surg. 2012; 38: 499-509
        • Fuchs T.
        • Rottbeck U.
        • Hofbauer V.
        • Raschke M.
        • Stange R.
        Beckenringfrakturen im alter.
        Unfallchirurg. 2011; 114: 663-670
        • Van der Vet P.C.R.
        • Kusen J.Q.
        • Rohner-Spengler M.
        • Link B-C.
        • Houwert R.M.
        • Knobe M.
        • Babst R.
        • Henzen C.
        • Schmid L.
        • Beeres F.J.
        Fear of falling, recurrence of falls, and quality of life in patients with a low energy fracture – part II of an observational study.
        Medicina. 2021; 7: 576-584
        • Rommens P.M.
        • Hofmann A.
        Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment.
        Injury, Int J Care Injur. 2013; 44: 1733-1744
        • Iorio J.A.
        • Jakoi A.M.
        • Rehman S.
        Percutaneous sacroiliac screw fixation of the posterior pelvic ring.
        Orthop Clin N Am. 2015; 46: 511-521
        • Costa F.
        • Ortolina A.
        • Galbusera F.
        • Cardia A.
        • Sala G.
        • Ronchi F.
        • Uccelli C.
        • Grosso R.
        • Fornari M.
        Pedicle screw cement augmentation. A mechanical pullout study on different cement augmentation techniques.
        Med Eng Phys. 2016; 38: 181-186
        • Osterhoff G.
        • Dodd A.E.
        • Unno F.
        • Wong A.
        • Amiri S.
        • Lefaivre K.A.
        • Guy P.
        Cement augmentation in sacroiliac screw fixation offers modest biomechanical advantages in a cadaver model.
        Clin Orthop Relat Res. 2016; 474: 2522-2530
        • Oberkircher L.
        • Masaeli A.
        • Bliemel C.
        • Debus F.
        • Ruchholtz S.
        • Krüger A.
        Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens – a biomechanical investigation.
        Spine J. 2016; 16: 226-232
        • Collinge C.A.
        • Crist B.D.
        Combined percutaneous iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery.
        J Orthop Trauma. 2016; 30: 217-222
        • Rommens P.M.
        • Wagner D.
        • Hofmann A.
        Osteoporotische Frakturen des Beckenrings.
        Z Orthop Unfall. 2012; 150: 107-120
        • Wähnert D.
        • Raschke M.J.
        • Fuchs T.
        Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants.
        Int Orthopaed (SICOT). 2013; 37: 1147-1150
        • Rommens P.M.
        • Hofmann A.
        • Kraemer S.
        • Kisilak M.
        • Boudissa M.
        • Wagner D.
        Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients.
        Eur J Trauma Emerg Surg. 2022; 48: 2881-2896
        • Routt M.L.
        • Simonian P.T.
        • Mills W.J.
        Iliosacral screw fixation: early complications of the percutaneous technique.
        J Orthop Trauma. 1997; 11: 584-589
        • Tillou A.
        • Kelley-Quon L.
        • Burruss S.
        Long-term postinjury functional recovery: outcomes of geriatric consultation.
        JAMA Surg. 2014; 149: 83-89
        • Oberkircher L.
        • Ruchholtz S.
        • Rommens P.M.
        • Hofmann A.
        • Bücking B.
        • Krüger A.
        Osteoporotic pelvic fractures.
        Dtsch Artebl Int. 2018; 115: 70-80
        • Höch A.
        • Pieroh P.
        • Henkelmann R.
        • Josten C.
        • Böhme J.
        In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up.
        BMC Surgery. 2017; 17: 132
        • Park J.
        • Park S.
        • Lee H.J.
        • Lee C.
        • Chang B.
        • Kim H.
        Mortality following benign sacral insufficiency fracture and associated risk factors.
        Arch Osteoporos. 2017; 12: 100
        • Hopf J.C.
        • Krieglstein C.F.
        • Müller L.P.
        • Koslowsky T.C.
        Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients.
        Injury, Int. J. Care Injured. 2015; 46: 1631-1636
        • Rommens P.M.
        • Arand C.
        • Hofmann A.
        • Wagner D.
        When and how to operate fragility fractures of the pelvis.
        Indian J Orthop. 2019; 53: 128-137
        • Wagner D.
        • Ossendorf C.
        • Gruszka D.
        • Hofmann A.
        • Rommens P.M.
        Fragility fractures of the sacrum: how to identify and when to treat surgically?.
        Eur J Trauma Emerg Surg. 2015; 41: 349-362