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Sacroplasty

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Fragility Fractures of the Pelvis

Abstract

In elderly patients, the sacral ala and the lateral parts of S1 contain fat tissue within an alar void , which is an area of very low bone density and bone strength. Fractures occur when shear stresses exceed the reduced strength of the sacral ala. Sacroplasty consists of a minimally invasive, percutaneous technique for cement injection into the sacral trabecular bone in order to augment fragility fractures of the sacrum. Sacroplasty stiffens fractured areas with as little alteration to the existing bone architecture as possible. Sacroplasty achieves short-term pain relief due to thermal injury with neurolysis of periosteal nerve endings. Sacroplasty provides mechanical stabilization of the fracture site reducing painful micromotion. Cannulas can be placed utilizing a posterior short-axis lateral oblique, a posterior short-axis central oblique, a posterior long-axis or a lateral transiliac approach. Selection of the appropriate approach is determined by the location, length and type of the lesion, and the patient’s individual anatomy. An adequate imaging technique is paramount for precise localization of the fracture site and for monitoring of the cement distribution. The surgeon should be familiar with properties of different PMMA cements and have experience with common cement augmentation techniques. Intra-osseous application of contrast media before cement application may be used to confirm correct needle placement and to detect potential sites of leakage. The cement should have a toothpaste consistency and injected slowly in small aliquots of 0.1–0.5 mL. Cement application and distribution is monitored using fluoroscopy with alternating views. The “multiple-step-injection”—technique allows the already injected cement to act as a plug, sealing areas of lower resistance. The volume of the injected cement should be as small as necessary. When cement leakage is detected intra-operatively, cement injection has to be stopped. In case of an injected cement volume of less than 5 mL, leakage is not associated with clinical symptoms. In different studies, sacroplasty resulted in pain relief of varying degrees, improved patients’ ability to ambulate, and increased their quality of life. Whether or not sacroplasty should be performed as primary treatment remains unclear. Prospective randomized studies are needed to gain evidence of the benefit of sacroplasty as well as to compare this technique with alternative stabilization methods.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Johannes D. Bastian M.D. & Marius J. B. Keel M.D.

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  1. Johannes D. Bastian M.D.
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  2. Marius J. B. Keel M.D.
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Correspondence to Johannes D. Bastian M.D. .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany

    Pol Maria Rommens

  2. Department of Traumatology and Orthopaedics, Westpfalz-Clinics Kaiserslautern, Kaiserslautern, Germany

    Alexander Hofmann

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Bastian, J.D., Keel, M.J.B. (2017). Sacroplasty. In: Rommens, P., Hofmann, A. (eds) Fragility Fractures of the Pelvis. Springer, Cham. https://doi.org/10.1007/978-3-319-66572-6_10

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