Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Trans Iliac Rod Fixation (TIRF) through a posterior approach for fragility fracture of pelvis, one of the causes of low back pain in the elderly, enables early bed release and  shorter hospital stay. (#166)

Yasuaki Okada 1 , Eiichiro Nakamura 2 , Naohito Sato 1 , Kenji Kosugi 1 , Daishi Hamada 1 , Teppei Muramoto 3 , Ukichi Zenke 1 , Akinori Sakai 3
  1. Trauma reconstruction Center, Hospital of the University of Occupational and Environmental Health Japan., Kitakyusyu Yahatanishiku Iseigaoka 1-1, Fukuoka, Japan
  2. Spine Center, Hospital of the University of Occupational and Environmental Health Japan., kitakyuusyu yahatanishiku iseigaoka1-1, Fukuoka, Japan
  3. Department of Orthopedics Surgery, University of Occupational and Environmental Health Japan., Iseigaoka Yahatanishi-ku Kitakyushu city, Fukuoka, Japan

Introduction: Fragility fracture of the pelvis (FFP) is a common cause of low back pain in the elderly, and has been reported to cause a similar loss of walking ability and poor outcome as proximal femoral fracture. In our hospital, we have actively operated on patients with Rommens classification type II or higher FFPs and difficulty sitting up, resulting in significant benefits from immediate mobilization after fracture. The purpose of this study is to analyze the impact of the transiliac rod fixation (TIRF) through a posterior approach for FPPs in our hospital.

Methods: A total of 25 patients (25 women) with a FFP underwent minimally invasive TIRF through a posterior approach were included. The mean age was 83.7 ± 5.9 years. One patient had a type 2b fracture, 1 had a type 2c fracture, 10 had type 3a fractures, 1 had a type 3c fracture, 1 had a type 4a fracture and 11 had type 4b fractures per the Rommens classification. In all patients, 2 pedicle screws were inserted into the bilateral iliac crests: the caudal screw was at least 9 mm in diameter and 90 mm long, and the cephalic screw was at least 8 mm in diameter and 90 mm long. All screws were connected with rods and connectors. Postoperatively, full weight bearing was allowed on the first postoperative day depending on pain level, and rehabilitation was performed with the goal of early hospital discharge. 

Results: The waiting period from injury to surgery was 14 ± 14.9 days, the average operative time was 113 ± 20 minutes, the average blood loss was 152 ± 104 mL, the average transfer to a wheelchair was 1.1 ± 0.4 days after the procedure, the average time to start using a walker was 4.2 ± 2.2 days. No additional pelvic fractures and no instrumentation failure after the procedure were observed. Complications occurred in by 2patients with skin disorders and 1patient with a deep infection, and 1 patient died during the 2 year observation period after the surgery. 

Discussion: TIRF using a posterior approach for patients with an FFP could be performed using minimally invasive techniques, provide good pain relief, achieve early ambulation and gait training, and avoided deterioration in quality of life. The mortality rate during the observation period was low at 4% (1/25).

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