SIR 2024
Pain Management/MSK
Patrick Moran, MD
PGY-3 IR resident
Medical College of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Mustafa Haddad, MD
Assistant Professor
Medical College of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Sean Tutton, MD (he/him/his)
Professor
UCSD HEALTH
Financial relationships: Full list of relationships is listed on the CME information page.
Brandon M. Key, MD
Assistant Professor - Vascular and Interventional Radiology
Medical College of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Matthew J. Scheidt, MD, FSIR
Associate Professor of Radiology
Medical College of Wisconsin
Financial relationships: Full list of relationships is listed on the CME information page.
Adam Wooldridge, MD
Assistant Professor
Medical College of Wisconsin
Disclosure information not submitted.
The purpose of this study was to assess the long term outcomes, safety, and complications of percutaneous pelvic screw fixation with or without osteoplasty in a large patient cohort.
Materials and Methods:
This is a single-center retrospective study of 150 patients who underwent pelvic screw fixation ± osteoplasty from 1/2012 to 10/2022. Of the 150 patients a total of 139 patients underwent fixation for malignancy (of which 72 had concurrent ablation), 9 for insufficiency fractures, and 2 for traumatic pelvic fractures. There were 5 patients with no long term follow up beyond the 30 day post-procedural period. All procedures were done in conjunction with orthopedic surgery utilizing a combination of cone beam CT and real time fluoroscopic needle guidance. Chart and imaging review was performed to evaluate for 30- day complications and primary outcomes including need for future interventions, hardware failure (screw fracture, loosening or retraction), post-fixation fracture, and local disease recurrence.
Results:
Of the 150 patients who underwent percutaneous pelvic fixation, there were 9 (6%) 30-day postoperative complications. These included 2 infections requiring intravenous antibiotics, 5 patients with ablation related nerve injuries, 1 malpositioned screw requiring removal, and 1 patient who developed acute on chronic lower extremity ischemia requiring revascularization and ultimately BKA. In 145 patients who had follow up beyond 30 days, 7 patients (5%) had hardware failure within 3 months to 2 years with 6 undergoing reintervention. There were two patients (1%) with post fixation fractures occurring 4 months and 2 years later requiring additional percutaneous screws and open surgical repair respectively. In 72 patients who underwent concurrent ablation there was local recurrence in 8 patients (11%) ranging from 2 months to 2 years with 6 undergoing repeat ablation and intervention.
Conclusion:
This large single center review demonstrates that percutaneous pelvic fixation can be a safe and less invasive option to provide long term pelvic stability and prevent future fractures in patients who have metastatic disease to pelvis, low bone density or are poor surgical candidates.