Objectives To evaluate the functional outcomes after percutaneous screw fixation combined with cement augmentation in patients with osteoporotic sacral insufficiency fractures. Materials and methods In this bicentric retrospective study, elderly patients with sacral insufficiency fractures were treated using percutaneous screw fixation with cement augmentation. Functional mobility was assessed using a 6-point scale at baseline, Day 1, 6 weeks, and 6 months. Secondary outcomes included pain scores, hospital stay, and complications. Functional and pain score evolutions were analyzed using linear mixed-effects models. Subgroup analyses explored interaction effects with fracture characteristics. Results Sixty-eight patients were included. Functional scores increased from an estimated marginal mean of 2.43 (95% CI, 2.00–2.86) at baseline to 3.51 (3.05–3.97) on Day 1, 4.15 (3.69–4.61) at 6 weeks, and 4.06 (3.31–4.81) at 6 months (all p < 0.001). Pain scores decreased from 6.60 (6.11–7.10) at baseline to 2.48 (1.96–3.01) on Day 1, 1.15 (0.62–1.67) at 6 weeks, and 1.10 (0.27–1.92) at 6 months (all p < 0.001). Same-day discharge was achieved in 43% of patients. Three complications occurred (4.4%): one asymptomatic cement leakage and two grade 3 events, including one delayed hemorrhage and one screw loosening, both of which were managed without lasting effects. Functional gains varied by fracture pattern, with a statistically significant interaction observed in patients with associated obturator ring fractures (interaction p = 0.003). Conclusion Percutaneous screw fixation with cement augmentation provides early and sustained improvement in both function and pain in elderly patients with osteoporotic sacral insufficiency fractures, with a low complication rate and potential for outpatient management. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> The clinical effectiveness of percutaneous screw fixation with cement augmentation remains to be further characterized in osteoporotic sacral insufficiency fractures. <Emphasis Type="BoldItalic">Findings</Emphasis> Functional and pain scores improved significantly from Day 1 to 6 months, with a low complication rate and 43% of patients managed as outpatients. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Facilitating rapid discharge and symptom relief, this strategy aligns with the goals of geriatric care by minimizing hospitalization and promoting early functional recovery. Graphical Abstract

Percutaneous screw fixation combined with cement augmentation for sacral insufficiency fractures: bicentric study

期刊论文
发表日期：

2026年4月3日

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Lucas Peraldi,
Emmanuel Dien,
Bastien Chalamet,
Ilyess Ben-rejeb,
Joris Lavigne,
William Boulade,
Stéphane Cadot,
Nicolas Amoretti,
Jean-baptiste Pialat,
Nicolas Stacoffe

摘要

Objectives

To evaluate the functional outcomes after percutaneous screw fixation combined with cement augmentation in patients with osteoporotic sacral insufficiency fractures.

Materials and methods

In this bicentric retrospective study, elderly patients with sacral insufficiency fractures were treated using percutaneous screw fixation with cement augmentation. Functional mobility was assessed using a 6-point scale at baseline, Day 1, 6 weeks, and 6 months. Secondary outcomes included pain scores, hospital stay, and complications. Functional and pain score evolutions were analyzed using linear mixed-effects models. Subgroup analyses explored interaction effects with fracture characteristics.

Results

Sixty-eight patients were included. Functional scores increased from an estimated marginal mean of 2.43 (95% CI, 2.00–2.86) at baseline to 3.51 (3.05–3.97) on Day 1, 4.15 (3.69–4.61) at 6 weeks, and 4.06 (3.31–4.81) at 6 months (all p < 0.001). Pain scores decreased from 6.60 (6.11–7.10) at baseline to 2.48 (1.96–3.01) on Day 1, 1.15 (0.62–1.67) at 6 weeks, and 1.10 (0.27–1.92) at 6 months (all p < 0.001). Same-day discharge was achieved in 43% of patients. Three complications occurred (4.4%): one asymptomatic cement leakage and two grade 3 events, including one delayed hemorrhage and one screw loosening, both of which were managed without lasting effects. Functional gains varied by fracture pattern, with a statistically significant interaction observed in patients with associated obturator ring fractures (interaction p = 0.003).

Conclusion

Percutaneous screw fixation with cement augmentation provides early and sustained improvement in both function and pain in elderly patients with osteoporotic sacral insufficiency fractures, with a low complication rate and potential for outpatient management.

Key Points

Question The clinical effectiveness of percutaneous screw fixation with cement augmentation remains to be further characterized in osteoporotic sacral insufficiency fractures.

Findings Functional and pain scores improved significantly from Day 1 to 6 months, with a low complication rate and 43% of patients managed as outpatients.

Clinical relevance Facilitating rapid discharge and symptom relief, this strategy aligns with the goals of geriatric care by minimizing hospitalization and promoting early functional recovery.

Graphical Abstract