Unstable posterior pelvic ring fractures are becoming increasingly common due to demographic changes. At the same time, modifications to diagnostic algorithms with early incorporation of CT and MRI imaging procedures also lead to such fractures being diagnosed more often.
Pain-related immobilisation of the patient can only be avoided by early operative, biomechanically adequate stabilisation of the posterior pelvic ring. The use of sacroiliac screws has become established as a minimally invasive procedure to stabilise the posterior pelvic ring. However, this procedure lacks stability in the 3rd dimension even with simultaneous placement in the S1 and S2 corridor. The remaining vertical instability of the posterior pelvic ring often leads to failure of the assembly.
Therefore SACRONAIL® is developed: It is intended to eliminate this deficiency. With this first intrinsically fixed-angle implant for the posterior pelvic ring, implantation is performed in the covered technique through small incisions. The biiliac symmetrical anchorage gives the posterior pelvic ring three-dimensional stability. At the same time, the intraosseous implant position minimises the risk of pressure damage to the soft tissue.
The implant was recently launched on the German market. Find out more about the surgical procedure, the instruments and the implant components!
The established benefits of intramedullary nail treatment of fractures have been translated to the treatment of pelvic ring injuries and thus an implant system has been developed that satisfies the generally recognised AO principles for internal fixation of fractures:
⦁ Fracture reduction
Fracture reduction and compression are performed using a guide frame.
⦁ Fracture stabilisation
Three-dimensional stabilisation of the posterior pelvic ring results from fixedangle locking of the nail using locking screws.
⦁ Implantation that protects soft tissue
All implant components are placed using mini incisions.
⦁ Early functional physiotherapy
SACRONAIL® enables pain-adapted mobilisation of the patient immediately following surgery.
The minimally invasive surgical procedure and the intraosseous implant position with preservation of the fracture haematoma reduce soft tissue irritation and maintain the blood supply of the bony structures.
The biiliac symmetrical anchorage means that SACRONAIL® provides sustainable, stable treatment of posterior pelvic ring lesions and sacral insufficiency fractures.
The interaction between the minimally invasive surgical technique, intraosseous implant position and fixed angle make SACRONAIL® a concept that is unique to date.
⦁ Established implantation technique
⦁ Equivalent surgical technique to placement of a transsacral SI screw
⦁ Minimally invasive percutaneous procedure
⦁ Enables perioperative protection of the soft tissue
⦁ Prevents high infection-related complication rates
⦁ Leads to less blood loss than open procedures
⦁ Shortens the surgery time
⦁ Enables more rapid mobilisation of the patient
⦁ Precise and safe placement of the locking screws using the guide frame
⦁ Simplifies orientation with complex bone anatomy prior to placement of the screw
⦁ Reduces radiation exposure for patient and personnel
⦁ Uses standard projections as for transiliac screws or when applying the Schanz screws for supra-acetabular external fixation (in inverse projection)
⦁ Fixed-angle anchorage of the components
⦁ Aims to prevent secondary implant loosening of the individual components from each other in osteopenic bone (such as back-out of SI screws)
⦁ Complete intraosseous position of the implants
⦁ Avoids compromising soft tissue, particular with cachectic and polytraumatised patients
⦁ Intraoperative compression option using guide frame
⦁ Enables defined fracture reduction
⦁ No stiffening of healthy motor segments of the spine
⦁ Implant removal is thus not essential, unlike spinopelvic fixation
⦁ Reduces the danger of adjacent fractures of the lumbar spine
⦁ Only two trays are needed for this procedure
⦁ Simplifies handling with minimal layout
⦁ Helps to save space in storage
⦁ Reduces costs for cleaning and sterilisation
⦁ Instrumentation from the tray corresponds to the numbered instruments
⦁ Allows clear overview when working and tracking of the surgical workflow by nursing staff
⦁ Access instruments are provided
⦁ No hospital trays have to be opened
⦁ Additional saving of costs and time
⦁ The SACRONAIL® implant portfolio includes a number of size graduations
⦁ This enables better accommodation of the anatomical features of the patient.
⦁ The selection can be determined using CT scan datasets preoperatively or in situ intraoperatively.
⦁ All implant components are manufactured from established titanium alloy (TiAl6V4) with type II anodising
⦁ The combination of alloy and anodising technique
⦁ increases the strength
⦁ improves the biomechanical properties
⦁ has proven biocompatibility
See Study: Eur J Trauma Emerg Surg. 2023; 49(4): 1873–1882
Minimally invasive bilateral fixed angle locking fixation of the dorsal pelvic ring: clinical proof of concept and preliminary treatment results
Published by Dipl. med. Ivan Marintschev and Prof. Dr. med. Dr. rer. nat. Gunther O. HofmannDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
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