13th Annual Global Embolization Symposium & Technologies
Purpose : To systematically review, discuss the techniques, and evaluate available level of evidence on percutaneous screw fixation of pathologic fractures and impending fractures as an emerging procedure for interventional radiologists.
Material and Methods : Using PubMed, the search terms “percutaneous fixation of pathologic fractures”, “interventional radiology AND percutaneous fixation”, “screw fixation AND interventional radiology”, “interventional radiology AND (pathologic fracture) OR (impending fracture) AND (percutaneous fixation) OR (osteosynthesis) OR (consolidation)” generated 310 articles. These were narrowed to only those articles involving percutaneous fixation of a pathologic or impending fracture with screws, with image guidance by an interventional radiologist. 12 articles were included in the final review, and 10 were appropriate for statistical analysis.
Results : Here we review the available literature to discuss the techniques and level of evidence on imaging-guided percutaneous screw fixation for insufficiency, impending, or pathologic fractures in patients judged not to be candidates for surgery. The best available evidence for the efficacy and safety of this technique is level IV. Multiple sizable cohort studies were identified which evaluate this topic, however these reported a variety of endpoints. The technical success rate across all studies for which this was reported was 96.7%. Studies reported many different measures of pain relief, but most reported the number of patients who experienced some level of relief. This was 92.7% across these studies. For those that reported complication rates, the rates for significant (AQC cgrade II or III) and minor complications (AQC grade I) were 6.4% and 4.7%, respectively. There were no grade IV or V complications reported.
Conclusions : Percutaneous screw fixation of pathological and pending pathological fractures by image guidance is a safe viable option in select cases of this high risk patient population. Further multi-center studies are needed to provide higher level of evidence for this emerging procedure. Interventional radiologists are uniquely equipped with the skill set needed to advance this procedure.