Percutaneous Image-Guided Screw Fixation Combined with Cementoplasty for Radiation-Induced Pelvic Insufficiency Fractures: Feasibility, Safety, and Early Outcomes in a Multicenter Retrospective Study.

PURPOSE: To evaluate the feasibility, safety, and early outcomes of percutaneous image-guided screw fixation (PIGSF) for radiation-induced pelvic insufficiency fractures (R-PIFs).

MATERIALS AND METHODS: This study retrospectively analyzed consecutive patients with symptomatic R-PIFs treated by PIGSF under computed tomography (CT) or cone-beam CT guidance between January 2021 and January 2024 in 3 tertiary centers. Screws were positioned via transsacroiliac approaches, with cement injected into the fracture site and screw trajectory. Clinical evaluation included pain, analgesic use, mobility, and patient-reported quality of life (QoL). Follow-up included standardized consultation and CT at 1 month.

RESULTS: Eighteen patients (mean age, 71.0 years [SD ± 6.5]; women, 61%) were included. Technical success was achieved in all interventions, with a median procedure duration of 63 minutes (range, 45-90 minutes). A total of 32 screws were implanted (mean, 1.8 per procedure). No intraoperative or early adverse events occurred. All patients were able to stand up and walk within 24 hours, and 17 of 18 were discharged on Day 1. At 1 month, maximal pain intensity decreased from 8.6 (SD ± 1.8) to 3.3 (SD ± 2.8) (P < .0001), and mean pain intensity decreased from 7.2 (SD ± 2.0) to 2.0 (SD ± 1.8) (P < .0001). QoL improved from 40.0 (SD ± 22.4) to 72.3 (SD ± 22.4) (P = .0036).

CONCLUSIONS: PIGSF for R-PIFs is technically feasible, safe, and associated with rapid pain relief, early mobilization, and improved QoL.