A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint

Phelps, Kevin D.; Ming, Bryan W.; Fox, Wade E.; Bellamy, N.; Sims, Stephen H.; Karunakar, Madhav A.; Hsu, Joseph R.

doi:10.1097/00005131-201606000-00006

Cited by 2 publications

(3 citation statements)

References 38 publications

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“…Using the antero-lateral approach in SIJ (fracture-)dislocation for plate stabilization, anatomical dissections revealed that the LT can nearly always be visualized 10 . Insertion of retractors to visualize the SIJ intraoperatively may additionally harm the LT.…”

Section: Introductionmentioning

confidence: 99%

Relation of the lumbosacral trunk to the sacro-iliac joint

Grechenig

Hohenberger³

et al. 2021

Sci Rep

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This study aims to evaluate the relation between the lumbosacral trunk (LT) and the sacro-iliac joint (SIJ). In forty anatomic specimens (hemipelves) a classical antero-lateral approach to the SIJ was performed. The SIJ was marked at the linea terminalis (reference point A). Reference point B was situated at the upper edge of the interosseous sacro-iliac ligament. The length of the SIJ (distance A to B) and the distance between point A and the ventral branch of the fourth (L4) and fifth (L5) lumbar spinal nerves at the linea terminalis were measured. The SIJ had a mean length of 58.0 mm. The ventral branch of L5 was located closer to the SIJ in very long SIJs (mean length: ≥ 6.5 cm; mean distance: 9.8 mm) compared to very short joints (≤ 5 mm; mean distance: 11.3 mm). For the ventral branch of L4, very long SIJs had a mean distance of 7 mm and very short joints an average distance of 9.7 mm between point A and the nerve branch. A safe zone of approximately 1 cm to 2 cm (anterior to posterior) is present on the sacral surface (lateral to medial) for safe fixation of plates during anterior plate stabilization of the SIJ. Pelves with a shorter dorsoventral diameter of the most superior part of the SIJ apparently give more space for inserting plates.

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Section: Introductionmentioning

confidence: 99%

Relation of the lumbosacral trunk to the sacro-iliac joint

Grechenig

Hohenberger³

et al. 2021

Sci Rep

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“…This technique has been used in a previous investigation into exposure of the proximal femur by other authors and we feel this method best replicates the actual vantage point during surgical procedures [7]. Additional studies have compared surgical exposures with digital imaging in other anatomic locations, often with the goal of improving access for fracture care [5,7,25,26,43,44]. These studies have used similar methodology, the same software package (ImageJ), and have yielded clinically useful insights.…”

Section: Discussionmentioning

confidence: 95%

“…Proximal, femoral, and articular areas were measured separately to evaluate the exposure of the femoral neck and head. Kappa values were not performed; however, this methodology and software program have been reliably used to quantify exposure in previously published surgical exposure studies [5,7,8,25,26,30,43,44]. Seven anatomic landmarks-the labrum, femoral head, subcapital femoral neck, basicervical femoral neck, greater and lesser trochanters, and medial neck-were characterized as visible, readily palpable with a tonsil clamp, or both.…”

Section: Methodsmentioning

confidence: 99%

Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

Lichstein

Kleimeyer

Githens

et al. 2018

Clin Orthop Relat Res

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Open reduction and internal fixation of a femoral neck fracture is typically performed in a young patient (< 60 years old) with the objective of obtaining anatomic reduction that would not be possible by closed manipulation, thus enhancing healing potential. In the hands of surgeons experienced in both approaches, the modified Smith-Petersen approach offers improved direct access for reduction and fixation. Higher quality reductions and fixation are expected to translate to improved healing potential and outcomes. Although our experimental results are promising, further clinical studies are needed to verify if this larger exposure area imparts increased quality of reduction, healing, and improved outcomes compared with other approaches. The learning curve for the exposure is unclear, but the approach has broad applications and is frequently used in other subspecialties such as for direct anterior THA and pediatric septic hip drainage. Surgeons treating femoral neck fractures with open reduction and fixation should familiarize themselves with the modified Smith-Petersen approach.

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A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint

Cited by 2 publications

References 38 publications

Relation of the lumbosacral trunk to the sacro-iliac joint

Relation of the lumbosacral trunk to the sacro-iliac joint

Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

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