A Useful Preoperative Planning Technique for Transiliac–Transsacral Screws

Lucas, Justin F.; Routt, Milton L; Eastman, Jonathan Garland

doi:10.1097/bot.0000000000000708

Cited by 35 publications

(31 citation statements)

References 27 publications

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“…The sacral screw trajectory is orthogonal to a sacral fracture line as determined on preoperative CT scan, and the screw terminates in the body of S1 or S2. 17 Finally, TITS screws traverse the injured ilium and sacrum to the contralateral ilium.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…16), the vast majority of femoral shaft fractures in adults are treated with intramedullary nailing (►Figs. [17][18][19].…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Intramedullary nailing of the femur can be performed antegrade (from the hip down) or retrograde (from the knee up) (►Fig. 17). Both techniques are associated with high rates of union, similar blood loss, similar surgical time, and few complications.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Sanal¹,

Boulton

Neyisci³

et al. 2019

Semin Musculoskelet Radiol

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Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.

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Section: Treatment Optionsmentioning

confidence: 99%

“…16), the vast majority of femoral shaft fractures in adults are treated with intramedullary nailing (►Figs. [17][18][19].…”

Section: Treatment Optionsmentioning

confidence: 99%

See 1 more Smart Citation

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Sanal¹,

Boulton

Neyisci³

et al. 2019

Semin Musculoskelet Radiol

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show abstract

“…The advantages of this technique include minimal tissue damage due to the surgical procedure, improved stability of the fixation, short surgery time, and reduced risk for wound-related problems in the postoperative period. [ 9 , 10 ] However, patients may be prone to develop complications due to some factors, including variability in pelvic anatomy, the narrowness of the bone corridor to be screwed, and inadequacies in imaging and surgical procedures. [ 11 ] In the literature, the current technique has been modified by combining with different imaging techniques in order to decrease the complication rates and increase surgical success.…”

Section: Introductionmentioning

confidence: 99%

Do three-dimensional modeling and printing technologies have an impact on the surgical success of percutaneous transsacral screw fixation?

2020

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Caused by high-energy traumas, pelvic injuries are life-threatening complex injuries posing several unfavorable effects on the body. Pelvic fractures account for approximately 3-4.3% of all skeletal fractures. [1,2] Mortality rates due to pelvic injuries vary from 10 to 16%. [1,3] Victims of these injuries display an increased tendency to develop complications due to the nature of the injury and modes of treatment. [4-8] Complications are critical for patient survival and sequelae development. Percutaneous iliosacral and transsacral-transiliac screw fixation are the commonly preferred surgical methods for the treatment of posterior pelvic injuries. The advantages of this technique include minimal tissue damage due to the surgical procedure, improved stability of the fixation, short surgery time, and reduced risk for wound-related problems in the postoperative period. [9,10] However, patients may be prone to develop complications due to some factors, including variability in pelvic anatomy, the narrowness of the bone corridor to be screwed, and inadequacies in imaging and Objectives: This study aims to determine the role of computed tomography (CT)-derived templates, produced by threedimensional (3D) modeling, image processing and printing technology, in percutaneous transsacral screw fixation and evaluate the effects of their use on surgical success. Materials and methods: This prospective study conducted between June 2018 and December 2019 utilized 15 composite pelvis models for transsacral-transiliac screw fixation. For the procedure, modeled templates were utilized for wiring on the left side of the pelvis models, while the conventional method was performed on the right side of the pelvis models. In the computed tomography images acquired after wiring, appropriate wire position was evaluated. Results: The placed wires held the S1 body appropriately in all of the procedures with or without template use. With the template use, the wires were placed appropriately in the surgical bone corridor suitable for the transsacral-transiliac screw fixation in all of the models. However, with the conventional methods, the wires were not placed in the safe surgical bone corridor in four models. The wire deviation angle in the axial plane was significantly lower in the template group (p=0.001), whereas it was not different between the template group and the conventional method group in the coronal plane (p=0.054). The amount of deviation from the ideal wire entry site was significantly reduced in the template group compared to the conventional method group (p=0.001). Conclusion: With the use of 3D modeling and printing technology, CT-derived templates can be produced and utilized for transsacral screw fixation procedures and their use increases surgical success by reducing the surgical margin of error.

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“…Although the reported preoperative and intraoperative techniques [4][5][6] may aid in IS screw insertion, they require additional software for imaging and data analysis. Separately, although a safe and sufficient corridor for screw placement was also identified using preoperative planning [7][8][9], there is still the possibility of extraosseous screw placement because of misinterpreted fluoroscopic imaging or incorrect technical execution [10,11].…”

Section: Introductionmentioning

confidence: 99%

Successful Use of Fluoroscopic Inlet and Outlet Views to Verify Safe Screw Trajectories when Placing Percutaneous Iliosacral Screws

Kwak¹,

Heo²,

Jung³

2018

Med Case Rep J

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The purpose of this study was to introduce practical landmarks for the successful use of the fluoroscopic inlet and outlet views to verify safe screw trajectories when placing percutaneous iliosacral (IS) screws. Materials and Methods: A total of 10 sacra (19 hemi-sacra) from cadavers without gross deformity or previous injury were included in this study. The upper boundaries and S1 were marked with 1 mm lead wire. The marked sacra were positioned on a radiolucent operative table similar to the operative supine position and projected into the pelvic inlet and outlet views and the true lateral view of the pelvis via an image intensifier. Using image editing software, fluoroscopic images were analyzed to identify the fluoroscopic landmarks and ideal entry points. Results: The posterior-superior corner of the lateral articular surface was constantly projected as a curve point in the pelvic inlet view, and the imaginary connecting line between two points did not violate the posterior walls of S1 in any of the sacra with a little space. Based on the curve points, screws had to be directed either straight or anteriorly (range: 18.3°-29.6°) on inlet view. On outlet view, the ideal screw trajectory was the imaginary oblique line from the height of the S1 foramen to the opposite upper corner of S1 (range: 15.5°-24.4°) and the sacral ala was not violated. Conclusion: For successful fluoroscopy, two simple landmarks could be utilized, the imaginary connecting line between the two curve points in the pelvic inlet view and the oblique screw trajectory toward the opposite corner of S1 in the pelvic outlet view, using the standard technique and irrespective of sacral dysplasia.

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A Useful Preoperative Planning Technique for Transiliac–Transsacral Screws

Cited by 35 publications

References 27 publications

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

Do three-dimensional modeling and printing technologies have an impact on the surgical success of percutaneous transsacral screw fixation?

Successful Use of Fluoroscopic Inlet and Outlet Views to Verify Safe Screw Trajectories when Placing Percutaneous Iliosacral Screws

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