CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

Pieske, Oliver; Landersdorfer, Christoph; Trumm, C.; Greiner, Andreas; Wallmichrath, Jens; Gottschalk, Oliver; Rubenbauer, Bianka

doi:10.1016/j.injury.2014.11.009

Cited by 50 publications

(39 citation statements)

References 31 publications

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“…Those studies concluded that, since fluoroscopic-guided closed reduction and lag screw fixation of sacroiliac luxations restored and maintained pelvic canal dimensions, MIO could be considered as an alternative to ORIF. A potential advantage of MIO is that it may improve drilling accuracy, thus allowing optimal screw orientation and purchase in the sacral body (16,18,19). Preventing inadvertent infraction of the vertebral canal or the seventh lumbar (L7)-first sacral (S1) intervertebral disc space could also reduce postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation

Déjardin

Marturello

Guiot

et al. 2016

Vet Comp Orthop Traumatol

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This study demonstrates that MIO fixation of canine sacroiliac luxations provides more accurate and consistent sacral screw placement than ORIF. With proper techniques, iatrogenic neurological damage can be avoided with both techniques. The PL /SW-R, which relates to safe screw fixation, also demonstrates that screw penetration of at least 60% of the sacral width is achievable regardless of surgical approach. These findings, along with the limited dissection needed for accurate sacral screw placement, suggest that MIO of sacroiliac luxations is a valid alternative to ORIF.

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Section: Introductionmentioning

confidence: 99%

Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation

Déjardin

Marturello

Guiot

et al. 2016

Vet Comp Orthop Traumatol

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“…Using 3D fluoroscopic navigation when performing pelvic surgery is reported to be useful in evaluating screw position. The above disadvantages could be reduced with 2D-or 3D-fluoroscopic navigation, but the malposition rate of screw fixation for pelvic fractures ranges from 0-31%, demonstrating that there's still certain room to improve the technology [29][30][31] . What's more, too much radiation exposure to patients and surgeons will also cause great harm to their bodies.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional printing simulated operation combined with robot-aided minimally invasive lumbopelvic fixation in treatment of unstable bilateral sacral fractures: technical notes and 8 case series

Liu

Tian

Jin

et al. 2020

Preprint

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Background Despite their seldom appearance, unstable bilateral sacral fractures are severe injuries and always cause surgical management difficulties. Lumbopelvic fixation is reliable for rigid method, but wound-related complications with open procedure have been relatively common. Methods Data of 8 patients with unstable bilateral sacral fractures who were treated surgically in our institution from March 2016 to April 2019 were retrospectively analyzed. There were 5 men and 3 women with an average age of 38.5 years (range, 19-60years). According to the sharp of sacral fractures, there were one case with simple bilateral vertical fracture lines, 6 cases with “U” and one case with “H”. According to Roy-Camille classification, 7 of 8 sacral fractures involving sacral canal were classified with type I 2 cases, type II 4 cases and type III 1 case. Three-dimensional(3D) printing pelvis were performed to simulate lumbopelvic and sacroiliac screw fixation for preoperative planning. Eight bilateral sacral fractures were treated with minimally invasive lumbopelvic fixation under robotic guidance. Results The screws inserted with robotic assistance were exposed to radiation with an average of 41.6±10.2 times (range, 27–53 times) intraoperatively. The total fluoroscopy time was 32–59 s, and the average fluoroscopy time for each screw was 4.2±0.6s. According to modified Gras classification of screw position, there were Grade I in 7 cases and Grade II in one case (left S1 screw). The average operation time was 150.6 min (range, 95-220 min), and intraoperative blood loss was 87.5 ml (range, 60-120 ml). Eight patients were followed up consecutively for at least 12 months, with an average of 17.0 months (range, 12–24months). No patient suffered a neurovascular injury intraoperatively. There were no incision-related complications. All fractures healed with an average time of 4.2 months (range, 3–10 months). According to Majeed functional assessment investigation, the mean score was 88.4 points (range, 78–98 points), which were graded as follows: 5, excellent and 3, good. Conclusion Under robot guidance, minimally invasive lumbopelvic fixation for unstable bilateral sacral fractures is a feasible option with the advantages of accuracy, less radiation and safety. Simulated operation with 3D printing for preoperative planning can simplify the actual surgery.

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“…To overcome these difficulties, new methods of CT and computer-assisted navigation screw fixation techniques are continuously being developed and introduced. [7,8,22,23] However; high costs, low utility, and rare availability of CT and computer navigation-assisted techniques lead to significantly infrequent use of these techniques. Therefore, the iliosacral screw fixation technique performed under fluoroscopy guidance is currently the most commonly used method.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Furthermore, several studies have reported a number of deficiencies in the description of these techniques. [7,8] Today, fluoroscopy and conventional radiographs are still the most commonly used preoperative imaging methods to perform percutaneous iliosacral screw fixation compared to the use of CT and other computer-assisted techniques. In this study, we aimed to investigate if pelvic mapping is applicable in iliosacral screw fixation to determine screw entry point and screw trajectory.…”

mentioning

confidence: 99%

Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory?

Durusoy

Paksoy

Korkmaz

et al. 2019

Eklem Hastalik Cerrahisi

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Pelvis injuries account for approximately 3% of all skeletal injuries. [1] In unstable fractures, morbidity and mortality rates are particularly high, requiring surgery to provide stability and prevent potential morbidities and mortality. [2] In posterior pelvis fractures and dislocations, surgery can be performed with an open or percutaneous approach; however, the latter has become the preferred mode of treatment in recent years. [3,4] ÖZ Amaç: Bu çalışmada, iliyosakral vida sabitlemede vida giriş noktası ve vida yöneliminin belirlenmesinde pelvik haritalamanın uygulanabilir olup olmadığı araştırıldı. Hastalar ve yöntemler: Sakroiliyak eklem yaralanması ve sakrum kırığı nedeniyle iliyosakral vida sabitleme uygulanan 16 hastanın (10 erkek, 6 kadın; ort. yaş 35 yıl; dağılım, 20-57 yıl) klinik dosyaları ve görüntüleri retrospektif olarak incelendi. Hastaların ameliyat öncesi tomografi görüntüleri kullanılarak pelvik haritalama yapıldı ve uygun vida giriş noktası ve yönelimi belirlendi. Tüm hastaların ameliyat sonrası bilgisayarlı tomografi taramaları alındı ve bunlar vida pozisyonunun doğruluğunu değerlendirmek için kullanıldı. Bulgular: Ameliyat sırasında herhangi bir komplikasyon gelişmedi. Vidaların giriş noktaları ve yönelimleri ameliyat öncesi ve sonrasında tüm hastalar için uyumluydu. Sonuç: Pelvisin haritalanması, iliyosakral vidalamanın ameliyat öncesi planlamasında kullanılabilecek bir yöntemdir.Anahtar sözcükler: İliyosakral vida sabitleme, haritalama yöntemi, pelvik kırığı, perkütanöz sabitleme, sakroiliyak eklem. ABSTRACTObjectives: This study aims to investigate if pelvic mapping is applicable in iliosacral screw fixation to determine screw entry point and screw trajectory. Patients and methods: Clinical files and images of 16 patients (10 males, 6 females; mean age 35 years; range, 20 to 57 years) who underwent iliosacral screw fixation due to sacroiliac joint injury and sacrum fracture were retrospectively reviewed. Pelvic mapping was performed using preoperative tomography images of the patients and appropriate screw entry point and trajectory were determined. Postoperative computed tomography scans of all patients were obtained and these were used to evaluate the accuracy of the screw position. Results: No intraoperative complications occurred. The entry points and trajectory of the screws were compatible for all patients pre-and postoperatively. Conclusion: Mapping of the pelvis is a method that can be used for preoperative planning of iliosacral screwing.

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CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

Cited by 50 publications

References 31 publications

Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation

Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation

Three-dimensional printing simulated operation combined with robot-aided minimally invasive lumbopelvic fixation in treatment of unstable bilateral sacral fractures: technical notes and 8 case series

Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory?

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