Posterior pelvic ring fractures: Closed reduction and percutaneous CT-guided sacroiliac screw fixation

Jacob, Augustinus Ludwig; Messmer, Peter; Stock, K W; Suhm, Norbert; Baumann, Bernard; Regazzoni, P.; Steinbrich, W.

doi:10.1007/s002709900153

Cited by 73 publications

(37 citation statements)

References 12 publications

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“…Comparable results have been published previously [5,9]. Previous studies reported screw malpositioning rates of 3-17% [5,8,16,19,23] and nerval lesions in 0-8% [5,8,14,16,19,23].…”

Section: Discussionsupporting

confidence: 78%

“…Fracture and vertical displacement were determined and classiWed as previously described by Nelson and Duwelius [13]. Fracture displacement was deWned as the widest distance between the fragments when measured perpendicular to the fracture line [9]. Vertical displacement was deWned as the vertical dislocation of the cranial auricular face of the ilium.…”

Section: Methodsmentioning

confidence: 99%

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Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

Osterhoff

Ossendorf

Wanner

et al. 2010

Arch Orthop Trauma Surg

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Objective Percutaneous iliosacral screw placement allows for minimally invasive Wxation of posterior pelvic ring instabilities. The objective of this study was to describe the technique for screws in S1 and S2 using conventional C-arm and to evaluate perioperative complications. Methods Thirty-eight consecutive patients after percutaneous pelvic ring Wxation with cannulated screws in S1 and S2 using conventional C-arm Xuoroscopy were analysed. Accuracy of screw placement, nerval lesions, need for second surgery, operation time, and time to full weight bearing were assessed postoperatively and during regular follow-up examinations. Results Twenty-one patients underwent unilateral screw Wxation and 17 patients underwent bilateral screw Wxation. In total, 83 screws were placed. Mean age of the patients was 52 § 19 years. Mean operation time was 16 § 7 min/ screw. Mean follow-up was 5 § 3 months. Time to full weight bearing in 28 patients was 9 § 4 weeks. Eight patients were still not able to support full weight bearing, partially due to concomitant injuries. Patients without concomitant injuries that aVected walking were able to bear full weight after 8 § 4 weeks (n = 17). Two patients had persistent postoperative hypaesthesia. No motor weakness was apparent and no postoperative bleeding was observed. Secondary surgery due to screw malpositioning or loosening had to be performed in four patients. The presence of a screw in S2 was not indicated for perioperative complications. Conclusions Percutaneous iliosacral screw Wxation is a rapid and deWnitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm Xuoroscopy was also found to be safe for screws placed in S2.

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“…Comparable results have been published previously [5,9]. Previous studies reported screw malpositioning rates of 3-17% [5,8,16,19,23] and nerval lesions in 0-8% [5,8,14,16,19,23].…”

Section: Discussionsupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

Osterhoff

Ossendorf

Wanner

et al. 2010

Arch Orthop Trauma Surg

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“…23 minutes for unilateral and 35 minutes for bilateral screw placements correspond to the results of other studies [20,21,24]. The time needed is probably less for experienced staff as 40 % of the unilateral screw placements took less than 20 minutes.…”

Section: Time Requiredsupporting

confidence: 65%

CT-Guided Screw Fixation of Vertical Sacral Fractures in Local Anaesthesia Using a Standard CT

Reuther

Röhner

Will

et al. 2014

Fortschr Röntgenstr

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Purpose: To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Material and Methods: Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. Results: A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1,?10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14???52 minutes) and 35 minutes (range: 21???60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy???cm (range: 162???1014 mGy???cm) for the unilateral and 470mGy???cm (range: 270???1271 mGy???cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7?%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). Conclusion: CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention. Key Points: ??Sacral fractures are frequent in the elderly and are often only detected in CT or MRI. ??CT-guided screw placement is a precise and time-efficient procedure in non-dislocated vertical fractures of the sacral wings. ??Contralateral stress fractures may occur after unilateral screw placements. Citation Format: ??Reuther G, R?hner U, Will T et?al. CT-Guided Screw Fixation of Vertical Sacral Fractures in Local Anaesthesia Using a Standard CT . Fortschr R?ntgenstr 2014; 186: 1???6

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“…[17,18] İliosakral çıkığın perkütan vida stabilizasyonunda kaynamama oranı %7'ye kadar çıkmaktadır. [19][20][21][22] İhmal edilmiş pelvik kırık olgularında uzun dönem sonuçları genellikle başarısızdır. Hastaların çoğunda tam iyileşme ve ağrısız ambulasyon sağlanamamaktadır.…”

Section: Tedavi̇unclassified

Pelvis ve asetabulum kırıklarında kaynamama

Şahin¹,

Alemdaroğlu²

2017

TOTBID

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Posterior pelvic ring fractures: Closed reduction and percutaneous CT-guided sacroiliac screw fixation

Cited by 73 publications

References 12 publications

Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

CT-Guided Screw Fixation of Vertical Sacral Fractures in Local Anaesthesia Using a Standard CT

Pelvis ve asetabulum kırıklarında kaynamama

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