Rate of intraoperative problems during sacroiliac screw removal: expect the unexpected

Abstract

Background The indications for sacroiliac screw (SI) removal have been under debate. Data on complication rates of SI screw removal is missing in the current literature. The objective of this study was to compare the rate of intra- and perioperative problems and complications during SI screw removal to those with SI screw fixation. Methods A retrospective observational study with two interventions in the same cohort was performed. Consecutive patients who underwent both sacroiliac screw fixation for an isolated fracture of the pelvic ring and removal of the same implants between November 2008 and September 2015 ( n = 19; age 57.3, SD 16.1 years) were included. Intraoperative technical problems, postoperative complications, duration of surgery, and radiation dose were analysed. Results Intraoperative technical problems occurred in 1/19 patients (5%) during SI screw fixation and in 7/19 cases (37%) during SI screw removal ( p = .021). Postoperative complications were seen in 3/19 patients after SI screw fixation and in 1/19 patients after SI screw removal ( p = 0.128). The surgical time needed per screw was longer for screw removal than for implantation ( p = .005). The amount of radiation used for the whole intervention ( p = .845) and per screw ( p = .845) did not differ among the two interventions. Conclusions Intraoperative technical problems were more frequent with SI screw removal than with SI screw fixation. Most of the intraoperative technical problems in this study were implant-related. They resulted in more surgical time needed per screw removed but similar radiation time.

Evaluation of Cannulated Compression Headless Screw (CCHS) as an alternative implant in comparison to standard S1-S2 screw fixation of the posterior pelvis ring: a biomechanical study

“…A complete IR may be necessary in the event of suspected infection or metal allergies, as well as in case of unexplained pain and/or explicit patient request. The aspect of removing the washer – "the Washer problem" – has already been described in the literature [ 15 , 16 ]. To combat these issues, an endoscopic SI IR approach was introduced in order to minimalize radiation exposure and soft tissue trauma [ 38 ].…”

“…The recovery of the washer can be the most difficult part of the procedure and may be the most time consuming aspect of an IR surgery. It has been described as challenging and as the aspect being most prone to problems [ 15 , 16 ]. Considering these adverse observations, alternative screw designs avoiding the use of a washer could be of benefit.…”

Results of minimally invasive quick definitive fixation of unstable bony pelvic disruption by combined retrosacral transiliac rods and anterior external fixator during a critical national period

“…Methods to accurately identify a specific entry point and aiming point for ideal screw position in each sacrum (perpendicular to SI joint) to avoid screw misplacement, reduce the operating time and radiation exposure have not been described yet. [19][20][21][22][23][24][25][26] In our study, the sacral bars were placed behind the sacrum away from the sacral nerve roots in a short operative time even in cases of sacral dysmorphism with minimal radiation exposure and the ability to do the technique in the emergency setting.…”

Is a Washer a Mandatory Component in Young Trauma Patients with S1-S2 Iliosacral Screw Fixation of Posterior Pelvis Ring Injuries? A Biomechanical Study

“…Some authors even recommend implant removal routinely [ 8 , 15 ]. Due to the difficulty and proneness to intraoperative problems, the retrieval of the washer can be the most demanding part of the surgery and constitute the longest part of the surgery [ 16 , 17 ]. Therefore, Oberst et al suggested an endoscopic IR in order to reduce x-ray exposure and soft tissue damage [ 18 ].…”