Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-06-2011 | Trauma Surgery

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

Authors: Georg Osterhoff, Christian Ossendorf, Guido A. Wanner, Hans-Peter Simmen, Clément M. L. Werner

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2011

Abstract

Objective

Percutaneous iliosacral screw placement allows for minimally invasive fixation 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 fixation with cannulated screws in S1 and S2 using conventional C-arm fluoroscopy 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 fixation and 17 patients underwent bilateral screw fixation. 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 affected 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 fixation is a rapid and definitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm fluoroscopy was also found to be safe for screws placed in S2.

Briem D, Rueger J, Begemann P et al (2006) Computerassistierte Verschraubung des hinteren Beckenrings. Unfallchirurg 109(8):640–646PubMedCrossRef

Briem D, Windolf J, Rueger JM (2007) Perkutane, 2D-fluoroskopisch navigierte Sakrumverschraubung in Rückenlage. Der Unfallchirurg 110(5):393–401PubMedCrossRef

Farrell EDMD, Gardner MJMD, Krieg JCMD, Chip Routt MLJMD (2009) The upper sacral nerve root tunnel: an anatomic and clinical study. J Orthop Trauma 23(5):333–339PubMedCrossRef

Furey AJMDF, O’Toole RVMD, Nascone JWMD, Sciadini MFMD, Copeland CEMD, Turen CMD (2009) Classification of pelvic fractures: analysis of inter and intraobserver variability using the Young-Burgess and Tile classification systems. Orthopedics 32(6):401–406PubMedCrossRef

Gänsslen A, Hüfner T, Krettek C (2006) Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper Orthop Traumatol 18(3):225–244PubMedCrossRef

Gautier E, Bächler R, Heini PF, Nolte LP (2001) Accuracy of computer-guided screw fixation of the sacroiliac joint. Clin Orthop Relat Res 393:310–317PubMedCrossRef

Gunterberg B, Goldie I, Slätis P (1978) Fixation of pelvic fractures and dislocations. An experimental study on the loading of pelvic fractures and sacro iliac dislocations after external compression fixation. Acta Orthop Scand 49(3):278–286PubMedCrossRef

Hilgert RE, Finn J, Egbers HJ (2005) [Technique for percutaneous iliosacral screw insertion with conventional C-arm radiography]. Unfallchirurg 108(11):954, 956–960CrossRef

Jacob AL, Messmer P, Stock KW et al (1997) Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 20(4):285–294PubMedCrossRef

10.

Josten C, Schildhauer TA, Muhr G (1994) [Therapy of unstable sacrum fractures in pelvic ring. Results of of osteosynthesis with early mobilization]. Chirurg 65(11):970–975PubMed

11.

Käch K, Trentz O (1994) [Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis]. Unfallchirurg 97(1):28–38PubMed

12.

Koo HMDF, Leveridge MMD, Thompson CMD et al (2008) Interobserver reliability of the Young-Burgess and Tile classification systems for fractures of the pelvic ring. J Orthop Trauma 22(6):379–384PubMedCrossRef

13.

Nelson DW, Duwelius PJ (1991) CT-guided fixation of sacral fractures and sacroiliac joint disruptions. Radiology 180(2):527–532PubMed

14.

Peng KT, Huang KC, Chen MC, Li YY, Hsu RW (2006) Percutaneous placement of iliosacral screws for unstable pelvic ring injuries: comparison between one and two C-arm fluoroscopic techniques. J Trauma 60(3):602–608PubMedCrossRef

15.

Routt ML Jr (2006) Posterior pelvic-ring disruptions: iliosacral screws. In: Wiss DA (ed) Fractures. Lippincott Williams & Wilkins, Philadelphia, pp 649–667

16.

Routt ML Jr, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 11(8):584–589PubMedCrossRef

17.

Schep NW, Haverlag R, van Vugt AB (2004) Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain. J Trauma 57(6):1299–1302PubMedCrossRef

18.

Schildhauer TA, Josten C, Muhr G (2006) Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma 20(1 Suppl):S44–S51PubMed

19.

Schweitzer D, Zylberberg A, Cordova M, Gonzalez J (2008) Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury 39(8):869–874PubMedCrossRef

20.

Smith HEMD, Yuan PSMD, Sasso RMD, Papadopolous SMD, Vaccaro ARMD (2006) An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine 31(2):234–238PubMedCrossRef

21.

Suzuki T, Hak DJ, Ziran BH et al (2009) Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury 40(4):405–409PubMedCrossRef

22.

Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12PubMed

23.

van den Bosch EWMD, van Zwienen CMAMD, van Vugt ABMD (2002) Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma 53(1):44–48PubMedCrossRef

24.

van Zwienen CMAM, van den Bosch EWMDP, Snijders CJP, Kleinrensink GJP, van Vugt ABMDP (2004) Biomechanical comparison of sacroiliac screw techniques for unstable pelvic ring fractures. J Orthop Trauma 18(9):589–595PubMedCrossRef

25.

Yinger K, Scalise J, Olson SA, Bay BK, Finkemeier CG (2003) Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma 17(7):481–487PubMedCrossRef

26.

Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160(2):445–451PubMed

27.

Zwingmann J, Konrad G, Kotter E, Sudkamp NP, Oberst M (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 467(7):1833–1838PubMedCrossRef

Title: Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications
Authors: Georg Osterhoff
Christian Ossendorf
Guido A. Wanner
Hans-Peter Simmen
Clément M. L. Werner
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2011
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-010-1230-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2011

Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis

Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique

A triangular support screw improves stability for lateral locking plates in proximal tibial fractures with metaphyseal comminution: a biomechanical analysis

Effects of low-energy NMR on posttraumatic osteoarthritis: observations in a rabbit model

Percutaneous endoscopic lumbar discectomy and interbody fusion with B-Twin expandable spinal spacer

Newcastle approach to the elbow, a cadaveric study