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Percutaneous Iliosacral Screw Insertion With Only Outlet and Inlet Fluoroscopic View for Unstable Pelvic Ring Injuries: Clinical and Radiological Outcomes Publisher



Zarei M1 ; Saghebdoust S3 ; Shafizadeh M2 ; Rostami M2, 4
Authors
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Authors Affiliations
  1. 1. Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Surgical Neurology International Published:2022


Abstract

Background: Percutaneous iliosacral screw fixation in posterior pelvic ring fractures is challenging and commonly performed under fluoroscopy or navigation techniques. This study aimed to assess the safety and efficacy of percutaneous iliosacral screw implantation under fluoroscopy guidance with only inlet and outlet views. Methods: This retrospective study included 58 consecutive unstable posterior pelvic injury patients (36 sacral fractures and 22 sacroiliac joint disruptions) treated with percutaneous iliosacral screws between January 2015 and November 2019. Acceptable inlet radiographs show the anterior cortex of the S1 body superimposed on the S2 body. Acceptable outlet radiographs show the superior pubic symphysis at the level of the S2 foramen and visualize the S1 and S2 sacral foramina. In our technique, the screw was inserted at the inferior half of the outlet view and the posterior half of the inlet view. The time needed for screw insertion and the radiation exposure time was recorded. Intra and postoperative complications were documented. Postoperative computed tomography (CT) scans assessed screw position. Results: In total, 69 iliosacral screws were inserted in 58 patients. In postoperative CT scans, the screw position was assessed, 89.8% were in a secure position, and 10.2% had malposition. The mean operation time per screw was 21.18 min and the mean fluoroscopy time per screw was 112 s. There was no evidence of wound infection or iatrogenic neurovascular injury. No reoperation was performed. Conclusion: Percutaneous iliosacral screws can be placed using the only outlet and inlet fluoroscopic views with comparable radiological and clinical outcomes to the conventional method. ©2022 Published by Scientific Scholar on behalf of Surgical Neurology International.