S2 Iliosacral Screw Fixation for Disruptions of the Posterior Pelvic Ring: A Report of 49 Cases

2006 ◽  
Vol 20 (6) ◽  
pp. 378-383 ◽  
Author(s):  
Berton R. Moed ◽  
Benjamin L. Geer
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Iliosacral Screw Fixation

scholarly journals Comparison of Lumbopelvic Fixation and Iliosacral Screw Fixation for the Treatment of Bilateral Sacral Fractures

2021 ◽  
Author(s):  
Katharina E. Wenning ◽  
Emre Yilmaz ◽  
Thomas A. Schildhauer ◽  
Martin F. Hoffmann
Keyword(s):  
Operative Time ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Weight Bearing ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Sacral Fractures ◽  
Lumbopelvic Fixation ◽  
Pelvic Ring Injuries ◽  
Iliosacral Screw Fixation

Abstract Background: Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose: The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications, and postoperative mobilization. The secondary aim was to determine if demographics influence surgical treatment.Methods: Over a 4-year period (2016-2019) 188 consecutive patients with pelvic ring injuries were treated at one academic level-1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. 77 patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma, and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight-bearing was used as outcome variable. Follow-up was at least 6 months postoperatively.Results: Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Thereof, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p=0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (165 min vs. 73 min; respectively, p<0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p=0.008) but were all weight-bearing as tolerated when discharged (p<0.001). Conclusion: Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight-bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

scholarly journals Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Katharina E. Wenning ◽  
Emre Yilmaz ◽  
Thomas A. Schildhauer ◽  
Martin F. Hoffmann
Keyword(s):  
Operative Time ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Weight Bearing ◽  
Iliosacral Screw ◽  
Posterior Pelvic Ring ◽  
Sacral Fractures ◽  
Lumbopelvic Fixation ◽  
Pelvic Ring Injuries ◽  
Iliosacral Screw Fixation

Abstract Background Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications and postoperative mobilization. The secondary aim was to determine whether demographics influence surgical treatment. Methods Over a 4-year period (2016–2019), 188 consecutive patients with pelvic ring injuries were treated at one academic level 1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. Seventy-seven patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight bearing was used as outcome variable. Follow-up was at least 6 months postoperatively. Results Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Therefore, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p = 0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (73 min vs. 165 min; respectively, p < 0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p = 0.008) but were all weight bearing as tolerated when discharged (p < 0.001). Conclusion Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

scholarly journals Percutaneous iliosacral screw fixation for posterior pelvic ring injuries: the first experience, complicatons

2013 ◽  
Vol 12 (4) ◽  
pp. 233-237
Author(s):  
Valentinas Uvarovas ◽  
Andrius Vaitiekus ◽  
Igoris Šatkauskas ◽  
Donatas Ulevičius
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Operation Time ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Iliosacral Screw ◽  
Early Results ◽  
First Results ◽  
Group B ◽  
Iliosacral Screw Fixation

BackgroundPercutaneous iliosacral screw fixation is a minimally invasive technique for the treatment of unstable pelvic injuries involving the posterior ring. Nevertheless, screw malposition may result in dangerous complications involving injury to adjacent neurological structures. This study was conducted in order to evaluate the first results of using the percutaneous iliosacral screw technique at the Republican Vilnius University Hospital.ObjectiveTo report the early results and possible complications of percutaneous iliosacral screw fixation in the management of unstable pelvic ring injuries.MethodsThe data for the period 2011–2013 were collected retrospectively. Fifty-five patients who suffered from injury to the pelvic ring requiring surgical treatment were included in this study. Twenty-two operations were done using canulated screws(group A, 20 operations using 7.3 mm and 2 operations 8.3 mm screws), and 33 (group B) operations were done using noncanulated 6.5 mm screws. We compared our first results of using canulated and non-canulated screws. The data were analysedusing MS Exel.ResultsFrom the analysed 55 patients, 20 (36.4%) were men and 35 (63.6%) women; the average age of the patients was 51 (range, 21–98) years. According to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, there were 49 patients withtype B and 6 patients with type C. The mean operation time was 36 min (range, 10–115). Three patients from group B required reoperation because of a neurological injury. Two of these patients suffered from L5 neuropathy and one from S1 radiculalgy.The complication rate was 9.1 per cent in group B, and they were now complicationa in group B. Twelve patients underwent percutaneous iliosacral screw fixation and anterior fixation, one patient underwent percutaneous iliosacral conversion to open posterior SI fixation osteosynthesis because of neurological complications, while the other 43 patients underwent percutaneous screw fixation only.ConclusionsPercutaneous iliosacral screw fixation is a rapid, safe and definitive treatment for unstable pelvic ring injury. The technique using standard C-arm fluoroscopy may allow accurate location of the screw placed in S1 and result in fewer complications when using percutaneous canulated screws. Key words: percutaneous iliosacral fixation, canulated iliosacral screws, three-dimensional fluoroscopyPerkutaninė kryžkaulio klubikaulio sąnario fiksacija esant užpakalinio dubens žiedo sužalojimams: pirmoji patirtis, komplikacijos  Įvadas / tikslasPerkutaninė kryžkaulio klubakaulio sąnario fiksacija sraigtais yra minimaliai invazinis operacinio gydymo metodas nestabiliems užpakalinio dubens žiedo sužalojimams gydyti. Vis dėlto gretimos nervinės struktūros gali būti pažeistos dėl blogossraigto padėties. Mūsų darbo tikslas – įvertinti Respublikinės Vilniaus universitetinės ligoninės pirmuosius kryžkaulio klubikaulio sąnario operacinio gydymo perkutaninės fiksacijos būdu rezultatus ir nustatyti nestabilių dubens žiedo sužalojimųgydymo komplikacijų dažnį.MetodaiRetrospektyviai išanalizuoti 2011–2013 metais gydytų 55 pacientų duomenys. Atliktos 22 operacijos naudojant kaniuliuotus (A grupė, 20 operacijų naudojant 7,3 mm ir 2 operacijos 8,3 mm sraigtus) ir 33 (B grupė) – nekaniuliuotus 6,5 mm sraigtus.Palyginome pirmuosius operacinio gydymo kaniuliuotais ir nekaniuliuotais sraigtais rezultatus. Duomenys analizavome MS Exel programa.RezultataiOperuoti 55 pacientai, iš jų 20 (36,4 %) vyrų ir 35 (63,6 %) moterys. Tiriamųjų amžiaus vidurkis – 51 (21–98) metai. Pagal AO (Arbeitsgemeinschaft für Osteosynthesefragen) klasifikaciją buvo 49 pacientai. Trys B grupės (9,1 %) pacientai buvo peroperuoti dėl neurologinių komplikacijų (du pacientai dėl L5 neuropatijos ir vienas dėl S1 radikulialgijos). A grupės pacientams komplikacijų nebuvo. Dvylikai pacientų atlikta perkutaninė kryžkaulio klubakaulio sąnario fiksacija ir kartu priekinė fiksacija ir 43 pacientams – tik užpakalinė kryžkaulio klubakaulio sąnario fiksacija sraigtu.IšvadosPerkutaninė kryžkaulio klubakaulio sąnario fiksacija yra greitas, saugus ir galutinis nestabilių užpakalinio dubens žiedo sužalojimų operacinio gydymo metodas. Naudojant standartinį rentgeno C-lanką galima tiksliai lokalizuoti sraigto padėtį S1slankstelio lygyje. Naudojant kaniuliuotus sraigtus komplikacijų nepasitaikė, o naudojant nekaniuliuotus sraigtus galimos neurologinės komplikacijos.Reikšminiai žodžiai: perkutaninė kryžkaulio klubakaulio sąnario fiksacija, kaniuliuoti kryžkaulio klubakaulio sraigtai, trijų dimensijų fluoroskopija.

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