CT-guided percutaneous sacroiliac stabilization in unstable pelvic fractures: a safe and accurate technique

Abstract

ObjectiveThe use of open reduction and internal fixation (ORIF) for unstable pelvic injuries is associated with extensive blood loss, iatrogenic neurovascular injury, and infection. Moreover, the placement of sacroiliac (SI) screws is a blinded procedure, guided primarily by palpation and two-dimensional radiological screening, which demands expertise. The complex three-dimensional anatomy of SI joint and its proximity to neurovascular structure require a safe and precise technique. Computed tomography (CT)-guided SI joint stabilization allows an accurate intra-operative assessment of screw placement. This study demonstrated a technique of CT-guided closed reduction and screw fixation of the SI joint in unstable pelvic fractures.MethodsThis was a retrospective non-randomized cohort study conducted at a tertiary care hospital. Six patients with unstable pelvic fractures were operated; the anterior rim was stabilized first by ORIF with plate on the superior and anterior aspects of the pubic symphysis. Subsequently, the posterior stabilization was made percutaneously under CT guidance with a 7-mm cannulated cancellous screw.ResultsThe mean operative time was 48 min (35–90 min), the mean effective radiation dose was 9.32 (4.97–13.27), and the mean follow-up was 26 months (6–72 months). All patients had satisfactory healing, with near-anatomic reduction and no complications, except in one case where the plate broke at 61 months post surgery, but no intervention was required. The mean VAS score at the final follow-up was 1.8, and all patients returned to their original occupation without any limitations.ConclusionCT-guided SI joint stabilization offers many advantages, including safe and accurate screw placement, reduced operating time, decreased blood loss, early definitive fixation, immediate mobilization, and fewer infections and wound complications.

The Role of MRI and CT Scan in Classification and Management of Pelvic Fractures: A Systematic Review

“…Two articles were prospective [12,13]. 10 articles were retrospective [14][15][16][17][18][19][20][21][22][23].…”

“…ROBIN: ; DECT: Dual-energy CT; ED: Emergency department; FFP: Fresh frozen plasma; MDCT: Multidetector CT; PXR: Pelvis x-ray; SI: Sacro-iliac A single-stage CT scan considerably reduced the time to definitive pelvic fixation, was utilized to assess the presence or absence of internal organ injury or hemorrhage, and was integrated with 3D pictures to aid surgical planning [18][19][20]. In the emergency room, a pelvic X-ray may help diagnose severe pubic symphysis diastasis.…”

Design of Proposed Software System for Prediction of Iliosacral Screw Placement for Iliosacral Joint Injuries Based on X-ray and CT Images

“…CT-guided iliosacral fixation offers direct visualization of the screws, thus reducing the malposition of the screws and radiation dose. This procedure provides a precise geometry of fracture fragments and anatomical structures, allowing an accurate insertion [ 11 , 12 , 13 , 14 ].…”

Clinical Analysis of Single and Double Sacroiliac Screws in the Treatment of Tile C1 Pelvic Fracture

“…With the development of digital orthopedics, a variety of auxiliary screw placement technologies have emerged to enable precise sacroiliac screw placement. Gandhi et al demonstrated that CT-guided SI joint stabilization offers many advantages, including safe and accurate screw placement, reduced operating time, early definitive fixation, immediate mobilization, and fewer infections and wound complications [ 5 ]. Takeba et al also achieved satisfactory clinical results using O-arm-assisted nail placement technology [ 6 ].…”