Closed Reduction and Percutaneous Skeletal Fixation of Sacral Fractures

Routt, Milton L; Simonian, Peter T.

doi:10.1097/00003086-199608000-00015

Cited by 202 publications

(32 citation statements)

References 12 publications

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“…The technique of percutaneous screw fixation used to fix the acetabular fracture was first described by Routt and Starr in the 1990s [13, 14]. In 2001, professor Starr introduced different kinds of techniques about the percutaneous screw fixation and firstly proposed the magic screw to fix the quadrilateral plate fractures [10].…”

Section: Discussionmentioning

confidence: 99%

“…Operation time will be extended while finding the ideal image and the entry point [18], especially when the standard fluoroscopic view was not established. Recording the position and the rotation angle of the C-arm fluoroscopy preoperatively can facilitate the percutaneous techniques and reduce radiation time [13, 14]. In clinical practice, we use adhesive bandage as the mark sticking on the ground.…”

Section: Discussionmentioning

confidence: 99%

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Establishment of fluoroscopy views and standardized procedure of percutaneous magic screw insertion for acetabulum fractures

Wang

et al. 2018

BMC Musculoskelet Disord

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BackgroundTo place the magic screw more simply, we established a set of reproducible fluoroscopic views and a standardized procedure of magic screw insertion.Materials and methodsThis study on the magic screw tunnel uses a three-dimensional reconstruction model and a skeleton projection. The 3D model of the pelvis was made to be transparent and it was rotated to the place where the ischial spine was just sheltered by the posterior wall of the acetabulum. The angles of this view projection were recorded in the transverse plane and coronal plane. Six cadaveric pelvises (three males, three female) were used to validate the proper projection angle of the C-arm fluoroscopy. The skeleton specimens were all positioned latericumbent on a radiolucent table.ResultIn all pelvis 3D models, all magic cylinders with a 7.3 mm diameter were successfully inserted along the bone structure tunnel in 30 3D pelvic models. The average angle of the transverse view rotated by the C-arm fluoroscopy was 162° in males and 157° in females, the angle of the coronal plane was 22° in males and 24° in females. The average distance between the front wheel of the C-arm machine and the middle axial line of the radiolucent bed was 43 cm in males and 43 cm in females. In skeleton pelvis research, all the screws were safely inserted using this method.ConclusionThe magic screw technique could be a good choice for the treatment of acetabular fractures, especially quadrilateral plate fractures. If the proper fluoroscopy view technique is used properly, the magic screw can be inserted rapidly and safely.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Establishment of fluoroscopy views and standardized procedure of percutaneous magic screw insertion for acetabulum fractures

Wang

et al. 2018

BMC Musculoskelet Disord

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“…While some surgeons advocate relying on computer-assisted and navigated systems, it is common to utilize inlet, outlet, and lateral fluoroscopic images to safely instrument the posterior pelvic ring [1, 2, 7, 12, 21–23]. Obtaining quality intraoperative fluoroscopic images remains incredibly important and being able to correctly interpret the radiographic landmarks of the pelvis and their relationship to anatomical structures is mandatory [7, 24, 25].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous iliosacral screw fixation of unstable posterior pelvic ring injuries has become a common successful treatment method [1–4]. In order to place iliosacral screws safely, a thorough understanding of the possible osseous fixation pathways is paramount [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Correlating preoperative imaging with intraoperative fluoroscopy in iliosacral screw placement

Eastman

Routt

2015

J Orthopaed Traumatol

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BackgroundPercutaneous iliosacral screw placement can successfully stabilize unstable posterior pelvic ring injuries. Intraoperative fluoroscopic imaging is a vital component needed in safely placing iliosacral screws. Obtaining and appropriately interpreting fluoroscopic views can be challenging in certain clinical scenarios. We report on a series of patients to demonstrate how preoperative computed tomography (CT) imaging can be used to anticipate the appropriate intraoperative inlet and outlet fluoroscopic views.Materials and methods24 patients were retrospectively identified with unstable pelvic ring injuries requiring operative fixation using percutaneous iliosacral screws. Utilizing the sagittal reconstructions of the preoperative CT scans, anticipated inlet and outlet angle measurements were calculated. The operative reports were reviewed to determine the angles used intraoperatively. Postoperative CT scans were reviewed for repeat measurements and to determine the location and safety of each screw.ResultsPreoperative CT scans showed an average inlet of 20.5° (7°–37°) and an average outlet of 42.8° (30°–59°). Intraoperative views showed an average inlet of 24.9° (12°–38°) and an average outlet of 42.4° (29°–52°). Postoperative CT scans showed an average inlet of 19.4° (8°–31°) and an average outlet of 43.2° (31°–56°). The average difference from preoperative to intraoperative was 4.4° (−21° to 5°) for the inlet and 0.45° (−9° to 7°) for the outlet. The average difference between the preoperative and postoperative CT was 2.04° (0°–6°) for the inlet and 2.54° (0°–7°) for the outlet.ConclusionThere is significant anatomic variation of the posterior pelvic ring. The preoperative CT sagittal reconstruction images allow for appropriate preoperative planning for anticipated intraoperative fluoroscopic inlet and outlet views within 5°. Having knowledge of the desired intraoperative views preoperatively prepares the surgeon, aids in efficiently obtaining correct intraoperative views, and ultimately assists in safe iliosacral screw placement.Level of evidenceIV, Retrospective case series.

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An anatomical study defining the safe range of angles in percutaneous iliosacral and transsacral screw fixation

2021

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Percutaneous iliosacral screw fixation and transsacral fixation are challenging procedures requiring extensive knowledge of sacral anatomy to avoid damaging nearby neurovascular structures. Greater knowledge of anatomical screw trajectory and size allowances would be helpful to guide surgical placement. An anatomical study of 40 cadaveric sacra in specimens ages 18–65 was performed. Three‐dimensional surface scans were obtained, and computer modeling software was used to simulate a 7.3 mm diameter screw with 1 mm buffer inserted orthogonal to the sacroiliac joint in the pelvic inlet and outlet views. Transsacral screws were also inserted into S1 and S2 vertebrae. For screws orthogonal to the sacroiliac joint, the overall mean screw insertion angle was 4.1° ± 7.5° (range, −18.3° to 22.0°) in the inlet view in the posterior to anterior direction, and 21.7° ± 5.1° (range, 8.2°–36.3°) in the outlet view in the caudal to cranial direction. Before breaching the sacrum, the range of sacral tunnel lengths was between 31.1 and 70.1 mm with a range of diameters between 9.3 and 13.3 mm. Transsacral screws inserted into either the S1 or S2 vertebrae did not breach the sacrum in 40% (16/40) at each level. 30% (12/40) of sacra could not safely accommodate both S1 and S2 transsacral screws. There is an initial screw insertion angle range of −4° to 12° in the inlet view and 16°–27° in the outlet view. There was always adequate size to accept a 7.3 mm or larger screw.

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Closed Reduction and Percutaneous Skeletal Fixation of Sacral Fractures

Cited by 202 publications

References 12 publications

Establishment of fluoroscopy views and standardized procedure of percutaneous magic screw insertion for acetabulum fractures

Establishment of fluoroscopy views and standardized procedure of percutaneous magic screw insertion for acetabulum fractures

Correlating preoperative imaging with intraoperative fluoroscopy in iliosacral screw placement

An anatomical study defining the safe range of angles in percutaneous iliosacral and transsacral screw fixation

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