Fluoroscopic iliosacral screw placement made safe

Gusić, Nadomir; Grgorinić, Igor; Fedel, I.; Lemac, Domagoj; Bukvić, Nado; Gusic, Matko; Cicvarić, Tedi; Lovrić, Zvonimir

doi:10.1016/s0020-1383(17)30744-1

Cited by 9 publications

(13 citation statements)

References 19 publications

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“…Iliosacral screw placement is regarded as a challenging procedure with the risk of damaging neurological and/or vascular structures. Several technologies have been developed to enhance the accuracy of iliosacral screw placement: planning tools [ 15 , 26 , 32 , 33 ], 3D-fluoroscopic navigation [ 34 ], CT-based navigation [ 35 , 36 ] and robot-assisted navigation [ 37 ]. Several authors comparing 2D-fluoroscopy with computer navigation prefer the navigation techniques, although screw perforations have been documented between 0 and 22.6% with the navigation technique [ 36 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Rommens

Nolte

Hopf

et al. 2020

Eur J Trauma Emerg Surg

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Introduction Iliosacral screw osteosynthesis is a well-accepted procedure for stabilization of sacral fractures and iliosacral (fracture) dislocations. Materials and Methods In this monocentric study, safety and efficacy of conventional 2D-fluoroscopic-guided iliosacral screw insertion were evaluated. Results During a 10-year period (2005-2014), 98 patients between the age of 18 and 65 years received 207 iliosacral screws in 101 procedures. Average patient age was 43.2 years. There were 46 Type B and 40 Type C injuries in the AO/OTA classification, nine patients had a fragility fracture of the pelvis. In three patients, primary radiological data were missing. The indication for surgical treatment was a sacral fracture in 97 patients, a pure iliosacral dislocation in 37 patients and a fracturedislocation in 31 patients. 70 procedures were performed with the patient in supine position, 31 with the patient in prone position. Surgery was done in a minimal-invasive technique in 76 patients, in 22 patients an open reduction was necessary before screw insertion. 81 patients received a unilateral, 17 patients a bilateral screw osteosynthesis. 199 screws were inserted in S1, only eight screws in S2. 65 patients received two screws unilaterally, ten patients two screws bilaterally. There were no vascular or neurologic complications. During in-hospital stay, there were seven complications, which needed 12 operative revisions: three wound infections, two hematomas, one screw malalignment and one early screw loosening. In 28 patients with 56 iliosacral screws, a pelvic CT-scan was performed during follow-up. A penetration of a cortical layer was diagnosed in 20 of these screws. All penetrations were seen in double screw osteosynthesis of S1. In none of the patients, complaints could be explained by the malalignment of these screws. Five operative revisions were performed during follow-up: two for screw loosening, two for fracture healing problems and one for screw malalignment. Metal removal was performed in 39 patients with 75 screws. 2D-fluoroscopic-guided iliosacral screw osteosynthesis is a safe and efficient procedure in clinical practice. Discussion A thorough preoperative evaluation of the morphology of the upper sacrum and careful operative procedure are indispensable. Fluoroscopic views in AP, lateral, inlet and outlet must allow recognition of all anatomical landmarks. The indication for double screw osteosynthesis in S1 should be taken with caution. Screw malalignments do not inevitably correlate with complaints.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Rommens

Nolte

Hopf

et al. 2020

Eur J Trauma Emerg Surg

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“…ey suggested that two different inlet views, inlet anterior and inlet posterior, should be used separately because of the sacrum's conical shape and to evaluate the sacrum's body's borders [19] . Gusic et al [9] analyzed 30 pelvic CT scans from individuals of all ages and genders at random and reported that the average angles required to obtain appropriate intraoperative inlet and outlet views were 22.3° (range 10.4-39.8°) and 42.3° (range 31.5-53.1°), respectively. Ricci et al [22] recommended that the accurate angle for inlet view was 25° when it was 60° for outlet views.…”

Section: Discussionmentioning

confidence: 99%

“…Gusic et al . [ 9 ] analyzed 30 pelvic CT scans from individuals of all ages and genders at random and reported that the average angles required to obtain appropriate intraoperative inlet and outlet views were 22.3° (range 10.4–39.8°) and 42.3° (range 31.5–53.1°), respectively. Ricci et al .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous iliosacral screw insertion with only outlet and inlet fluoroscopic view for unstable pelvic ring injuries: Clinical and radiological outcomes

Zarei

Moosavi

Saghebdoust

et al. 2022

Surgical Neurology International

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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.

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“…The complex 3D anatomy of the pelvic structures varies between individuals 8,9 . In the current literature, there are many studies investigating the optimal inlet and outlet view angles, which required for the accurate placement of iliosacral screws in first sacral vertebrae (S1) using fluoroscopy or two‐dimensional computed tomography images 1,6,8,9,11–13 . Although, the studies, that investigate the inlet and outlet view angles for the accurate placement of S1 iliosacral screws, using 3D native anatomical models are limited 7 .…”

Section: Introductionmentioning

confidence: 99%

“…The main aim of these studies is to obtain the optimal fluoroscopic inlet and outlet angles to ensure the appropriate placement of iliosacral screws not to endanger the neurovascular structures and to reduce the amount of radiation, to which the surgeon is exposed 14–16 . According to the results of these studies, the different mean inlet and outlet view angles of S1 were determined to view the correct placement of iliosacral screw 4,5,7,11–13,17 …”

Section: Introductionmentioning

confidence: 99%

Mean S1 inlet and outlet view angles are not safe for all individuals according to three‐dimensional tomographic measurements

Tanoğlu,

Gökgöz,

Subaşı

et al. 2023

Journal Orthopaedic Research

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Although there are many studies evaluating optimal inlet and outlet angles required for the correct placement of S1 iliosacral screws, there is no study evaluating reliability and feasibility of these angles for all individuals on three‐dimensional (3D) anatomical models. A total of 100 women and 100 men were selected randomly. A vertical line was created according to long axis of the tomography device on which patient was lying in supine position. The automatized best‐fit planes were created on superior and inferior endplates, anterior cortex including notch region and posterior cortex of first sacral vertebrae using 3D imaging software to measure mean inlet and outlet angles. We observed no statistically significant difference between gender groups in terms of inlet and outlet angles. Mean inlet view is obtained for anterior cortex of S1 in 22.5 ± 9.5° and for posterior cortex in 46.5 ± 9.3°. Mean fluoroscopic view angle of S1 for superior outlet is 40.3 ± 7.6 and for inferior outlet is 46.9 ± 8.8. Mean anterior and posterior S1 inlet view angles do not accurately visualize anterior cortex of 74 (37%) and posterior cortex of 66 (33%) individuals. Mean superior and inferior S1 outlet view angles do not accurately visualize superior endplate of 74 (37%) and inferior endplate of 56 (28%) individuals. Due to individual alterations of spatial position of sacrum, mean inlet and outlet view angles of S1 are not sufficient to visualize the iliosacral screws under fluoroscopy in many individuals.

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Fluoroscopic iliosacral screw placement made safe

Cited by 9 publications

References 19 publications

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study

Percutaneous iliosacral screw insertion with only outlet and inlet fluoroscopic view for unstable pelvic ring injuries: Clinical and radiological outcomes

Mean S1 inlet and outlet view angles are not safe for all individuals according to three‐dimensional tomographic measurements

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