Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis

Zwingmann, J.; Hauschild, Oliver; Bode, Gerrit; Südkamp, Norbert P.; Schmal, Hagen

doi:10.1007/s00402-013-1788-4

Cited by 137 publications

(100 citation statements)

References 33 publications

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“…Nowadays preoperative CT imaging is mandatory for injury-classification and surgicalplanning [7,18,23]. As shown in a recently published metaanalysis, 2D-and 3D-CAS ameliorated the surgical results in UPPRI but is still associated with a significant higher rate of screw malposition (1.3%) compared to CT-navigated SPSP (0.01%) (p < 0.0001) [14]. UPPRI-patients of our cohort were operated by the use of a new-generation CT-scanners which allows not only a fluoroscopic reduction and screw-control but also a reduction of radiation dose not only for the patient but also for the operating-team.…”

Section: Discussionmentioning

confidence: 88%

“…CTG-SPSP concurs with other techniques concerning the correct screw placement [14]. Nevertheless, UPPRI-patients operated by CAS compared to those treated by the use of CBF had a better sacroiliac-screw-position [7,14].…”

Section: Accuracy Of Screw Placementmentioning

confidence: 84%

“…General aspects of CTG-SPSP SPSP for stabilisation of UPPRI is progressively applied [5][6][7][8][11][12][13][14]18]. Nevertheless, appropriate reduction of the injury is mandatory before percutaneous fixation.…”

Section: Discussionmentioning

confidence: 99%

“…However, data regarding modern fluoroscopic CT-guided sacroiliac percutaneous screw placement (CTG-SPSP) are limited [8][9][10][11][12][13][14]. To our knowledge, a precise determination of screw placement in relation to the sacral bone including the neuroforamen is not available.…”

mentioning

confidence: 91%

See 3 more Smart Citations

CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

Pieske

Landersdorfer²,

Trumm³

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 88%

Section: Accuracy Of Screw Placementmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 91%

See 2 more Smart Citations

CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

Pieske

Landersdorfer²,

Trumm³

et al. 2015

Injury

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“…In non-dysmorphic sacra, the direction of the iliosacral screw can be transverse (in the coronal plane) and horizontal (35 (38). Accuracy is the highest when using 2D-or 3D-image based navigation, but this procedure needs the availability of an expensive navigation system in the operation theatre (39,40).…”

Section: Introductionmentioning

confidence: 99%

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Rommens¹,

Wagner²,

Hofmann³

2017

chr

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RezumatIncidenţa fracturilor de fragilitate ale pelvisului creşte rapid. Caracteristicile acestor fracturi sunt diferite de întreruperile de inel pelvin la adulţi. Fracturile de fragilitate pelviene sunt consecinţa unei traume de mică energie la pacienţi cu scădere importantă a densităţii minerale osoase. Ca urmare a unui model persistent de alterare a distribuţiei masei osoase la nivelul sacrumului, apar alte morfologii de fracturi osoase decât în cazul adulţilor tineri. Simptomul principal este durerea imobilizantă la nivel lombar, fesier, în regiunile inghinală şi/sau a simfizei pubiene. Imaginile radiologice convenţionale şi computerul tomograf vor revela prezenţa şi localizarea fracturilor la nivelul inelului pelvin anterior şi posterior. O nouă clasificare cuprinzătoare distinge 4 categorii de instabilitate. Primul criteriu este cel mai important, deoarece indică şi tipul de tratament preferenţial. Cel de-al doilea criteriu, care determină subtipurile celor patru categorii, este localizarea instabilităţii la nivelul inelului pelvin posterior. Acest criteriu indică tipul de procedură chirurgicală ce trebuie efectuată. Atunci când este ales tratamentul chirurgical, procedura aleasă ar trebui să fie cât mai puţin invazivă cu putinţă. Au fost dezvoltate diverse tehnici percutane sau de fixare mai puţin invazivă a inelului pelvin posterior. Sunt prezentate avantajele şi limitările acestora -sacroplastie, osteosinteză ileosacrată cu şurub, plasare de ciment, fixare internă transiliacă, osteosinteză transsacrată, fixare lombopelvină. Fracturile inelului pelvin anterior necesită de

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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.

show abstract

Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis

Cited by 137 publications

References 33 publications

CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

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

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