Proximity of Iliosacral Screws to Neurovascular Structures After Internal Fixation

Templeman, David C.; Schmidt, Andrew H.; Freese, J.; Weisman, I. D.

doi:10.1097/00003086-199608000-00023

Cited by 198 publications

(100 citation statements)

References 10 publications

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“…All infections occurred during the first 4 weeks postoperatively in patients who required long-term invasive ventilation. The risk of neurologic injury after positioning of sacroiliac screws has been reported between less than 1% and as much as 8% [12,36], and in a study of 101 patients using either ORIF with plate osteosynthesis or iliosacral screws, one L5 nerve root lesion occurred [22]. We identified no case of neurovascular damage in our 62 patients.…”

Section: Discussionmentioning

confidence: 53%

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Open reduction and stabilization of dorsal pelvic ring injuries is accompanied by a high rate of soft tissue complications. Minimally invasive techniques have the potential to decrease soft tissue trauma, but the risk of iatrogenic nerve and vessel damage through the reduced surgical exposure should be considered. We treated these injuries using a transiliac internal fixator (TIFI) in a minimally invasive technique characterized by implantation of a pedicle screw and rod system, bridging the sacroiliac joints and the sacral area. Questions/purposes We asked whether (1) we could achieve anatomic restoration with the device, (2) specific complications were associated with this minimally invasive approach (particularly enhanced intraoperative blood loss, soft tissue complications, and iatrogenic neurovascular damage), and (3) function 3 years after trauma was comparable to that of established methods. Methods We retrospectively reviewed 67 patients with dorsal pelvic injuries during a 7-year period. We evaluated the (1) reduction by grading the maximal displacement measured with three radiographic views, (2) the complications during the observation period, and (3) the function with a validated questionnaire (Pelvic Outcome Score) in all but five patients at least 3 years after trauma (mean, 37 months; range, 36-42 months). Results At last followup we observed a secondary fracture displacement greater than 5 mm in one patient. The intraoperative blood loss was less than 50 mL in all patients. No neurovascular lesions occurred owing to implantation. Four patients had wound infections, one had loosening of a single pedicle screw, and one had an iatrogenic screw malpositioning. Thirty-five of the 62 patients achieved Pelvic Outcome Scores of either a maximum score or 6 of 7 points. Conclusion Our observations suggest TIFI is a reasonable alternative to other established fixation devices for injuries of the dorsal pelvic ring with minor risks of major blood loss or iatrogenic neurovascular damage.

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Section: Discussionmentioning

confidence: 53%

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…This is due not only to the high anatomical variability of the sacrum, but-in obese patients, in particular-fluoroscopic guidance is difficult and associated with a high risk of sacral nerve damage. Malpositioning of the screw by as little as 4°can cause damage to neurovascular structures [23], which is reported to be as high as 7.7% [7]. Although the incidence of malpositioned SI screws may be reduced by navigated screw insertion, this technique is still associated with misplaced screws in 1.8% of cases [9,31].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

Kobbe

Hockertz

Sellei³

et al. 2011

International Orthopaedics (SICOT)

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Purpose Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic-ring injuries; however, this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. This study evaluates whether minimally invasive transiliac locked compression plate stabilisation may be an alternative to sacroiliac screw fixation in unstable posterior pelvic-ring injuries. Methods We performed a retrospective analysis of patients with unstable pelvic-ring injuries treated with a transiliac locked compression plate at a level I trauma centre. Outcome evaluation was assessed using the Pelvic Outcome Score and analysis of complications, intraoperative fluoroscopic time, and duration of the surgical procedure. Results Twenty-one patients were available for follow-up after an average of 30 months. The main findings were as follows: Overall outcome for the Pelvic Outcome Score was excellent in 47.6% (ten patients), good in 19% (four patients), fair in 28.6% (six patients), and poor in 4.8% (one patient). Average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 s. No iatrogenic neurovascular injuries were observed. Conclusion Minimally invasive transiliac locked compression plate stabilisation may be a good alternative to sacral screw fixation because it is quick, safe and associated with a good functional outcome.

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“…Ebraheim et al [9] suggested placement of one screw through the S1 pedicle into the vertebral body is safer, whereas others recommended placement of two screws [5,8,28]. In our treatment algorithm, we used only one screw in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Screw malposition rates with fluoroscopic guidance have been reported to range from 2% to 15% [13,28], with an incidence of neurologic injury between 0.5% and 7.7% [32]. Malposition of the screw by as little as 4°can cause damage to neurovascular structures [28].…”

Section: Introductionmentioning

confidence: 99%

Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Zwingmann¹,

Konrad²,

Kotter³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

150

110

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Insertion of percutaneous iliosacral screws with fluoroscopic guidance is associated with a relatively high screw malposition rate and long radiation exposure. We asked whether radiation exposure was reduced and screw position improved in patients having percutaneous iliosacral screw insertion using computer-assisted navigation compared with patients having conventional fluoroscopic screw placement. We inserted 26 screws in 24 patients using the navigation system and 35 screws in 32 patients using the conventional fluoroscopic technique. Two subgroups were analyzed, one in which only one iliosacral screw was placed and another with additional use of an external fixator. We determined screw positions by computed tomography and compared operation time, radiation exposure, and screw position. We observed no difference in operative times. Radiation exposure was reduced for the patients and operating room personnel with computer assistance. The postoperative computed tomography scan showed better screw position and fewer malpositioned screws in the three-dimensional navigated groups. Computer navigation reduced malposition rate and radiation exposure. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Proximity of Iliosacral Screws to Neurovascular Structures After Internal Fixation

Cited by 198 publications

References 10 publications

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

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