Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum

Cai, Hongmin; Zhang, Ruipeng; Yin, Yingchao; Li, Junran; Hou, Zhiyong; Zhang, Yingze

doi:10.2106/jbjs.23.00397

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…During the progress of placing oblique sacroiliac screw in dysmorphic S1 segments, there will be no direct evidence that the implant has not damaged the S1 nerve root, unless non-standard lateral image of sacrum is applied 14 .…”

Section: Introductionmentioning

confidence: 99%

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

Zhao,

Liu,

Shen

et al. 2024

Preprint

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This article reviews the research progress of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury, reports one case of S1-S3 sacroiliac screws fixation for posterior pelvic ring injury with S1 sacral dysmorphism. The clinical data, preoperative preparation, surgical procedure, and postoperative outcomes of a patient with pelvic fracture who underwent treatment of 3 sacroiliac screws(S1-S3) fixation on August 07, 2023, at Weifang City People’s Hospital were summarized. The patient successfully underwent treatment of 3 sacroiliac screws(S1-S3) fixation. Postoperative X-rays and CT scans confirmed that all screws were in good position and located in the bone corridors. For patients with S1 sacral dysmorphism, the traditional S1 corridor is often difficult to place nails, while the S3 is an alternative corridor to easily place sacroiliac screw.

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Section: Introductionmentioning

confidence: 99%

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

Zhao,

Liu,

Shen

et al. 2024

Preprint

View full text Add to dashboard Cite

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Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum

Cai,

Yin,

Zhang

et al. 2024

Journal of Bone and Joint Surgery

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Background: Determining the proper iliosacral screw orientation in a dysmorphic S1 sacral segment using a C-arm is difficult, and pelvic computed tomography (CT) is often necessary for the preoperative planning. On the preoperative pelvic axial CT section, the intended screw trajectory can be delineated intraosseously along the axis of the oblique osseous corridor. An inherently accurate orientation would be determined by 2 factors: (1) the trajectory is in the pelvic transverse plane, and (2) it is oriented relative to the coronal plane at a patient-specific angle, which should be measured preoperatively. Based on the above reasoning, we aimed to simplify and verify the orientation. Methods: After establishing the starting point on the sacral lateral view, we tested a method of simplifying the guidewire orientation: placing the guidewire in the pelvic transverse plane and then manipulating it to be angled relative to the coronal plane at the preoperatively measured patient-specific angle. The guidewire orientation should then be reproducibly accurate on the pelvic outlet and inlet views. The feasibility and safety of our method were verified through computer-simulated virtual surgical procedures in 95 dysmorphic sacra and clinical surgical procedures in 12 patients. The primary outcome parameters were the guidewire orientation and screw placement accuracy. Results: Using our method, the S1 guidewire orientation was reproducibly accurate on the pelvic outlet and inlet views in all of the virtual and clinical surgical procedures. Ninety-five virtual S1 screws (1 screw in each left hemipelvis) were placed intraosseously in the pelvic transverse plane. Fourteen unilateral S1 screws were placed intraosseously in the pelvic transverse plane in the 12 patients (2 patients had double screws) without iatrogenic injuries. Conclusions: The guidewire orientation can be simplified by placing the guidewire in the pelvic transverse plane and replicating the preoperatively measured patient-specific angle between the guidewire and the coronal plane. After establishing the starting point on the sacral lateral view, our simplified manipulation yields a reproducibly accurate orientation on the pelvic outlet and inlet views. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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An investigation to the clinical application of personalized 3D printed guides combined with preoperative virtual iliosacral screws for the management of posterior pelvic ring injury

Zhao,

Liu,

Chen

et al. 2024

Preprint

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Purpose Percutaneous iliosacral screws are difficult to utilise to treat pelvic ring instability injuries, and they usually require navigational or fluoroscopic guidance. The goal of this study is to create a unique 3D-printed guide for iliosacral screw insertion during surgery and evaluate its effectiveness and safety. Methods The same group of surgeons did a retrospective examination of patients who received surgery for an unstable posterior pelvic ring injury at our hospital's trauma centre between January 2020 and May 2023, in accordance with the selection criteria. Patients were categorised into two groups: the conventional surgery (CS) group (n = 17) and the 3D guide plate (GP) group (n = 14), based on the surgical techniques employed, the following variables were documented: Gender, age, cause of injury, sacral dysmorphism, fracture classification, screw insertion time, radiation exposure time for each screw, postoperative screw position grading, follow-up period, and fracture reduction quality. Results The CS group consisted of 17 patients, nine female and eight male, with an average age of 42.6 ± 13.4 years. A total of 14 patients presented with the GP group, consisting of eight females and six males, with an average age of 40.4 ± 13.1. The two groups had no statistically significant differences in sacral dysmorphism, follow-up time, fracture reduction quality, gender, age, cause of injury, or AO fracture classification (p > 0.05). A total of 42 iliosacral screws were inserted in 31 patients: 24 screws in the CS group (18 S1 and 6 S2), and 18 screws in the GP group (14 S1 and 4 S2). In comparison to the CS group, the GP group had substantially lower rates of screw misposition, radiation exposure time per screw, and insertion time per screw (5.56% versus 25.00%; 0.31 ± 0.14min versus 0.91 ± 0.17min; 17.29 ± 1.90min versus 25.18 ± 3.99min). Comparisons between the two groups regarding the duration of radiation exposure for each screw, and the time required to insert each screw were all statistically significant (p < 0.05), however, there was no significant difference in the rate of screw misposition between the two groups (P > 0.05). Conclusion In combination with 3D guide plate technology, the preoperative virtual screw can precisely position the iliosacral screw, thereby introducing a novel technique for percutaneous iliosacral screw placement.

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Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum

Cited by 3 publications

References 25 publications

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum

An investigation to the clinical application of personalized 3D printed guides combined with preoperative virtual iliosacral screws for the management of posterior pelvic ring injury

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