Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. Conventional)

Mini-open stabilization of a sacral fracture: technical case report

BACKGROUND AND IMPORTANCE

Comminuted sacral fractures present significant challenges for operative management. Open and percutaneous sacroiliac screws have been used for stabilization but carry not insignificant rates of complications, including wound infection for the former and malposition and neurological injury for the latter. We report the use of a novel mini-open lumbar-ilium fixation for stabilization of a patient with a comminuted sacral fracture.

CLINICAL PRESENTATION

A 33-year-old man with intact neurologic function was admitted after a fall of approximately 25 ft. A comminuted sacral fracture was diagnosed. The patient was unable to tolerate conservative management because of pain in upright positions. The patient was taken to the operating room for stabilization with a "mini-open" procedure involving L4 and L5 pedicle screws and bilateral iliac screws. Four 2-in paramedian incisions were made overlying the L4-L5 facet joints and medial to the sacroiliac joints. Minimally invasive retractors were placed to expose bony landmarks. L4-L5 pedicle screws and bilateral iliac screws were placed with minimal fluoroscopic guidance. Titanium rods were tunneled inferior-superiorly between incisions and affixed to screw heads. Total operative time was approximately 3.5 hours. The patient remained neurologically intact and had an uncomplicated recovery. One-year follow-up computed tomography showed successful healing of the sacrum.

CONCLUSION

We report the first case of a mini-open procedure to treat a comminuted sacral fracture. Use of this procedure offers a straightforward method for sacral stabilization with minimal blood loss and minimal radiation exposure. If indicated, this method could be combined with decompressive procedures.

[Percutaneous iliosacral screw fixation for pelvis insufficiency fracture after implantation of a pedestal cup: case report]

Insufficiency fractures of the sacrum are frequently overlooked injuries especially in postmenopausal women with an osteoporotic bone structure and without a history of significant trauma. Plain radiographs are frequently inadequate in showing insufficiency fractures of the sacrum. Regarding this a fracture of a pubic ramus combined with appropriate clinical symptoms should raise the suspicion of a concomitant sacral injury. Therefore, further investigations including a CT scan are necessary.The case of an osteoporotic female patient with bilateral insufficiency fractures of the sacrum and a fracture of the right superior and inferior pubic ramus 5 weeks after primary total hip arthroplasty and implantation of a pedestal cup due to an intraoperative fracture of the right acetabulum is presented. To ensure early mobilization as well as avoidance of further concomitant morbidities a percutaneous iliosacral screw fixation was performed. This approach has been established as an operative treatment for minimally or non-displaced insufficiency fractures of the sacrum.

Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation: surgical technique

BACKGROUND

The percutaneous three-dimensional (3D)-fluoroscopic-navigated screw directing to the quadrilateral plate was attempted.

MATERIALS AND METHODS

Five patients with acetabular fractures were treated by 3D navigated percutaneous screw. The quadrilateral plate was involved in all the patients. The Arcadis 3D (ARCADIS Orbic 3D(®); Siemens AG Healthcare Sector, Erlangen, Germany) and computer navigation system (stryker navigation system) were employed, screwing trajectory was attempted to anchor the quadrilateral plate perpendicularly to the fracture line and close to the joint cartilage as much as possible. Parameters including fracture gap closure (P1), distance to the joint cartilage (P2), angulations between the screw and the fracture line (P3), were measured with the software installed on the machine of Arcadis 3D.

RESULT

Seven screws were inserted with the use of 3D fluoroscopic navigation. The quadrilateral plate was hold by percutaneous screws. The closure of fracture gap was achieved in 3 patients by 2-3mm. The nearest distance from the screw to the joint cartilage was ranged from <1mm to 6mm. The angulations between the screw and the fracture line was 80-90° in three patients, it was 60° and 65° respectively on the rest two patients. All patients felt pain free 1week after the operation. No complication was noted postoperatively.

CONCLUSION

The surgical technique of percutaneous screwing for the acetabular fracture with three-dimensional fluoroscopy-based navigation was demonstrated.

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

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.