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. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Pieske, Oliver; Landersdorfer, Christoph; Trumm, Christoph; Greiner, Axel; Wallmichrath, Jens; Gottschalk, Oliver; Rubenbauer, Bianka
• Is Part Of: Injury. Volume 46:Issue 2(2015)
• Page Start: 333
• Page End: 339
• Publication Date: 2015-02
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2014.11.009
• Languages: English
• ISSNs: 0020-1383

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">Sacroiliac-percutaneous-screw-placement (SPSP) for unstable-posterior-pelvic-ring-injuries (UPPRI) might be associated with severe neurovascular complications because of screw-mal-position. The aim of the present study was to analysis the effectivity of computer-tomography-guided (CTG)-SPSP including accuracy of screw-placement, quality of injury-reduction and documentation of perioperative-complications. Additionally, procedure-dependent radiation-dose and outcome should be analysed.</p> </sec> <sec> <title id="sect0015">Methods</title> <p id="spar0010">A consecutive cohort of 71 patients with UPPRI was operated by CTG-SPSP at a single trauma level 1 hospital. 136 sacroiliac screws were inserted to S1 and S2. Postoperatively, by the use of a computerised-radiologic-work-station all screws were visualised three-dimensionally. Their distances<sub>min</sub> to the sacral-borders in anterior-posterior and cranio-caudal direction as well as to the neuroforamen S1/S2 were determined. After CTG-SPSP, injury-dislocation in anterior-posterior and cranio-caudal direction was quantified. Local and general complications were documented during the 30-day-period. In 55 patients (77.5%) a follow-up-investigation (29.1 ± 19.1 months) was performed.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">132 screws (97.1%) were placed completely intraosseous, 3 screws (2.2%) perforated up to 1.0 mm (<italic>n</italic><sub>(S1)</sub> = one screw; <italic>n</italic><sub>(S2)</sub> = two screws), and one screw (0.7%) extended 2.2 mm into the S2-neuroforamen without contact to neural structures. Postoperative dislocation<sub>anterior-posterior</sub> was 1.3 ± 0.9 mm and dislocation<sub>cranio-caudal</sub> 1.5 ± 0.9 mm. No procedure-associated-complication was observed. Operation time showed a significant "learning curve" during the six-year study period (initially: 88.6 ± 60.3 min; finally: 44.3 ± 24.6 min). Perioperative effective-radiation-dose for patients<sub>male</sub> was 5.9 ± 3.1 mSv and for patients<sub>female</sub> 8.7 ± 4.5 mSv. All injuries healed and 33 patients (46.5%) had metal removal after 11.0 (±4.9) months. Only two (5.0%) out of 40 patients complained persistent UPPRI-related pain so they were not able to restart work.</p> </sec> <sec> <title id="sect0025">Conclusions</title> <p id="spar0020">The CTG-SPSP is a safe procedure for UPPRI-stabilisation especially in S1 but also in S2. Injury reduction was excellent and no procedure associated complications were observed.</p> </sec> </abstract>