Abstract
BackgroundIliosacral screw fixation is a popular method for the management of posterior pelvic ring fractures or dislocations, providing adequate biomechanical stability. Our aim in this study was to describe the use of a new patient-specific external template to guide the insertion of iliosacral screws and to evaluate the efficacy and safety of this technique compared with the conventional fluoroscopy-guided technique.MethodsThis was a retrospective study of patients with incomplete or complete posterior pelvic ring disruptions who required iliosacral screw fixation. For analysis, patients were divided into two groups: the external template group (37 screws in 22 patients) and the conventional group (28 screws in 18 patients). The operative time per screw, radiation exposure time and the rate of screw perforation (accuracy) were compared between groups. In the external template group, the difference between the actual and planned iliosacral screw position was also compared.ResultsIn the conventional group, the average operative time per screw was 39.7 ± 10.6 min, with an average radiation exposure dose of 1904.0 ± 844.5 cGy/cm2, with 4 cases of screw perforation. In the external template group, the average operative time per screw was 17.9 ± 4.7 min, with an average radiation exposure dose of 742.8 ± 230.6 cGy/cm2 and 1 case of screw perforation. In the template group, the mean deviation distance between the actual and planned screw position was 2.75 ± 1.0 mm at the tip, 1.83 ± 0.67 mm in the nerve root tunnel zone and 1.52 ± 0.48 mm at the entry point, with a mean deviation angle of 1.73 ± 0.80°.ConclusionsThe external template provides an accurate and safe navigation tool for percutaneous iliosacral screw insertion that could decrease the operative time and radiation exposure.
Highlights
Iliosacral screw fixation is a popular method for the management of posterior pelvic ring fractures or dislocations, providing adequate biomechanical stability
Use of an internal template provides an accuracy in screw placement that is similar to that of computer-assisted navigation, it does require an incision of approximately 5 cm and soft tissue dissection to provide a clear bone surface to match the template [8, 9]
No incidence of pin site infection was noted among patients treated with emergent external fixation
Summary
Iliosacral screw fixation is a popular method for the management of posterior pelvic ring fractures or dislocations, providing adequate biomechanical stability. The use of computer-assisted navigation systems has been advocated to lower the risk of screw malposition, and of associated neurovascular injury, as well as to decrease exposure to radiation during IS screw insertion [5,6,7]. Use of an internal template provides an accuracy in screw placement that is similar to that of computer-assisted navigation, it does require an incision of approximately 5 cm and soft tissue dissection to provide a clear bone surface to match the template [8, 9]. Soft tissue residues on the bone may contribute to a mismatch between the template and bone surface, again resulting in malposition of the IS screw
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