Delayed sacroiliac joint infection after robot-assisted percutaneous iliac screw fixation for tile type C2 pelvic fractures: A case report and literature review.

In calcaneal fractures, percutaneous screw fixation (PSF) is currently considered a promising alternative to established techniques such as the L-shape or sinus tarsi approach. The present study establishes a novel percutaneous sustentaculum tali (ST) screw fixation model for Sanders type II and type III calcaneal fractures, assessing construct stability via finite element analysis (FEA) while concurrently evaluating clinical efficacy through postoperative follow-up. This study utilized FEA, based on the Sanders III fracture line model, to compare the stability of internal implants and fracture fragments between the percutaneous ST screw fixation model, the intramedullary nail model, the locking compression plate (LCP), and minimally invasive plate (MIP), thereby evaluating the biomechanical stability of the percutaneous ST screw construct. In parallel, 23 clinical surgical cases of percutaneous ST screw fixation were included. Through postoperative follow-up, the therapeutic effect was observed to jointly verify the effectiveness of percutaneous ST fixation. Regarding the FEA, after stress loading, among the four internal fixation models, the peak von Mises stress within the calcaneus was maximal in the intramedullary nail model and minimal in the ST screw model. Regarding implant-related stresses, the LCP model exhibited the highest von Mises stress, while the percutaneous ST screw model demonstrated the lowest. In parallel, the maximal fragment displacement in every model was below the reference threshold (150μm). Percutaneous ST screw fixation demonstrates equivalent biomechanical stability compared with the other constructs. In the clinical follow-up, both the AOFAS and MFS indicated good to excellent functional outcomes, and the low VAS values reflected minimal to no pain, collectively confirming satisfactory restoration of foot function. This study, through FEA and postoperative clinical follow-up, validates percutaneous ST screw fixation as a reliable modality for Sanders type II and III calcaneal fractures, thereby providing an evidence-based reference for calcaneal fracture management. Nevertheless, further biomechanical investigations and larger clinical series are warranted for corroboration.

Introduction: About 1%-2% of all fractures are calcaneal fractures, which are the most common injuries to the tarsal bone. The subtalar joint is involved in about 75% of intra -articular calcaneal fractures. The most frequent way for an injury to occur is from a fall that strikes the heel squarely. There are several ways to treat calcaneum fractures, including Kirschner wire fixation, percutaneous cannulated screw fixation, and plate fixation, however no one technique has shown to consistently produce positive outcomes. Material and Methods: Patients with calcaneal fractures who were admitted to Narayana Medical College and hospital between June 2022 and Oct 2023 were evaluated for this retrospective analysis. For some of these patients, percutaneous screw fixation was the method of treatment; for the remaining patients, plate fixation was employed. Twenty patients in one group and twenty in the other met the inclusion criteria. The groups were categorized using Sanders classification, age, sex, and the mechanism of injury, among other factors. The average interval between admission to the hospital following an injury and the start of operation was four days. Discussion: In the past, conservative management of calcaneum fractures was thought to be the best course of action. But over time, a number of internal fixation techniques began to produce outstanding outcomes. In contrast to the 0 patients in the plating group, 12 (or 60%) of the patients in the percutaneous cc screw fixation group in our study had outstanding results. In both groups, 8 patients (or 40%) had good results; in the plating group, 4 patients (20%) had bad results and 8 patients (or 40%) had medium results. This shows that whereas patients treated with plating had inconsistent outcomes, all patients treated with percutaneous cc screw fixation for calcaneum fractures in this study had either excellent or good results. Conclusion: We found that, when the AOFAS score was combined with patient satisfaction, the group receiving percutaneous CC screw fixation performed better statistically than the group receiving calcaneal plate fixation for calcaneal fractures Sander's types II, IIIa, and IIIb.

BackgroundThis study aimed to compare the clinical outcomes and complications between two minimally invasive surgical techniques: percutaneous transiliac plate fixation and iliosacral (IS) screw fixation for the treatment of Tile C-type pelvic bone fractures.MethodsWe retrospectively reviewed the data of 77 consecutive patients with Tile C pelvic ring injuries who underwent either percutaneous transiliac plate fixation or IS screw fixation in a single academic center between November 2007 and January 2018. We recorded patients’ demographics, surgery-related data, and postoperative surgical outcomes and compared the incidence of complications and revision surgery rates between the two groups.ResultsOverall, 14 patients were included in the plate group, while 63 were included in the IS screw fixation group. No significant differences were observed in the patients’ demographics between the two groups except for a longer interval from injury to surgery (13.5 days vs. 5.4 days, P = 0.001). Both groups acquired fracture union in all cases. There was one case of infection requiring surgical debridement in the plating group. Notably, nerve injury (n = 3) and implant loosening (n = 5) occurred in the IS screw group, but the difference was not significant.ConclusionsBoth percutaneous posterior transiliac plating and IS screw fixation in patients with Tile C-type pelvic bone fractures showed good results. We recommend IS screw fixation as the primary treatment and propose posterior plating as treatment for sacral dysmorphism and bilateral sacral alar fractures in patients with spinopelvic dissociation.Level of evidenceIII

ObjectiveThe percutaneous IS screws and the minimally invasive percutaneous plate are the most popular internal methods for Zone II unstable sacral fractures. However, the choice of fixation remains controversial for orthopaedic surgeons. The purpose of study was to evaluate and compare the clinical results of percutaneous iliosacral (IS) screw fixation under three‐dimensional (3D) navigation and minimally invasive percutaneous plate fixation in the treatment of Zone II unstable sacral fractures.MethodsA retrospective study was performed, including 64 patients with Zone II unstable sacral fractures who underwent percutaneous IS screw fixation under 3D navigation (navigation group) and minimally invasive percutaneous plate fixation (plate group) from January 2011 and March 2021 in our department. The age, gender, fracture type, mechanism of injury, injury severity score (ISS), time from admission to operation, operative time, intraoperative blood loss, hospital stay, incision length, follow‐up time, time to clinical healing, and complications were recorded and analyzed. Matta standard was used to assess fracture reduction outcomes. The Majeed function system assessed functional outcomes at the last follow‐up.ResultsThe average follow‐up time was (14.42 ± 1.57) months in the navigation group and (14.79 ± 1.37) months in the plate group. No statistical difference between the two groups in age, gender, fracture type, mechanism of injury, ISS, time from admission to operation, and time to clinical healing. However, significant differences were detected in operative time, intraoperative blood loss, hospital stay, and incision length (p < 0.001). According to Matta standard at 2 days postoperatively, the excellent and good rate was 91.42% in the navigation group, and it was 93.10% in the plate group. There was no significant difference between the two groups (p = 0.961). According to Majeed function system at the follow‐up, the excellent and good rate was 97.14% in the navigation group, and 93.10% in the plate group. The difference between the two groups was not statistically significant (p = 0.748). There were no neurovascular injuries associated with this procedure. The incidence of complications was 44.82% (13/29) in the plate group, while 14.28% (5/35) in the navigation group (p = 0.007).ConclusionThis study found that compared with minimally invasive percutaneous plate fixation, percutaneous IS screw fixation under 3D navigation is a suitable option for the treatment of Zone II unstable sacral fractures. This approach is characterized by its shorter operation time, less surgical trauma, less bleeding, less hospital time, and fewer complications.

Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients

BackgroundThis cadaveric study compared efficacy and safety of an electromagnetic (EM) guidance system versus conventional fluoroscopy for percutaneous pedicle screw fixation. As percutaneous pedicle screw fixation becomes increasingly common in spinal surgery, intraoperative imaging systems that maximize efficiency while minimizing radiation exposure and inaccurate trajectories will be progressively more important. Published studies have validated the safety of percutaneous screw fixation using conventional fluoroscopic guidance and frameless optical stereotaxy, though EM guidance systems have not been evaluated for percutaneous placement in the lumbosacral spine. The aim of the study was to evaluate the clinical applicability of an EM system for minimally invasive spine fusion in the lumbosacral spine.MethodsFive human cadaveric specimens underwent bilateral lumbosacral percutaneous screw fixation from L1 to S1 using conventional anteroposterior (AP) and lateral fluoroscopic techniques on one side and 2-dimesional (2D) EM guidance on each matching side. Intraoperative efficiency was evaluated, and pedicle, vertebral, and critical breach rates were assessed on postoperative computed tomography (CT).ResultsOverall mean fluoroscopy time per screw was 58.9 ± 44.7 seconds for conventional fluoroscopy compared to 27.4 ± 13.5 seconds for electromagnetic guidance (P = .0003). Pedicle, vertebral, and critical breach rates for the L1-S1 were 32.1%, 10.7%, and 25.0% for conventional fluoroscopy and 42.8%, 10.7%, and 14.1% for electromagnetic guidance (difference not statistically significant [ns]). In comparing critical breaches in the lumbar spine (L1-L5), there was a significant difference between 2-D EM guidance (0) and CF guidance (6) (P = .02).ConclusionsTwo-dimensional EM navigation provides a modality for lumbosacral percutaneous pedicle screw fixation that is more efficient and safer than conventional fluoroscopy. This data provides a foundation for further clinical trials of this technology.Level of EvidenceLevel 5 – Bench Research

Electromagnetic Navigation in Minimally Invasive Spine Surgery: Results of a Cadaveric Study to Evaluate Percutaneous Pedicle Screw Insertion

Background Scaphoid fractures are the most frequent fractures of the carpal bones, comprising 70-80% of carpal fractures and about 11% of all fractures of the hand. Standard casting of the wrist leads to a union rate of 50-90% and a nonunion rate of 5-25%, especially problematic for the unstable fracture variants. As such, Percutaneous Herbert screw fixation is advantageous for providing rigid fixation while also keeping the fracture site blood supply intact and allowing for early range of motion to the joint. Objective The purpose of this study is to evaluate Union rates, functional disability scores, pain levels, and complication rates of acute scaphoid fractures fixed with percutaneous Herbert screw fixation in a tertiary care center and document the functional and radiological outcomes. Materials and Methods A prospective observational study was conducted over 29 months (August 2019December 2021) at the Department of Orthopaedics at Tertiary Care Centre, Nashik. Twenty-three consecutive patients with acute scaphoid fractures meeting strict inclusion criteria underwent percutaneous Herbert screw fixation via volar or dorsal approach. Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) for pain assessment, and radiological evaluation for fracture union at 6 weeks, 3 months, and 6 months postoperatively. Results Study cohort mean age was 29.65±8.19 years with males being the majority (91.3%, n=21). Rightsided scaphoid fractures were noted in 56.5% (n=13) cases. The majority of injuries were caused by road traffic accidents (82.6%, n=19). In 95.7% (n=22) of cases the Volar percutaneous approach was used. Radiological union was attained in 100% of cases with mean union time of 7.8±1.5 weeks. With regard to the functional outcomes, 39.1% (n=9) of patients were excellent, 56.6% (n=13) were good, 4.3% (n=1) were satisfactory, while there were no poor outcomes (mean DASH score 8.1±4.2). Pain assessment showed that 78.3% (n=18) of the patients had mild pain (VAS 1-2) postoperatively. Complications occurred in only 13% of cases, with no complications in 87% of the patients. Mean return to work was 9.2±2.8 weeks. Conclusion The advantages of percutaneous Herbert screw fixation for acute scaphoid fractures include 100% radiological union, 95.7% functional (excellent-to-good) outcome, and low morbidity (13% complications, mostly minor). This technique promotes early mobilization and faster return to work (mean 9.2 weeks vs &gt; 11 weeks for conservative treatment) and prevents complications related to prolonged immobilization. These benefits position percutaneous fixation as the best option for young active patients with acute scaphoid fractures. This study also confirms percutaneous fixation as a safe and effective method to replace conservative treatment.

The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies. Twenty-eight patients presenting with spinal degenerative diseases including concomitant central and/or lateral stenosis were treated with stand-alone percutaneous pedicle screw fixation. Radiographic measurements were made on axial and sagittal magnetic resonance (MR) images, performed before surgery and after a mean follow-up period of 25.2 months. Measurements included spinal canal and foraminal areas, and anteroposterior canal diameter. Percutaneous screw fixation was performed in 35 spinal levels. Measurements on the follow-up MR images showed statistically significant increase in the cross-sectional area of the spinal canal and the neural foramen, from a mean of 88.22 and 61.05 mm2 preoperatively to 141.52 and 92.18 mm2 at final follow-up, respectively. The sagittal central canal diameter increased from a mean of 4.9 to 9.1 mm at final follow-up. Visual analog scale (VAS) pain score and Oswestry Disability Index (ODI) both improved significantly after surgery (p < 0.0001). Stand-alone percutaneous pedicle screw fixation is a safe and effective technique for indirect decompression of the spinal canal and neural foramina in lumbar degenerative diseases. This minimally invasive technique may provide the necessary decompression in cases of common degenerative lumbar disorders with ligamentous stenosis.

Plate fixation, the conventional treatment for traumatic symphysis pubis diastasis, carries the risk of extensive exposure, blood loss and postoperative infections. Percutaneous screw fixation is a minimally invasive treatment. The goal of the present study was to compare the outcome of plate fixation and percutaneous screw technique in the treatment of traumatic pubic symphysis diastasis. Ninety patients with traumatic symphysis pubis diastasis were treated from January 2003 to December 2009 at two level 1 regional trauma centers. The mean time of follow-up was 21 months (18 to 26). Forty-five patients were treated by percutaneous screw fixation. Forty-five patients were treated by plate and screws fixation. The demographic, distribution of fracture patterns, blood loss, incision length, fixation failure, malunion, revision surgery and functional scores were compared. Seven cases were lost during follow-up. Demographics (age and gender), fracture classification and Injury Severity Score were comparable in the two groups (P > 0.05). Blood loss and extensive exposure were much less in screw group (P < 0.01). Patients in screw group achieved better functional performance (P = 0.01). There were no significant differences favoring plate fixation in reduction quality (P = 0.32), implant failure (P = 0.39), malunion (P = 0.15), revision surgery rates (P = 0.27), percentage of impotence in the male patients (P = 0.2) and implant removal time (P = 0.12) between the two groups. Our results indicate that besides lower rate of iatrogenic injuries and better functional outcome, percutaneous screw fixation of the pubic symphysis is as strong as plate fixation.

BACKGROUND This study aimed to assess the functional outcomes of percutaneous ilio-sacral screw fixation in the treatment of posterior pelvic ring injuries. METHODS A total of 34 (out of 42) adult patients treated with percutaneous ilio-sacral screw fixation for posterior pelvic ring injuries, with or without associated anterior ring injuries between January 2020 and December 2023, were included in this study. There were 35% females and 65% males, all of whom completed follow-up evaluation. Clinical and radiological follow-up assessments were performed at six months, and functional outcomes were evaluated using the Majeed Functional Score. RESULTS The mean age of patients was 34.29 years ±13.29. The average hospital length of stay was 22.88 days ±18.63. Patients were categorized by Tile classification, with B3 injuries being the most common (26.47%), followed by C2 injuries (20.59%). Injury mechanisms included two-wheeler accidents (35.29%), pedestrian accidents (17.65%), and falls from height (14.71%). Functional outcomes assessed using the Majeed Functional Score showed excellent results in 79.41% of patients, good in 8.82%, fair in 8.82%, and poor in 2.94%. There was no incidence of neurological injury in this cohort. CONCLUSION The findings suggest that, if executed correctly, percutaneous ilio-sacral screw fixation is a safe and effective method for managing posterior pelvic ring injuries. Most patients achieved excellent functional outcomes, aligning with previous research on this treatment modality. KEYWORDS Majeed functional score, percutaneous ilio-sacral fixation, unstable posterior pelvic injuries

Background/Objectives: Sacral dysmorphism is a common anatomical variant that may significantly affect the safety of percutaneous iliosacral screw fixation. Although its morphological characteristics are well described, its impact on clinically relevant outcomes—particularly cortical breach during S1 screw placement—remains insufficiently defined. This study aimed to evaluate whether sacral dysmorphism is an independent risk factor for cortical breach during percutaneous S1 iliosacral screw fixation. Methods: This retrospective cohort study included 112 adult patients with sacral fractures treated with percutaneous S1 iliosacral screw fixation between January 2018 and December 2024. Sacral dysmorphism was defined on preoperative CT scans using qualitative features, with ≥2 criteria required for classification as dysmorphic. Quantitative morphometric parameters, including S1 osseous corridor width and screw anteversion angle, were also measured. The primary outcome was the presence of cortical breach on postoperative CT imaging. Multivariate logistic regression analysis was performed to evaluate the independent association between sacral dysmorphism and cortical breach. Results: Sacral dysmorphism was identified in 32 patients (28.6%). Cortical breach occurred in 19 patients (17.0%) and was significantly more frequent in the dysmorphic group compared with the non-dysmorphic group (34.4% vs. 10.0%; p = 0.002). Sacral dysmorphism was independently associated with cortical breach (adjusted OR: 4.38; 95% CI: 1.42–13.50; p = 0.010). Dysmorphic sacra demonstrated significantly narrower S1 osseous corridors (16 mm vs. 25 mm; p < 0.001) and greater screw anteversion angles (28° vs. 9°; p < 0.001). Breach severity was also significantly greater in dysmorphic patients (p = 0.003). Conclusions: Sacral dysmorphism is an independent risk factor for cortical breach during percutaneous S1 iliosacral screw fixation. The geometric constraints of dysmorphic sacra, including corridor narrowing and increased anteversion requirements, significantly compromise screw placement safety. Careful CT-based evaluation and individualized trajectory planning are essential to optimize fixation outcomes in this high-risk anatomical subgroup.

To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures. From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed. There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups. The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.

Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture. Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union. Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration. We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Percutaneous retrograde screw fixation for acetabular fractures is a demanding procedure due to the complex anatomy of the pelvis and the varying narrow safe bony corridors. Limited information is available on optimal screw placement and the geometry of safe zones for screw insertion in the pelvis. Three-dimensional reconstructions of 50 consecutive CT scans of polytrauma patients (35 males, 15 females) were used to introduce three virtual CAD bolts (representing screws) into the anterior column (superior ramus of the pubic bone), posterior column (the ischial bone) and the supraacetabular region, as performed during percutaneous screw fixation. The three-dimensional (3D) position of these screws was evaluated with a computer software (MIMICS) after virtual optimal insertion. The 3D position, the narrowest zone and the distance to the hip joint of the two columns and the supraacetabular region were defined. The mean maximal screw length for the three virtual screws measured between 107.4 and 148 ± 18.7 mm. The narrowest zone of the pelvic bone (superior pubic ramus) had a width of 9.2 ± 2.4 mm. The average distances between the bolts and the hip joint were 3.9 and 19.4 ± 7.4 mm. For the anterior column (superior pubic ramus) screw, the mean lateral angle to the sagittal midline plane was 39.0 ± 3.2° and the mean posterior angle to the transversal midline plane was 15.1 ± 4.0°. The mean supraacetabular screw angles measured 22.4 ± 3.4° (medial), 35.3 ± 4.6° (cranial) and the mean angles for the ischial screw were 12.0 ± 5.4° (posterior) and 18.4 ± 4.0° (lateral). The zones for safe screw positioning are very narrow, making percutaneous screw fixation of the acetabulum a challenging procedure. The predefined angles for the most frequently positioned percutaneous screws may aid in preoperative planning, decrease operative and radiation times and help to increase safe insertion of screws.