Locked Transsacral Screw Fixation of Bilateral Injuries of the Posterior Pelvic Ring: Initial Clinical Series

Abstract

The purpose of this study was to evaluate the clinical safety and efficacy of using a cannulated transsacral screw having a novel locking capability for pelvic fracture fixation. Retrospective analysis of a treatment protocol, patient series. Level I trauma center. Beginning in 2001, 10 patients with bilateral injury to the posterior pelvic ring were treated using a cannulated transsacral screw having a novel locking capability. Patients ranged in age from 21 to 64 years. Follow-up averaged 2 years (range, 1-5 years). Preoperative and postoperative radiographic evaluation included anteroposterior, inlet and outlet pelvic x-rays, and two-dimensional computerized tomography with 3-mm slice thickness. Candidates for this fixation required adequate space estimated on computerized tomography across either the first or second sacral body. Locked transsacral screw fixation of bilateral injuries of the posterior pelvic ring consisting of a long 7.0-mm cannulated screw inserted over a washer from the near ilium, across one sacroiliac joint, through the body of the sacrum, and across the other sacroiliac joint, exiting the far iliac cortex. A self-locking nut was placed on the distal end of the screw. Intraoperative iatrogenic nerve root injuries, postoperative screw position, and maintenance of the fixation construct until fracture healing. There were no iatrogenic nerve injuries. Satisfactory screw position was documented on the postoperative computerized tomography in all cases. Fixation failure did not occur and satisfactory pelvic ring position was maintained in all cases. Locked transsacral screw fixation is a safe and effective technique that should be added to our surgical armamentarium. Indications include bilateral posterior injury as well as any situation in which routine transsacral screw fixation might otherwise be considered such as the presence of pelvic osteopenia or insufficient space for a second point of posterior fixation.