Percutaneous iliosacral screw and trans-iliac trans-sacral screw with single C-arm fluoroscope intensifier is a safe treatment for pelvic ring injuries

Jui-Ping Chen,Ping-Jui Tsai,Pai-Wei Lee,Chun-Yi Su,I.-Chuan Tseng,I.-Jung Chen,Yi-Hsun Yu,Ying-Chao Chou

doi:10.1038/s41598-021-04351-z

Abstract

To elucidate the accuracy, efficacy, and safety of percutaneous iliosacral screw (ISS) and trans-iliac trans-sacral screw (TITS) insertion using a single C-arm fluoroscopy intensifier. Additionally, the potential risk factors that might cause mal-positioned screws were identified. Patients with pelvic ring injuries who underwent percutaneous screw fixation in a single medical institute were divided into an ISS group (n = 59) and a TITS group (n = 62) and assessed. The angles deviated from ideal orientation (ADIO) of the implanted screw were measured, and potential risk factors for mal-positioned screws were analyzed. Overall, the reduction quality of the pelvic ring was good or excellent in 70 patients (82.4%) by Matta’s criteria and in 48 patients (56.5%) by Lefaivre’s criteria. ADIO measurements of the ISS and TITS groups via multi-planar computed tomography were 9.16° ± 6.97° and 3.09° ± 2.8° in the axial view, respectively, and 5.92° ± 3.65° and 2.10° ± 2.01° in the coronal view, respectively. Univariate statistical analysis revealed body mass index as the single potential risk factor of mal-positioned screws. With careful preoperative planning and intraoperative preparations, placing ISS and TITS under the guidance of single C-arm fluoroscopy intensifier is a reliable and safe technique. Caution should be exercised when performing this procedure in patients with a high body mass index.

Highlights

To elucidate the accuracy, efficacy, and safety of percutaneous iliosacral screw (ISS) and trans-iliac trans-sacral screw (TITS) insertion using a single C-arm fluoroscopy intensifier
Since restoring pelvic anatomy and providing sufficient stability of the posterior pelvic ring are the keystones of treatment of pelvic ring injury, anatomical reduction should be performed prior to osteosynthesis
We retrospectively collected patients’ medical records from the fracture registration database of our institute to identify those who were diagnosed with pelvic ring injury and underwent percutaneous screws fixation (ISS, TITS, or both) either through closed reduction and internal fixation or open reduction and internal fixation (ORIF) between January 2017 and June 2020

Summary

Introduction

Efficacy, and safety of percutaneous iliosacral screw (ISS) and trans-iliac trans-sacral screw (TITS) insertion using a single C-arm fluoroscopy intensifier. Patients with pelvic ring injuries who underwent percutaneous screw fixation in a single medical institute were divided into an ISS group (n = 59) and a TITS group (n = 62) and assessed. Several real-time image modifications have been proposed to improve the accuracy and safety of this technique, such as 2-arm fluoroscopy, O-arm fluoroscopy, intraoperative computed tomography, and navigation s ystem[16,17,18,19]. Reports from these new image-assisted surgery have revealed their efficacies, the advanced image tools are expensive and not routinely available to each orthopedic surgeon and facility. The usefulness of these advanced image tools for the percutaneous treatment of posterior pelvic ring may be limited

Objectives

Methods

Results

Conclusion