[Percutaneous sacroiliac lag screw fixation of the posterior pelvic ring. Increasing safety by standardization of visualization and insertion technique].
BACKGROUND
In recent years, the closed reduction and percutaneous fixation of posterior pelvic ring fractures by sacroiliac screws has become a well established treatment option for stabilization of posterior pelvic ring disruptions. Stable percutaneous pelvic ring fixation also implies a very low complication rate, e.g., in operative blood loss, wound healing, and operative time. To avoid malpositioning of the screws, sufficient reduction and radiologic visualization are essential. The surgical technique has been described in several studies; however, great importance is attached to the personal experience of the surgeon. Therefore, this study was conducted to establish a standard procedure that allows different surgeons a safe positioning of sacroiliac screws.


RESULTS
A total of 41 injuries of the posterior pelvic ring were stabilized with 73 sacroiliac lag screws inserted by 7 different surgeons using a standardized technique. In all cases adequate reduction of the fracture and radiologic visualization were achieved. No wound infections, no relevant bleedings, and no spiral fractures of screws were observed. In two cases malpositioning led to revision of the screws. Of interest, one case of S1 paresthesia resulting from a malpositioned screw could be revised. In contrast, two cases of screw loosening and one case of screw bending did not require further intervention.


CONCLUSIONS
We conclude that safe positioning of the sacroiliac screws was accomplished by all surgeons given a standardized technique. For safe insertion preparation of the patients, accurate visualization of the fracture zone, and potential closed reduction is always required.
Tosounidis
G
G
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Medizinische Fakultät der Universität des Saarlandes,Universitätsklinikum, Kirrberger Strasse 1, 66424, Homburg/Saar, Germany. chgtost@uniklinik-saarland.de
Culemann
U
U
Wirbel
R
R
Holstein
J H
JH
Pohlemann
T
T
D001863:Bone Screws; D001864:Bone Wires; D005471:Fluoroscopy / Q000295:instrumentation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000601:surgery; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments