Factors influencing the accuracy of iliosacral screw placement in trauma patients.
Correct placement of iliosacral screws remains a surgical challenge. The aim of this retrospective study was to identify parameters which impact the accuracy of this technically demanding procedure. Eighty-two patients with vertically unstable pelvic injuries treated with a total of 147 iliosacral screws were included. Assessment of postoperative CT scans revealed screw misplacement in 13 cases (8%), of which six occurred following insertion of two unilateral screws into S1. Six screw misplacements occurred in patients with dislocation injuries of the posterior pelvis. Comparison of a navigated and the standard technique revealed a decreased screw misplacement rate in the navigated group (15% standard vs. 3% navigation, p < 0.05). In addition, the malposition rate was influenced by the surgeon's individual experience (20% for low vs. 3.9% for high volume surgeons, p < 0.05). Overall, the accuracy of iliosacral screw placement depends on the number of screws inserted into S1 and the extent of dislocation. In experienced hands, the use of navigation represents a helpful tool to improve the placement accuracy.
Grossterlinden
Lars
L
Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. lgrosste@uke.de
Rueger
Johannes
J
Catala-Lehnen
Philip
P
Rupprecht
Martin
M
Lehmann
Wolfgang
W
Rücker
Andreas
A
Briem
Daniel
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws / Q000009:adverse effects*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery*; D004204:Joint Dislocations; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D055815:Young Adult