title: Factors influencing the accuracy of iliosacral screw placement in trauma patients.
abstract: 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.
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. lgrosste@uke.de
authors.forename: Lars
authors.initials: L
authors.lastname: Grossterlinden
authors.forename: Johannes
authors.initials: J
authors.lastname: Rueger
authors.forename: Philip
authors.initials: P
authors.lastname: Catala-Lehnen
authors.forename: Martin
authors.initials: M
authors.lastname: Rupprecht
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lehmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Rücker
authors.forename: Daniel
authors.initials: D
authors.lastname: Briem
mesh_terms: 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