title: Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications.
abstract: OBJECTIVE
  Percutaneous iliosacral screw placement allows for minimally invasive fixation of posterior pelvic ring instabilities. The objective of this study was to describe the technique for screws in S1 and S2 using conventional C-arm and to evaluate perioperative complications.
  
  
  METHODS
  Thirty-eight consecutive patients after percutaneous pelvic ring fixation with cannulated screws in S1 and S2 using conventional C-arm fluoroscopy were analysed. Accuracy of screw placement, nerval lesions, need for second surgery, operation time, and time to full weight bearing were assessed postoperatively and during regular follow-up examinations.
  
  
  RESULTS
  Twenty-one patients underwent unilateral screw fixation and 17 patients underwent bilateral screw fixation. In total, 83 screws were placed. Mean age of the patients was 52 ± 19 years. Mean operation time was 16 ± 7 min/screw. Mean follow-up was 5 ± 3 months. Time to full weight bearing in 28 patients was 9 ± 4 weeks. Eight patients were still not able to support full weight bearing, partially due to concomitant injuries. Patients without concomitant injuries that affected walking were able to bear full weight after 8 ± 4 weeks (n = 17). Two patients had persistent postoperative hypaesthesia. No motor weakness was apparent and no postoperative bleeding was observed. Secondary surgery due to screw malpositioning or loosening had to be performed in four patients. The presence of a screw in S2 was not indicated for perioperative complications.
  
  
  CONCLUSIONS
  Percutaneous iliosacral screw fixation is a rapid and definitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm fluoroscopy was also found to be safe for screws placed in S2.
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland. georg.osterhoff@usz.ch
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.forename: Christian
authors.initials: C
authors.lastname: Ossendorf
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.forename: Clément M L
authors.initials: CM
authors.lastname: Werner
mesh_terms: D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D059035:Perioperative Period; D011183:Postoperative Complications; D012086:Reoperation; D012447:Sacrum / Q000601:surgery; D016474:Weight-Bearing