title: Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring.
abstract: OBJECTIVE
  To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries.
  
  
  METHODS
  Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed.
  
  
  RESULTS
  We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min.
  
  
  CONCLUSIONS
  CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose.
authors.affiliation: Institute for Clinical Radiology, Marchioninistr. 15, 81377, Munich, Germany, frederik.strobl@med.lmu.de.
authors.forename: Frederik F
authors.initials: FF
authors.lastname: Strobl
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Haeussler
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Ralf-Thorsten
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Pieske
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Trumm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D010388:Pelvis; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult