title: CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT.
abstract: OBJECTIVE
  To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia.
  
  
  METHODS
  Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws.
  
  
  RESULTS
  A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1,10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14 -52 minutes) and 35 minutes (range: 21 - 60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy  ×  cm (range: 162 - 1014 mGy  ×  cm) for the unilateral and 470 mGy  ×  cm (range: 270 - 1271 mGy  ×  cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7  %). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days).
  
  
  CONCLUSIONS
  CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.
authors: Radiology, Thüringen-Klinik Saalfeld.
authors: G
authors: G
authors: Reuther
authors: Orthopaedics and Trauma Surgery, Thüringen-Klinik Saalfeld.
authors: U
authors: U
authors: Röhner
authors: Orthopaedics and Trauma Surgery, Thüringen-Klinik Saalfeld.
authors: T
authors: T
authors: Will
authors: Radiology, Thüringen-Klinik Saalfeld.
authors: I
authors: I
authors: Dehne
authors: Orthopaedics and Trauma Surgery, Thüringen-Klinik Saalfeld.
authors: U
authors: U
authors: Petereit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D015775:Fractures, Stress / Q000000981:diagnostic imaging; D005858:Germany; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D015642:Radiology, Interventional / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult