title: CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: accuracy of screw position, injury reduction and complications in 71 patients with 136 screws.
abstract: BACKGROUND
  Sacroiliac-percutaneous-screw-placement (SPSP) for unstable-posterior-pelvic-ring-injuries (UPPRI) might be associated with severe neurovascular complications because of screw-mal-position. The aim of the present study was to analysis the effectivity of computer-tomography-guided (CTG)-SPSP including accuracy of screw-placement, quality of injury-reduction and documentation of perioperative-complications. Additionally, procedure-dependent radiation-dose and outcome should be analysed.
  
  
  METHODS
  A consecutive cohort of 71 patients with UPPRI was operated by CTG-SPSP at a single trauma level 1 hospital. 136 sacroiliac screws were inserted to S1 and S2. Postoperatively, by the use of a computerised-radiologic-work-station all screws were visualised three-dimensionally. Their distancesmin to the sacral-borders in anterior-posterior and cranio-caudal direction as well as to the neuroforamen S1/S2 were determined. After CTG-SPSP, injury-dislocation in anterior-posterior and cranio-caudal direction was quantified. Local and general complications were documented during the 30-day-period. In 55 patients (77.5%) a follow-up-investigation (29.1±19.1 months) was performed.
  
  
  RESULTS
  132 screws (97.1%) were placed completely intraosseous, 3 screws (2.2%) perforated up to 1.0 mm (n(S1)=one screw; n(S2)=two screws), and one screw (0.7%) extended 2.2 mm into the S2-neuroforamen without contact to neural structures. Postoperative dislocationanterior-posterior was 1.3±0.9 mm and dislocationcranio-caudal 1.5±0.9 mm. No procedure-associated-complication was observed. Operation time showed a significant "learning curve" during the six-year study period (initially: 88.6±60.3 min; finally: 44.3±24.6 min). Perioperative effective-radiation-dose for patientsmale was 5.9±3.1 mSv and for patientsfemale 8.7±4.5 mSv. All injuries healed and 33 patients (46.5%) had metal removal after 11.0 (±4.9) months. Only two (5.0%) out of 40 patients complained persistent UPPRI-related pain so they were not able to restart work.
  
  
  CONCLUSIONS
  The CTG-SPSP is a safe procedure for UPPRI-stabilisation especially in S1 but also in S2. Injury reduction was excellent and no procedure associated complications were observed.
authors.affiliation: Department of Traumatology, Orthopaedics and Sport Injury, Evangelisches Krankenhaus, Campus University of Oldenburg, Steinweg 13-17, 26123 Oldenburg, Germany. Electronic address: Oliver.Pieske@evangelischeskrankenhaus.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Pieske
authors.affiliation: Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Christoph.Landersdorfer@gmx.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Landersdorfer
authors.affiliation: Department of Clinical Radiology, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Christoph.Trumm@med.uni-muenchen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Trumm
authors.affiliation: Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Axel.Greiner@med.uni-muenchen.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Greiner
authors.affiliation: Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Jens.Wallmichrath@med.uni-muenchen.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Wallmichrath
authors.affiliation: Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Oliver.Gottschalk@med.uni-muenchen.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gottschalk
authors.affiliation: Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany. Electronic address: Bianka.Rubenbauer@med.uni-muenchen.de.
authors.forename: Bianka
authors.initials: B
authors.lastname: Rubenbauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D015203:Reproducibility of Results; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: CT-guided operation; Complication; Injury; Minimally invasive surgery; Pelvis; Percutaneous; Sacroiliac-screw; Trauma