A Quantitative Exposure Planning Tool for Surgical Approaches to the Sacroiliac Joint.
OBJECTIVE
To aid in surgical planning by quantifying and comparing the osseous exposure between the anterior and posterior approaches to the sacroiliac joint.


METHODS
Anterior and posterior approaches were performed on 12 sacroiliac joints in 6 fresh-frozen torsos. Visual and palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J.


RESULTS
The average surface areas of exposed bone were 44 and 33 cm for the anterior and posterior approaches, respectively. The anterior iliolumbar ligament footprint could be visualized in all anterior approaches, whereas the posterior aspect could be visualized in all but one posterior approach. The anterior approach provided visual and palpable access to the anterior superior edge of the sacroiliac joint in all specimens, the posterior superior edge in 75% of specimens, and the inferior margin in 25% and 50% of specimens, respectively. The inferior sacroiliac joint was easily visualized and palpated in all posterior approaches, although access to the anterior and posterior superior edges was more limited. The anterior S1 neuroforamen was not visualized with either approach and was more consistently palpated when going posterior (33% vs. 92%).


CONCLUSIONS
Both anterior and posterior approaches can be used for open reduction of pure sacroiliac dislocations, each with specific areas for assessing reduction. In light of current plate dimensions, fractures more than 2.5 cm lateral to the anterior iliolumbar ligament footprint are amenable to anterior plate fixation, whereas those more medial may be better addressed through a posterior approach.
*Department of Orthopaedic Surgery and †Department of Orthopaedic Clinical Research, Carolinas Medical Center, Charlotte, NC.
Kevin D
KD
Phelps
Bryan W
BW
Ming
Wade E
WE
Fox
Nelly
N
Bellamy
Stephen H
SH
Sims
Madhav A
MA
Karunakar
Joseph R
JR
Hsu
D002102:Cadaver; D005069:Evaluation Studies as Topic; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D010348:Patient Care Team; D012446:Sacroiliac Joint / Q000293:injuries / Q000601:surgery*