title: Bowel preparation prior to percutaneous ilio-sacral screw insertion: is it necessary?
abstract: OBJECTIVE
  The aim of this study was to compare the outcomes of ilio-sacral (IS) screw fixation with and without the use of bowel preparation, in terms of obtaining adequate visualisation, malpositioning of screw requiring revision surgery and neurovascular injury.
  
  
  METHODS
  A retrospective case control study was performed. We reviewed 74 consecutive cases of IS screw fixation performed at our institution within the last 5 years. We included all patients who had undergone percutaneous IS screw fixation. Two groups, one consisting of patients who underwent bowel preparation prior to surgery (Group 1) and one consisting of patients who had no bowel preparation (Group 2), were compared in terms of the above outcomes. There were 37 patients in each group. The mean age in Group 1 was 41 years (17-63) and in Group 2 was 47 years (12-89).
  
  
  RESULTS
  In Group 1 there were two procedures abandoned due to poor visualisation. In Group 2 there were no cases abandoned for poor visualisation. There were two nerve injuries in Group 1 and no nerve injuries in Group 2. Revision surgery was performed in four patients in Group 1-for malposition, persistent buttock pain, sciatic nerve palsy and inadequate fixation while one revision performed in Group 2 for persistent buttock pain.
  
  
  CONCLUSIONS
  Based on these results, we conclude that bowel preparation is not necessary to obtain adequate visualisation for safe and accurate percutaneous IS screw insertion. In fact, in Group 1 two procedures were abandoned and there was higher incidence of complications. Therefore, it would appear that this treatment arm should be abandoned all together. Further studies to prove it conclusively and explain the reasons are required.
authors.affiliation: Department of Trauma Orthopaedics, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Raza
authors.affiliation: Department of Trauma Orthopaedics, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Bowe
authors.affiliation: Department of Trauma Orthopaedics, Tallaght Hospital, Dublin 24, Ireland. davarinn@yahoo.com.
authors.forename: N
authors.identifier: http://orcid.org/0000-0002-0596-4859
authors.initials: N
authors.lastname: Davarinos
authors.affiliation: Department of Trauma Orthopaedics, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016022:Case-Control Studies; D002400:Cathartics / Q000008:administration & dosage*; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012447:Sacrum / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D002400:Cathartics
keywords: Bowel preparation; Ilio-sacral joint fracture/dislocation