title: Effect of the subcutaneous route for iliac screw insertion in lumbopelvic fixation for vertical unstable sacral fractures on the infection rate: A retrospective case series.
abstract: OBJECTIVE
  To report the perioperative results and surgical outcomes of patients with vertical unstable sacral fractures who underwent lumbopelvic fixation through a modified subcutaneous route for iliac screw fixation.
  
  
  BACKGROUND
  Treating vertical unstable sacral fractures is still challenging for orthopedic surgeons. Among various methods for treating these fractures, lumbopelvic fixation provides a high reduction quality and promising stability for early weight-bearing ambulation. However, wound healing disturbance and surgical site infection (SSI) are the drawbacks of this extensive technique, especially after inserting iliac screws.
  
  
  METHODS
  Here, we provide an alternative subcutaneous route for iliac screw insertion during lumbopelvic fixation surgery to lessen soft tissue retraction and injury, and thus decrease soft tissue complications.
  
  
  RESULTS
  Using this modified technique, 28 patients with vertical unstable sacral fractures were treated between 2012 and 2014. One patient had an SSI (infection rate: 3.5%). All fractures were united with a mean sacral kyphosis correction angle of 10.5°. The mean Majeed score of the 17 patients during the 12-month follow-up was 84.5.
  
  
  CONCLUSIONS
  The subcutaneous route for iliac screw insertion is a simple, safe, and effective technique when performing lumbopelvic fixation for vertical unstable sacral fractures.
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: alanyu1007@gmail.com.
authors.forename: Yi-Hsun
authors.initials: YH
authors.lastname: Yu
authors.affiliation: Division of Spine, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: lumengling@gmail.com.
authors.forename: Meng-Ling
authors.initials: ML
authors.lastname: Lu
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: ichuantseng@adm.cgmh.org.tw.
authors.forename: I-Chuan
authors.initials: IC
authors.lastname: Tseng
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: su1491@adm.cgmh.org.tw.
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Su
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: laurencehsu.hsu@gmail.com.
authors.forename: Yung-Heng
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: yeh.wenlin@msa.hinet.net.
authors.forename: Wen-Lin
authors.initials: WL
authors.lastname: Yeh
authors.affiliation: Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan, Taiwan. Electronic address: ccwu@mail.cgu.edu.tw.
authors.forename: Chi-Chung
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016683:Supine Position; D013624:Taiwan; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult
keywords: Case series; Iliac screw; Iliac screw insertion; Lumbopelvic fixation; Pelvic fracture; Retrospective case series; Retrospective study; Sacral fracture; Surgical site infection; Vertical unstable sacral fracture