title: Critical dimensions of trans-sacral corridors assessed by 3D CT models: Relevance for implant positioning in fractures of the sacrum.
abstract: Trans-sacral implants can be used alternatively to sacro-iliac screws in the treatment of osteoporosis-associated fragility fractures of the pelvis and the sacrum. We investigated trans-sacral corridor dimensions, the number of individuals amenable to trans-sacral fixation, as well as the osseous boundaries and shape of the S1 corridor. 3D models were reconstructed from pelvic CT scans from 92 Europeans and 64 Japanese. A corridor of <12 mm was considered critical for trans-sacral implant positioning, and <8 mm as impossible. A statistical model of trans-sacral corridor S1 was computed. The limiting cranio-caudal diameter was 11.6 mm (±5.4) for S1 and 14 mm (±2.4) for S2. Trans-sacral implant positioning was critical in 52% of cases for S1, and in 21% for S2. The S1 corridor was impossible in 26%, with no impossible corridor in S2. Antero-superiorly, the S1 corridor was limited not only by the sacrum but in 40% by the iliac fossa. The statistical model demonstrated a consistent oval shape of the trans-section of corridor S1. Considering the variable in size and shape of trans-sacral corridors in S1, a thorough anatomical knowledge and preoperative planning are mandatory using trans-sacral implants. In critical cases, S2 is a veritable alternative. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2577-2584, 2017.
authors.affiliation: AO Research Institute Davos, Davos, Switzerland.|Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: Daniel
authors.identifier: 0000-0003-4455-1018
authors.initials: D
authors.lastname: Wagner
authors.affiliation: AO Research Institute Davos, Davos, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Kamer
authors.affiliation: Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sawaguchi
authors.affiliation: AO Research Institute Davos, Davos, Switzerland.
authors.forename: R
authors.identifier: 0000-0002-7778-2480
authors.initials: R
authors.lastname: Geoff Richards
authors.affiliation: AO Research Institute Davos, Davos, Switzerland.
authors.forename: Hansrudi
authors.initials: H
authors.lastname: Noser
authors.affiliation: Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Uesugi
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ossendorf
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D012447:Sacrum / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: corridor; fracture; sacroiliac screw; sacrum; trans-sacral