title: Intra-operative multi-dimensional fluoroscopy of guidepin placement prior to iliosacral screw fixation for posterior pelvic ring injuries and sacroiliac dislocation: an early case series.
abstract: Traditional fluoroscopic techniques during percutaneous fixation of the posterior pelvic ring at times cannot adequately visualize errant or malpositioned iliosacral screws. Intra-operative fluoroscopic techniques have been advanced using multi-dimensional fluoroscopy to generate computed tomography-like images. This provides the surgeon not only the ability to assess iliosacral screw placement, but also the opportunity to assess reduction. We present a case series of four patients in which the Ziehm RFD multi-dimensional fluoroscopy was used to assess reduction and guidepin placement prior to definitive iliosacral screw fixation.
  
  
  
  Four patients at our university level 1 trauma center with posterior pelvic ring disruptions were treated with percutaneous iliosacral screw fixation. Traditional fluoroscopic techniques were used during guidepin placement. Multi-dimensional fluoroscopy was performed using the Ziehm RFD 3D to assess guidepin placement and reduction prior to definitive iliosacral screw fixation.
  
  
  
  Our case series highlights two patients in which multi-dimensional fluoroscopy was utilized to ensure safe placement of iliosacral screws. In one of these two patients, a change was made after reviewing the imaging as a guidepin was found to be intruded into bilateral S2 neural tunnels. We also present two patient examples in which multidimensional fluoroscopy was used to assess reduction achieved by less invasive methods, precluding the need for direct visualization using more extensive open approaches.
  
  
  
  This retrospective case series demonstrates the direct impact that the Ziehm RFD 3D technology provides in surgical management of patients with complex posterior pelvic ring injuries.
authors.affiliation: Department of Orthopaedic Surgery, McGovern Medical School at UTHealth Houston, 6400 Fannin St. Suite 1700, Houston, TX, 77030, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Shaw
authors.affiliation: Department of Orthopaedic Surgery, McGovern Medical School at UTHealth Houston, 6400 Fannin St. Suite 1700, Houston, TX, 77030, USA.
authors.forename: Milton L Chip
authors.initials: MLC
authors.lastname: Routt
authors.affiliation: Department of Orthopaedic Surgery, McGovern Medical School at UTHealth Houston, 6400 Fannin St. Suite 1700, Houston, TX, 77030, USA. joshgary14@gmail.com.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Gary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000009:adverse effects; D005471:Fluoroscopy / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Acetabulum; Fluoroscopy; Iliosacral screw; Intra-operative; Multidimensional; Pelvic ring