Routt reports the first 68 consecutive patients treated with percutaneous iliosacral screw fixation for posterior pelvic ring disruptions, all performed supine. The study asks whether supine positioning offers technical advantages over prone, and documents early outcomes, complications, and the technique refinements that made the procedure reproducibly safe.
A 0% infection rate in a series where open posterior fixation historically ran 25% is not luck — it is a direct result of keeping instruments out of the contused posterior soft-tissue envelope.
When you plan iliosacral screw fixation, position the patient supine: fix the anterior ring first (which simplifies posterior manipulation), apply Schanz pins and femoral traction without repositioning, and run concurrent abdominal or urologic procedures under the same anesthetic.
When you see a complete SI joint dislocation, plan for open reduction. Every complete dislocation in this series failed closed manipulation and required direct clamp compression before the screw could be placed.
Obtain the lateral sacral fluoroscopic view on every case. Every screw complication in this foundational series happened before that view was adopted. It remains the non-negotiable safety check for staying within the S1 osseous corridor.
Routt reports the first 68 consecutive patients treated with percutaneous iliosacral screw fixation for posterior pelvic ring disruptions, all performed supine. The study asks whether supine positioning offers technical advantages over prone, and documents early outcomes, complications, and the technique refinements that made the procedure reproducibly safe.
A 0% infection rate in a series where open posterior fixation historically ran 25% is not luck — it is a direct result of keeping instruments out of the contused posterior soft-tissue envelope.
When you plan iliosacral screw fixation, position the patient supine: fix the anterior ring first (which simplifies posterior manipulation), apply Schanz pins and femoral traction without repositioning, and run concurrent abdominal or urologic procedures under the same anesthetic.
When you see a complete SI joint dislocation, plan for open reduction. Every complete dislocation in this series failed closed manipulation and required direct clamp compression before the screw could be placed.
Obtain the lateral sacral fluoroscopic view on every case. Every screw complication in this foundational series happened before that view was adopted. It remains the non-negotiable safety check for staying within the S1 osseous corridor.