Routt, J Orthop Trauma 1997 - Iliosacral Screw Fixation: Early Complications of the Percutaneous Technique - Article Summary

Iliosacral Screw Fixation: Early Complications of the Percutaneous Technique

Routt, Mills, et al.·J Orthop Trauma·1997·460 citations·Prospective cohort

Purpose

To report on the early complications related to the percutaneous placement of iliosacral screws for the operative treatment of displaced posterior pelvic ring disruptions.

Methods

Study Design: Prospective, consecutive.

Setting: Level-one trauma center.

Patients: 177 consecutive patients with unstable pelvic ring fractures. 102 male and 75 female patients ranging in age from 11 to 78 years (mean, 32 years).

Interventions:

Operative procedures were performed urgently according to the patient's clinical condition.
Anterior pelvic reductions and fixations were performed by using internal and external fixation techniques.
Accurate closed or open reductions of the posterior pelvic ring disruptions were accomplished by using a variety of surgical techniques dependent on the specific pattern of pelvic ring disruption.
Closed manipulative reductions of the posterior pelvic ring were attempted for all patients.
Open reductions were necessary in those patients with unacceptable closed manipulative reductions as assessed fluoroscopically at the time of operation (more than one centimeter in any field of fluoroscopic imaging).

Main Outcome Measures:

Plain inlet and outlet radiographs were obtained postoperatively at 6 weeks, 3 months, and 12 months.
A pelvic computed tomography scan was performed postoperatively to assess fracture or dislocation reduction and the implant safety.
Annual follow-up pelvic radiographs were obtained.
Residual pelvic deformities were quantified based on these imaging modalities.

Results

There were no posterior pelvic infections.
Minimal blood loss was associated with this technique.
Complications occurred due to inadequate imaging, surgeon error, and fixation failure.
Fluoroscopic imaging was inadequate due to obesity or abdominal contrast in 18 patients.
5 screws were misplaced due to surgeon error.
One misplaced screw produced a transient L5 neuropraxia.
Fixation failures related to either crandiocerebral trauma, delayed union, noncomplicance, and a deep anterior pelvic polymicrobial infection secondary to a urethral tear occurred in 7 patients.
There were 2 sacral nonunions that required debridement, bone grafting, and repeat fixation prior to healing.

Conclusions

Iliosacral screw fixation of the posterior pelvis is difficult. The surgeon must understand the variability of sacral anatomy. Quality triplanar fluoroscopic imaging of the accurately reduced posterior pelvic ring should allow for safe iliosacral screw insertions. Anticipated noncompliant patients or those with craniocerebral trauma may need supplementary posterior pelvic fixation. Low rates of infection, blood loss, and nonunion can be expected.

Core

Iliosacral Screw Fixation: Early Complications of the Percutaneous Technique.

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Iliosacral Screw Fixation: Early Complications of the Percutaneous Technique

Routt, Mills, et al.·J Orthop Trauma·1997·460 citations·Prospective cohort

DOI·PubMed

Purpose

To report on the early complications related to the percutaneous placement of iliosacral screws for the operative treatment of displaced posterior pelvic ring disruptions.

Methods

Study Design: Prospective, consecutive.

Setting: Level-one trauma center.

Patients: 177 consecutive patients with unstable pelvic ring fractures. 102 male and 75 female patients ranging in age from 11 to 78 years (mean, 32 years).

Interventions:

Operative procedures were performed urgently according to the patient's clinical condition.
Anterior pelvic reductions and fixations were performed by using internal and external fixation techniques.
Accurate closed or open reductions of the posterior pelvic ring disruptions were accomplished by using a variety of surgical techniques dependent on the specific pattern of pelvic ring disruption.
Closed manipulative reductions of the posterior pelvic ring were attempted for all patients.
Open reductions were necessary in those patients with unacceptable closed manipulative reductions as assessed fluoroscopically at the time of operation (more than one centimeter in any field of fluoroscopic imaging).

Main Outcome Measures:

Plain inlet and outlet radiographs were obtained postoperatively at 6 weeks, 3 months, and 12 months.
A pelvic computed tomography scan was performed postoperatively to assess fracture or dislocation reduction and the implant safety.
Annual follow-up pelvic radiographs were obtained.
Residual pelvic deformities were quantified based on these imaging modalities.

Results

There were no posterior pelvic infections.
Minimal blood loss was associated with this technique.
Complications occurred due to inadequate imaging, surgeon error, and fixation failure.
Fluoroscopic imaging was inadequate due to obesity or abdominal contrast in 18 patients.
5 screws were misplaced due to surgeon error.
One misplaced screw produced a transient L5 neuropraxia.
Fixation failures related to either crandiocerebral trauma, delayed union, noncomplicance, and a deep anterior pelvic polymicrobial infection secondary to a urethral tear occurred in 7 patients.
There were 2 sacral nonunions that required debridement, bone grafting, and repeat fixation prior to healing.

Conclusions

Purpose

To report on the early complications related to the percutaneous placement of iliosacral screws for the operative treatment of displaced posterior pelvic ring disruptions.

Methods

Study Design: Prospective, consecutive.

Setting: Level-one trauma center.

Patients: 177 consecutive patients with unstable pelvic ring fractures. 102 male and 75 female patients ranging in age from 11 to 78 years (mean, 32 years).

Interventions:

Operative procedures were performed urgently according to the patient's clinical condition.
Anterior pelvic reductions and fixations were performed by using internal and external fixation techniques.
Accurate closed or open reductions of the posterior pelvic ring disruptions were accomplished by using a variety of surgical techniques dependent on the specific pattern of pelvic ring disruption.
Closed manipulative reductions of the posterior pelvic ring were attempted for all patients.
Open reductions were necessary in those patients with unacceptable closed manipulative reductions as assessed fluoroscopically at the time of operation (more than one centimeter in any field of fluoroscopic imaging).

Main Outcome Measures:

Plain inlet and outlet radiographs were obtained postoperatively at 6 weeks, 3 months, and 12 months.
A pelvic computed tomography scan was performed postoperatively to assess fracture or dislocation reduction and the implant safety.
Annual follow-up pelvic radiographs were obtained.
Residual pelvic deformities were quantified based on these imaging modalities.

Results

There were no posterior pelvic infections.
Minimal blood loss was associated with this technique.
Complications occurred due to inadequate imaging, surgeon error, and fixation failure.
Fluoroscopic imaging was inadequate due to obesity or abdominal contrast in 18 patients.
5 screws were misplaced due to surgeon error.
One misplaced screw produced a transient L5 neuropraxia.
Fixation failures related to either crandiocerebral trauma, delayed union, noncomplicance, and a deep anterior pelvic polymicrobial infection secondary to a urethral tear occurred in 7 patients.
There were 2 sacral nonunions that required debridement, bone grafting, and repeat fixation prior to healing.

Conclusions

Purpose

To report on the early complications related to the percutaneous placement of iliosacral screws for the operative treatment of displaced posterior pelvic ring disruptions.

Methods

Study Design: Prospective, consecutive.

Setting: Level-one trauma center.

Patients: 177 consecutive patients with unstable pelvic ring fractures. 102 male and 75 female patients ranging in age from 11 to 78 years (mean, 32 years).

Interventions:

Operative procedures were performed urgently according to the patient's clinical condition.
Anterior pelvic reductions and fixations were performed by using internal and external fixation techniques.
Accurate closed or open reductions of the posterior pelvic ring disruptions were accomplished by using a variety of surgical techniques dependent on the specific pattern of pelvic ring disruption.
Closed manipulative reductions of the posterior pelvic ring were attempted for all patients.
Open reductions were necessary in those patients with unacceptable closed manipulative reductions as assessed fluoroscopically at the time of operation (more than one centimeter in any field of fluoroscopic imaging).

Main Outcome Measures:

Plain inlet and outlet radiographs were obtained postoperatively at 6 weeks, 3 months, and 12 months.
A pelvic computed tomography scan was performed postoperatively to assess fracture or dislocation reduction and the implant safety.
Annual follow-up pelvic radiographs were obtained.
Residual pelvic deformities were quantified based on these imaging modalities.

Results

There were no posterior pelvic infections.
Minimal blood loss was associated with this technique.
Complications occurred due to inadequate imaging, surgeon error, and fixation failure.
Fluoroscopic imaging was inadequate due to obesity or abdominal contrast in 18 patients.
5 screws were misplaced due to surgeon error.
One misplaced screw produced a transient L5 neuropraxia.
Fixation failures related to either crandiocerebral trauma, delayed union, noncomplicance, and a deep anterior pelvic polymicrobial infection secondary to a urethral tear occurred in 7 patients.
There were 2 sacral nonunions that required debridement, bone grafting, and repeat fixation prior to healing.