Post on 27-Dec-2015
• Iliosacral Screw “Safe Zone”
From Posterior Pelvic-Ring Disruptions: Iliosacral Screws, M.L Chip Routt, Jr. M.D. and Peter T. Simonian, M.D. in Master Techniques in Orthopaedic Surgery: Fractures. Lippincott Williams & Wilkins, 1998.
Sacral Ala (L5)
S1 Foramen
Upper Sacral Nerve Root Tunnel (S1)
Spinal Canal (cauda)
Imaging
All patients have different anatomy
Varying amounts of lordosis
Varying sacral slope
Views determined by anatomy
Not textbook (40-40)
From Posterior Pelvic-Ring Disruptions: Iliosacral Screws, M.L Chip Routt, Jr. M.D. and Peter T. Simonian, M.D. in Master Techniques in Orthopaedic Surgery: Fractures. Lippincott Williams & Wilkins, 1998.
Sacral Ala = 3D structure; Inlet/Outlet insufficient to r/o breach
Perfect Lateral of SacrumNeed REDUCED pelvis!
Superimposition Of AICD or Greater Notches Parallax makes both difficult
Farrell JOT 2009
Traction & Fluoroscopy Set Up
o Anterior/Caudad Traction Vector Appropriate For Most Fracture Displacements
From Posterior Pelvic-Ring Disruptions: Iliosacral Screws, M.L Chip Routt, Jr. M.D. and Peter T. Simonian, M.D. in Master Techniques in Orthopaedic Surgery: Fractures. Lippincott Williams & Wilkins, 1998.
Iliosacral Screw Inlet (Anterior / Posterior)Make Translations / Rotation In Relation To Beam (Perpendicular)
Iliosacral Screw Outlet (Cephalad / Caudad)Make Translations / Rotation In Relation To Beam (Perpendicular)
Iliosacral Screw Placement: Case 130 year old Hispanic male
Fall from scaffolding
Injury films obtained in binder
Hemodynamically unstable
Bladder injury
Iliosacral Screw Placement: Case 1
Immediate concerns?Unstable pelvic ring with hemodynamic instability
Binder vs ex-fix
Angiography?
Iliosacral Screw Placement: Case 1
Converted from binder to external fixatorAnterior ring injury more apparent out of binder
Bladder neck injury treated with foley catheter
Pelvic angiography
Iliosacral Screw Placement: Case 1
Planned open reduction of anterior sacrum and SI joint
IS screw fixation of central fracture
Continued external fixation of anterior ring injury
Issues?
Iliosacral Screw Placement: Case 1
Anterior sacral fragment and SI joint reduced
Central sacral fracture badly malreduced
IS screw a little anterior
Iliosacral Screw Placement: Case 1
Solution?Anterior sacral ORIF revised
ORIF of symphysis performed Bladder injury repaired
Improved central sacral reduction
IS screw removed
Postop CT to assess reduction