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Semin Musculoskelet Radiol 2013; 17(04): 407-415
DOI: 10.1055/s-0033-1356470
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

CT-Guided Iliosacral Screw Placement

Richard H. Daffner
1   Department of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
,
Robert L. Sciulli
1   Department of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Publikationsdatum:
07. Oktober 2013 (online)

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Abstract

Computed tomography (CT)–guided iliosacral screw placement for posttraumatic instability of that joint is a safe procedure that may be performed in a radiology department. CT guidance allows more accurate screw placement than traditional fluoroscopic imaging in the operating room. This article describes the technique for placing cannulated surgical screws percutaneously across the iliosacral joint in patients with unstable pelvic fractures using CT for guidance. We also discuss the pitfalls of the procedure and the complications.

Keywords

interventional radiology - CT-guided procedures - sacroiliac (iliosacral) joint injuries
 

  • References

  • 1 McMurtry R, Walton D, Dickinson D, Kellam J, Tile M. Pelvic disruption in the polytraumatized patient: a management protocol. Clin Orthop Relat Res 1980; 151 (151) 22-30
    PubMedGoogle Scholar
  • 2 Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res 1980; 151 (151) 12-21
    PubMedGoogle Scholar
  • 3 Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am 1987; 18 (1) 25-41
    PubMedGoogle Scholar
  • 4 Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 1989; 242 (242) 83-97
    PubMedGoogle Scholar
  • 5 van den Bosch EW, van Zwienen CMA, van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma 2002; 53 (1) 44-48
    CrossrefPubMedGoogle Scholar
  • 6 Routt Jr ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 1997; 11 (8) 584-589
    CrossrefPubMedGoogle Scholar
  • 7 Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O'Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma 1999; 13 (2) 107-113
    CrossrefPubMedGoogle Scholar
  • 8 Ebraheim NA, Rusin JJ, Coombs RJ, Jackson WT, Holiday B. Percutaneous computed-tomography-stabilization of pelvic fractures: preliminary report. J Orthop Trauma 1987; 1 (3) 197-204
    CrossrefPubMedGoogle Scholar
  • 9 Duwelius PJ, Van Allen M, Bray TJ, Nelson D. Computed tomography-guided fixation of unstable posterior pelvic ring disruptions. J Orthop Trauma 1992; 6 (4) 420-426
    CrossrefPubMedGoogle Scholar
  • 10 Ebraheim NA, Coombs R, Jackson WT, Rusin JJ. Percutaneous computed tomography-guided stabilization of posterior pelvic fractures. Clin Orthop Relat Res 1994; 307 (307) 222-228
    PubMedGoogle Scholar
  • 11 Barrick EF, O'Mara JW, Lane III HE. Iliosacral screw insertion using computer-assisted CT image guidance: a laboratory study. Comput Aided Surg 1998; 3 (6) 289-296
    CrossrefPubMedGoogle Scholar
  • 12 Blake-Toker A-M, Hawkins L, Nadalo L , et al. CT guided percutaneous fixation of sacroiliac fractures in trauma patients. J Trauma 2001; 51 (6) 1117-1121
    CrossrefPubMedGoogle Scholar
  • 13 Ziran BH, Smith WR, Towers J, Morgan SJ. Iliosacral screw fixation of the posterior pelvic ring using local anesthesia and computerised tomography. J Bone Joint Surg Br 2003; 85 (3) 411-418
    CrossrefPubMedGoogle Scholar
  • 14 Tsukushi S, Katagiri H, Nakashima H, Shido Y, Wasa J. Computed tomography-guided screw fixation of a sacroiliac joint dislocation fracture: a case report. J Orthop Sci 2003; 8 (5) 729-732
    CrossrefPubMedGoogle Scholar
  • 15 Nelson DW, Duwelius PJ. CT-guided fixation of sacral fractures and sacroiliac joint disruptions. Radiology 1991; 180 (2) 527-532
    CrossrefPubMedGoogle Scholar
  • 16 Jacob AL, Messmer P, Stock K-W , et al. Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol 1997; 20 (4) 285-294
    CrossrefPubMedGoogle Scholar
  • 17 Sciulli RL, Daffner RH, Altman DT, Altman GT, Sewecke JJ. CT-guided iliosacral screw placement: technique and clinical experience. AJR Am J Roentgenol 2007; 188 (2) W181-W192 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17179319&dopt=Abstract
    CrossrefPubMedGoogle Scholar
  • 18 Tonetti J, Carrat L, Lavalleé S, Pittet L, Merloz P, Chirossel JP. Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop Relat Res 1998; 354 (354) 103-110
    CrossrefPubMedGoogle Scholar
  • 19 Routt Jr ML, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res 2000; (375) 15-29
    PubMedGoogle Scholar
  • 20 Baskin KM, Cahill AM, Kaye RD, Born CT, Grudziak JS, Towbin RB. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation. Pediatr Radiol 2004; 34 (12) 963-969
    CrossrefPubMedGoogle Scholar
  • 21 Day AC, Stott PM, Boden RA. The accuracy of computer-assisted percutaneous iliosacral screw placement. Clin Orthop Relat Res 2007; 463: 179-186
    PubMedGoogle Scholar
  • 22 Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 2009; 467 (7) 1833-1838
    CrossrefPubMedGoogle Scholar
  • 23 Kraus MD, Krischak G, Keppler P, Gebhard FT, Schuetz UHW. Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion?. Clin Orthop Relat Res 2010; 468 (9) 2419-2429
    CrossrefPubMedGoogle Scholar
  • 24 Iguchi T, Ogawa K-I, Doi T , et al. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiol 2010; 39 (7) 701-705
    CrossrefPubMedGoogle Scholar