Skeletal Radiology

, Volume 39, Issue 7, pp 701–705

Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures

  • Toshihiro Iguchi
  • Ken-Ichi Ogawa
  • Takeshi Doi
  • Koji Miyasho
  • Kazuo Munetomo
  • Takao Hiraki
  • Toshifumi Ozaki
  • Susumu Kanazawa
Technical Report

Abstract

Objective

The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures.

Materials and methods

Six patients (four women and two men; mean age 55.8 years; range 35–77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic ring injury (AO types B and C) was the indication for this procedure.

Results

In all the six patients except one, CT fluoroscopy-guided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9–30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6–21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk.

Conclusion

CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures.

Keywords

Pelvis Fracture Screw fixation Computed tomography fluoroscopy 

References

  1. 1.
    Routt ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584–9.CrossRefPubMedGoogle Scholar
  2. 2.
    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;13:107–13.CrossRefPubMedGoogle Scholar
  3. 3.
    Ziran BH, Smith WR, Towers J, Morgan SJ. Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerized tomography. J Bone Joint Surg Br. 2003;85:411–8.CrossRefPubMedGoogle Scholar
  4. 4.
    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:W181–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Jacob AL, Messmer P, Stock K, et al. Posterior pelvic ring fractures: closed reduction and percutaneous CT-guided sacroiliac screw fixation. Cardiovasc Intervent Radiol. 1997;20:285–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Blake-Toker A, Hawkins L, Nadalo L, et al. CT guided percutaneous fixation of sacroiliac fractures in trauma patients. J Trauma. 2001;51:1117–21.CrossRefPubMedGoogle Scholar
  7. 7.
    Carlson SK, Bender CE, Classic KL, et al. Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology. 2001;219:515–20.PubMedGoogle Scholar
  8. 8.
    Daly B, Templeton PA. Real-time CT fluoroscopy: evolution of an interventional tool. Radiology. 1999;211:309–15.PubMedGoogle Scholar
  9. 9.
    Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160:445–51.PubMedGoogle Scholar
  10. 10.
    Orthopaedic Trauma Association. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996;10(Suppl 1):69.Google Scholar
  11. 11.
    Ebraheim NA, Rusin JJ, Coombs RJ, Jackson WT, Holiday B. Percutaneous computed-tomography-stabilization of pelvic fractures: preliminary report. J Orthop Trauma. 1987;1:197–204.CrossRefPubMedGoogle Scholar
  12. 12.
    Hiraki T, Mimura H, Gobara H, et al. CT fluoroscopy-guided biopsy of 1000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest (in press).Google Scholar
  13. 13.
    Katada K, Kato R, Anno H, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology. 1996;200:851–6.PubMedGoogle Scholar
  14. 14.
    Yueh N, Halvorsen RA, Letourneau JG, Grass JR. Gantry tilt technique for CT-guided biopsy and drainage. J Comput Assist Tomogr. 1989;13:182–4.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • Toshihiro Iguchi
    • 1
  • Ken-Ichi Ogawa
    • 2
  • Takeshi Doi
    • 2
  • Koji Miyasho
    • 3
  • Kazuo Munetomo
    • 2
  • Takao Hiraki
    • 4
  • Toshifumi Ozaki
    • 5
  • Susumu Kanazawa
    • 4
  1. 1.Department of RadiologyFukuyama City HospitalFukuyamaJapan
  2. 2.Division of Orthopaedic TraumaFukuyama City Hospital Emergency Medical CenterFukuyamaJapan
  3. 3.Fukuyama City Hospital Emergency Medical CenterFukuyamaJapan
  4. 4.Department of RadiologyOkayama University Medical SchoolOkayamaJapan
  5. 5.Department of Orthopaedic SurgeryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan

Personalised recommendations