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Assessment of pelvic injuries treated with ilio-sacral screws: injury severity and accuracy of screw positioning

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Abstract

Purpose

The aim of this study was to analyse possible indicative parameters for percutaneous ilio-sacral stabilisation and to identify parameters associated with screw misplacement.

Methods

Cohort study, level I trauma centre. Inclusion criteria: (1) unstable pelvic injury, (2) percutaneous ilio-sacral screws placement. Exclusion criteria: (1) sacral dysmorphy, (2) failed closed reduction, (3) navigated techniques. Indicative parameters were age, gender, body mass index, number of screws, screw angulation, fracture type and injury severity. End points were ilio-sacral screw position and associated complications. Screw placement accuracy was graded as follows: grade 0, no perforation; grade 1, perforation <2 mm; grade 2, perforation from 2 to 4 mm; grade 3, ≥4 mm perforation.

Results

Between March 2008 and March 2013, 102 (53 women) patients were included (mean age, 48.5 ± 21.4 years). The Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 18.9 ± 9.9 and 22.3 ± 22.3, respectively. The positions of 137 ilio-sacral screws were analysed. Of all screws, 87.6 % (120) were placed satisfactory (<2 mm perforation). The incidence of screw misplacement was significantly higher in the case of two unilateral S1 screws compared with a single screw (failure rate: two unilateral screws 23.1 % vs single screw 7.0 %; p < 0.05). Screw perforation anterior to the lateral mass (in-out-in) represented the most frequent malposition. Revision was necessary in three cases due to malpositioning. Furthermore, no major complication occurred.

Conclusions

We conclude, that twofold ilio-sacral screw positioning from one side increases the risk for screw misplacement. In this case, alternative techniques like navigation should be considered. Anterior screw perforation represents a common problem with a high incidence and warrants particular attention.

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Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstreet 30, 52074, Aachen, Germany

    Miguel Pishnamaz, Thomas Dienstknecht, Barbara Hoppe, Christina Garving, Henning Lange, Frank Hildebrand, Philipp Kobbe & Hans-Christoph Pape

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  1. Miguel Pishnamaz
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  2. Thomas Dienstknecht
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  3. Barbara Hoppe
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  4. Christina Garving
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  5. Henning Lange
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  6. Frank Hildebrand
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  7. Philipp Kobbe
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  8. Hans-Christoph Pape
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Correspondence to Miguel Pishnamaz.

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Pishnamaz, M., Dienstknecht, T., Hoppe, B. et al. Assessment of pelvic injuries treated with ilio-sacral screws: injury severity and accuracy of screw positioning. International Orthopaedics (SICOT) 40, 1495–1501 (2016). https://doi.org/10.1007/s00264-015-2933-1

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  • DOI: https://doi.org/10.1007/s00264-015-2933-1

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