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Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 7, pp 883–887 | Cite as

Intraosseous correction of misdirected cannulated screws and fracture malalignment using a bent tip 2.0 mm guidewire: technique and indications

  • John A. ScolaroEmail author
  • Milton Lee (Chip) Routt
Orthopaedic Surgery

Abstract

Percutaneous pelvic screw placement is a technically demanding procedure. A precise intraosseous pathway must be prepared before screw placement into any osseous fixation pathway of the pelvis. Adjustments to a drill or guidewire become increasingly difficult as the instrument is advanced within the pelvis. We present a reliable and reproducible technique using a 2.0 mm guidewire that allows for correction of an initially misdirected drill within the pelvis. This technique also allows for manipulation and reduction of certain malaligned pelvic fractures prior to percutaneous cannulated screw placement. This technique does not substitute for poor surgical technique but is used to optimize the position of percutaneously placed pelvic screws.

Keywords

Pelvis Percutaneous Cannulated screws Intraosseous fixation pathway 

References

  1. 1.
    Bishop JA, Routt ML Jr (2012) Osseous fixation pathways in pelvic and acetabular fracture surgery: osteology, radiology, and clinical applications. J Trauma Acute Care Surg 72(6):1502–1509CrossRefGoogle Scholar
  2. 2.
    Routt ML Jr, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 11(8):584–589PubMedCrossRefGoogle Scholar
  3. 3.
    Tonetti J, Carrat L, Lavalleé S, Pittet L, Merloz P, Chirossel JP (1998) Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop Relat Res 354:103–110PubMedCrossRefGoogle Scholar
  4. 4.
    Blake-Toker AM, Hawkins L, Nadalo L, Howard D, Arazoza A, Koonsman M, Dunn E (2001) CT guided percutaneous fixation of sacroiliac fractures in trauma patients. J Trauma 51(6):1117–1121PubMedCrossRefGoogle Scholar
  5. 5.
    Citak M, Hüfner T, Geerling J, Kfuri M Jr, Gänsslen A, Look V, Kendoff D, Krettek C (2006) Navigated percutaneous pelvic sacroiliac screw fixation: experimental comparison of accuracy between fluoroscopy and Iso-C3D navigation. Comput Aided Surg 11(4):209–213PubMedGoogle Scholar
  6. 6.
    Moed BR, Ahmad BK, Craig JG, Jacobson GP, Anders MJ (1998) Intraoperative monitoring with stimulus-evoked electromyography during placement of iliosacral screws. An initial clinical study. J Bone Joint Surg Am 80(4):537–546PubMedGoogle Scholar
  7. 7.
    Helfet DL, Koval KJ, Hissa EA, Patterson S, DiPasquale T, Sanders R (1995) Intraoperative somatosensory evoked potential monitoring during acute pelvic fracture surgery. J Orthop Trauma 9(1):28–34PubMedCrossRefGoogle Scholar
  8. 8.
    Vrahas M, Gordon RG, Mears DC, Krieger D, Sclabassi RJ (1992) Intraoperative somatosensory evoked potential monitoring of pelvic and acetabular fractures. J Orthop Trauma 6(1):50–58PubMedGoogle Scholar
  9. 9.
    Routt ML Jr, Nork SE, Mills WJ (2000) Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res 375:15–29PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Orthopaedics and Sports Medicine, Harborview Medical CenterUniversity of WashingtonSeattleUSA

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