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An evaluation of the inlet obturator oblique view for sacroiliac and transsacral screw placement

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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Abstract

Introduction

Between 2005 and 2017, the number of closed reduction and internal fixation of pelvic ring injuries increased by 1116%. Percutaneous fixation is currently the only minimally invasive technique that can stabilize the posterior elements of the pelvis. The purpose of this study was to investigate the utility of the inlet obturator oblique view (IOO) with the hypothesis that the IOO view will improve the accuracy of sacroiliac and transsacral screw placement in the S1 or S2 body and improve the accuracy of assessing whether the implant is fully seated against the outer cortex of the ilium.

Materials and methods

Ten male pelvic training models were used. Thirty-six screw configurations were inserted by a fellowship trained orthopedic trauma surgeon in appropriately and inappropriately placed sacroiliac and transsacral screw configurations. These configurations were imaged using fluoroscopy in different planes and saved for survey.

Results

Fourteen orthopedic professionals reviewed 313 fluoroscopic images. Interrater reliability demonstrated marked improvement in assessment of whether the screw head was seated against the outer cortex of the ilium with the IOO view (kappa = 0.841, without IOO kappa = 0.027). There was a statistically significant difference in overall accuracy (p value < 0.001, OR = 1.57, 95% CI = 1.35–1.84) and whether the screw head was seated (p value < 0.001, OR = 8.14, 95% CI = 5.52–11.99) when compared with and without the IOO view (accuracy with IOO view: 85%, accuracy without IOO view: 78.26%; screw seated with IOO view: 93.93%, screw seated without IOO view: 65.54%). There was no significant difference (p value 0.465, OR = 1.13, 95% CI = 0.82–1.55) determining if the screw was in a safe position (safe with IOO view: 84.64%, safe without IOO view: 83.04%).

Conclusions

Our findings demonstrate that misinterpretation of sacroiliac and transsacral screw placement can occur with the standard fluoroscopic imaging. We suggest the addition of the IOO view increases the overall accuracy of screw placement and whether the screw head is fully seated against the outer table of the ilium. This in turn can improve fixation and potentially improve patient outcomes and decrease adverse events.

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Change history

  • 12 March 2022

    Author’s personal address is listed next to the hospital name instead of the hospital address. The hospital address is 26520 Cactus Ave, Moreno Valley, CA 92555

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Authors and Affiliations

  1. Orthopaedic Surgery, Riverside University Health System Medical Center, 26520 Cactus Ave, Moreno Valley, CA, 92555, USA

    Kurt Barger & Matthew Robinson

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  1. Kurt Barger
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  2. Matthew Robinson
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Correspondence to Kurt Barger.

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The authors whose names are listed directly above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Informed consent was obtained by each participant who took part in completing the survey.

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Barger, K., Robinson, M. An evaluation of the inlet obturator oblique view for sacroiliac and transsacral screw placement. Arch Orthop Trauma Surg 143, 1869–1875 (2023). https://doi.org/10.1007/s00402-022-04370-z

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  • DOI: https://doi.org/10.1007/s00402-022-04370-z

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