Clinical results in the posterior pelvic injuries which are treated with percutaneous cannulated screw

Main Article Content

Zafer Sen
Alper Kurtoğlu https://orcid.org/0000-0001-9890-1330
Halil Ekrem Akkurt https://orcid.org/0000-0002-5521-1214
Halim Yılmaz https://orcid.org/0000-0002-5521-1214
İlker Çöven https://orcid.org/0000-0002-3888-8960

Keywords

Posterior pelvic ring injuries, PSV technique, Pelvic Outcome Score

Abstract

Study Objectives: The sacrum is an important structure that provides approximately 70% of the body weight to be transmitted to the pelvic ring. Sacral fractures and associated sacroiliac joint injuries may occur with high-energy injuries in young people and low-energy trauma due to osteoporosis in elderly patients. Methods: 21 patients who underwent posterior pelvic ring injury between 2012 and 2020 at the Health Sciences University Konya Training and Research Hospital were studied. Percutaneous Sacroiliac Screwing (PSS) technique was used as the operation technique. Patients who had bilateral posterior ring injury and were operated on were studied. Results: There was no significant difference between demographical characteristics (age, gender) and the fracture type, and POS also (p>0.05). However, the weight of the patients in “fair” class was found significantly higher (p=0,026). Besides, the operation time was significantly lower in “excellent” and “good” POS classes (p=0.017). Conclusions: In the study performed by Chen et al., the exposure of scopy was found to be 22.1 shots 5. In our study, it was found to be 25.04 shots on average although the method was bilateral PSS. Although PSS has a learning curve, it is an easy-to-apply technique. Although bilateral PSS was used in our study, the duration was found to be 22 minutes. It can be concluded that PSS is a minimally invasive technique with a high learning curve and performing bilateral PSS through the same guide shortens the surgical time and reduces the exposure of scopy.

Downloads

Download data is not yet available.
Abstract 0 | PDF Downloads 3

References

1. Kılınç CY. Posterior Pelvik Halka Yaralanmalarında Hangi Teknik Seçilmelidir: Perkütan Sakroiliak Vida Fiksasyonu Ya Da Posterior Perkutan Transiliak Plak Fiksasyonu? Journal of Kırıkkale University Faculty of Medicine 2019;21(1):80-4.
2. Denis F, Davis S, Comfort T. Sacral fractures: An important problem: Retrospective analysis of 236 cases. Clinical Orthopaedics and Related Research. 1988;227:67-81.
3. König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: A systematic review of current treatment strategies. European Spine Journal 2012;21(5):829-836.
4. Williams SK, Quinnan SM. Percutaneous lumbopelvic fixation for reduction and stabilization of sacral fractures with spinopelvic dissociation patterns. Journal of Orthopaedic Trauma. 2016;30(9):318.
5. Chen HW, Liu GD, Fei J, et al. Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: A comparative study. Journal of Orthopaedic Science. 2012;17(5):580-7.
6. Hak DJ, Baran S, Stahel P. Sacral fractures: Current strategies in diagnosis and management. Orthopedic surgery. 2009;32(10).
7. Schep NWL, Haverlag R, Van Vugt AB. Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain. The Journal of Trauma Injury Infection and Critical Care. 2004;57(6):1299-1302.
8. Josten C, Schildhauer TA, Muhr G. Therapy of unstable sacrum fractures in pelvic ring. Results of of osteosynthesis with early mobilization. Chirurg. 1994;65(11):970-5.
9. Kach K, Trentz O. Distraction spondylodesis of the sacrum in vertical shear lesions of the pelvis. Unfallchirurg. 1994;97(1):28-38.
10. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clinical Orthopaedics and Related Research. 1989;242:83-97.
11. Liu Y, Zhou W, Xia T, et al. Application of the Guiding Template Designed by Three-dimensional Printing Data for the Insertion of Sacroiliac Screws: a New Clinical Technique. Current Medical Science 2018;38(6):1090-5.
12. Farrell ED, Gardner MJ, Krieg JC, Chip Routt ML. The upper sacral nerve root tunnel: An anatomic and clinical study. Journal of Orthopaedic Trauma. 2009;23(5):333-9.
13. Gänsslen A, Hüfner T, Krettek C. Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper Orthop Traumatol. 2006;18(3):225-244.
14. Uğraş AA, Yilmaz M, Şener N. Sakrum Kırıkları İçin Perkütanöz İliosakral Vida Uygulaması. 2011;22(4):285-292.
15. Collinge C, Coons D, Aschenbrenner J. Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion. An anatomical cadaver study. Journal of Orthopaedic Trauma. 2005;19(2):96-101.
16. Bydon M, Fredrickson V, de la Garza-Ramos R, et al. Sacral fractures. Neurosurgical Focus. 2014;37(1):E12.
17. Krappinger D, Larndorfer R, Struve P, Rosenberger R, Arora R, Blauth M. Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: A clinical and radiological follow-up. Journal of Orthopaedic Trauma. 2007;21(9):595-602.
18. Tornetta P, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clinical Orthopaedics and Related Research. 1996;329:186-193.
19. Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T. Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. International Orthopaedics. 2012;36(1):159-164.
20. Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CML. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: Technique and perioperative complications. Archives of Orthopaedic and Trauma Surgery. 2011;131(6):809-813.
21. Iguchi T, Ogawa KI, Doi T, et al. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiology Journal.2010;39(7):701-5.
22. Galler RM, Dogan S, Fifield MS, et al. Biomechanical comparison of instrumented and uninstrumented multilevel cervical discectomy versus corpectomy. Spine (Phila Pa 1976). 2007;32(11):1220-6.
23. Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. Journal of Orthopaedic Trauma. 2004;18(3):138-143.
24. Hinsche AF, Giannoudis P V., Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clinical Orthopaedics and Related Research.. 2002;395:135-144.
25. Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthopaedica. 2005;76(5):667-678.
26. Zhang R, Yin Y, Li S, Hou Z, Jin L, Zhang Y. Percutaneous sacroiliac screw versus anterior plating for sacroiliac joint disruption: A retrospective cohort study. International Journal of Surgery. 2018;50(December 2017):11-16.
27. Acker A, Perry ZH, Blum S, Shaked G, Korngreen A. Immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures: is it safe enough? European Journal of Trauma and Emergency Surgery. 2018;44(2):163-9.
28. Tidwell J, Cho R, Spence Reid J, Boateng H, Copeland C, Sirlin E. Percutaneous sacroiliac screw technique. Journal of Orthopaedic Trauma. 2016;30(8):S19-S20.
29. Long T, Li K nan, Gao J hua, et al. Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures. Orthopaedic Surgery. 2019;11(3):386-396.
30. Tran ZV, Ivashchenko A, Brooks L. Sacroiliac joint fusion methodology - minimally invasive compared to screw-type surgeries: A systematic review and meta-analysis. Pain Physician. 2019;22(1):29-40.