• Kurt Barger and Matthew Robinson.
• Orthopaedic Surgery, Riverside University Health System Medical Center, 26520 Cactus Ave, Moreno Valley, CA, 92555, USA. kmbarger1993@gmail.com.
• Arch Orthop Trauma Surg. 2023 Apr 1; 143 (4): 186918751869-1875.

IntroductionBetween 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 MethodsTen 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.ResultsFourteen 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%).ConclusionsOur 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.© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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