• Matthew Burn, Joshua L Gary, Michael Holzman, John A Heydemann, John W Munz, Matthew Galpin, Catherine G Ambrose, Timothy S Achor, and Manickam Kumaravel.
• *Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, TX; andDepartments of †Orthopaedic Surgery and‡Radiology, University of Texas Health Science Center-Houston, Houston, TX.
• J Orthop Trauma. 2016 Jan 1; 30 (1): 41-7.

ObjectivesIliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients.SettingAcademic level I Trauma Center.PatientsAll patients between ages 2 and 16 years with a computed tomography scan including the pelvis obtained over a 6-week period (174 children, mean age 10.8 ± 3.9 years; 90 boys, 84 girls).InterventionThe width and height at the "constriction point" in 3 safe screw pathways were measured bilaterally by 3 orthopaedists (resident, trauma fellow, trauma attending). Pathways corresponding to: (1) an "iliosacral" screw at S1, a "trans-sacral trans-iliac" (TSTI) screw at S1, and a TSTI screw at S2.Main Outcome Measurements(1) Mean width and height of pathways, (2) interrater reliability coefficient, (3) availability of pathways greater than 7 mm, (4) growth of pathways with age, (5) sacral morphology.ResultsThe interrater reliability coefficient was above 0.917 for all measurements. Radiographically safe pathways were available for 99%, 51%, and 89% of children for iliosacral screws at S1 (width 16.4 ± 2.8 mm, height 15.1 ± 3.3 mm), TSTI screws at S1 (width 7.2 ± 4.9 mm, height 8.3 ± 5.6 mm), and TSTI at S2 (width 9.3 ± 2.2 mm, height 11.5 ± 2.7 mm), respectively.ConclusionsContrary to our hypothesis, almost all children aged 2-16 had a radiographically safe screw pathway for an iliosacral screw at S1, and most of the children had an available pathway for a TSTI screw at S2. However, only 51% had a pathway for a TSTI screw at S1.

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