Journal of orthopaedic trauma
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The purpose of this study was to evaluate the clinical safety and efficacy of using a cannulated transsacral screw having a novel locking capability for pelvic fracture fixation. ⋯ Locked transsacral screw fixation is a safe and effective technique that should be added to our surgical armamentarium. Indications include bilateral posterior injury as well as any situation in which routine transsacral screw fixation might otherwise be considered such as the presence of pelvic osteopenia or insufficient space for a second point of posterior fixation.
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Acute traumatic pelvic ring injuries are associated with life-threatening hemorrhage related to pelvic instability. Rapid and effective methods to mechanically stabilize the pelvic injury are often a prerequisite for patient survival. ⋯ Pelvic antishock clamp placement is difficult and dangerous, and circumferential pelvic antishock sheeting is not universally effective in reducing and stabilizing the pelvic ring. We describe a technique of acute posterior pelvic ring reduction and stabilization using a percutaneously inserted iliosacral screw as a resuscitation adjunct.
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To quantify upper sacral dysmorphic osseous anatomy and assess its impact on second sacral segment iliosacral screw insertion. ⋯ Dysmorphic S1 segments are anatomically competent for routine screw fixation. The S2 segment provides a larger osseous site for screw insertion than S1 in dysmorphic sacrums. Significantly longer screws are possible in S2 compared with the dysmorphic S1 segment. S2 iliosacral screws can be safely and accurately accomplished using a standard technique in patients with unstable posterior pelvic ring disruptions and sacral dysmorphism. Safe screw insertions avoid iatrogenic nerve root injuries.
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To quantify the obliquity and dimensions of the upper and second sacral segment iliosacral screw safe zones and to determine the differences between normal and dysmorphic sacral morphology. ⋯ Sacral dysmorphism occurred in 44% of patients in this consecutive series. Many anatomic differences were consistently found between the two morphologies with clinical relevance to iliosacral screw placement. Specifically, the dysmorphic upper sacral segment safe zone is significantly smaller and more obliquely oriented but is still large enough to accommodate an iliosacral screw in nearly all patients. The second sacral segment safe zone is approximately transversely oriented in both sacral types but is more than twice as large in dysmorphic sacra. This segment may be a primary fixation opportunity in patients with sacral dysmorphism.
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It has been proposed that 2.5 cm of diastasis of the symphysis pubis corresponds with injury to the anterior sacroiliac ligament and differentiates Young-Burgess anteroposterior compression Type I and II pelvic ring injuries. We hypothesized that if a pelvis has greater than 2.5 cm of symphysis pubis diastasis, the anterior sacroiliac ligaments are disrupted and the pelvic floor has failed. ⋯ We were not able to confirm 2.5 cm of symphysis pubis diastasis as a valid differentiation point between anteroposterior compression I and II injuries because significant morphologic variation seems to exist. Our data support that anterior sacroiliac ligament disruption is likely for displacement greater than 4.5 cm and unlikely for values less than 1.8 cm. Our study suggests that sacrospinous and sacrotuberous ligaments might not rupture at the same time as the anterior sacroiliac ligament.