Influence of the inclination angle of the S1 pedicle on screw malposition and operative revision in percutaneous iliosacral screw fixation of posterior pelvic ring fractures |
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| Affiliation: | 1. Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA;2. Orlando Health Orthopaedic Institute, Orlando, FL, USA;1. Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan;2. Department of Orthopedic Surgery, Showa University Northern Yokohama Hospital, Yokohama, Japan;3. Department of Orthopedic Surgery, Showa University, Tokyo, Japan;1. Harvard Medical School, Boston, MA, USA;2. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;3. Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark;1. Orthopaedic Surgery Department, Vall d''Hebron University Hospital; Universitat Autònoma de Barcelona (Departament de Cirurgia i Cències Morfològiques). Barcelona, Spain;2. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d''Hebron University Hospital, Barcelona, Spain;3. Musculoskeletal Tissue Engineering Group, Vall d''Hebron Research Institute, Barcelona, Spain;4. Orthopaedic Surgery Department, Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain;5. Department of Radiology, Vall d''Hebron University Hospital, Barcelona, Spain;6. Orthopaedic Surgery Department; Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia. Spain;7. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department; Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia. Spain;1. Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom;2. The University of Edinburgh, Little France Crescent, United Kingdom;1. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;2. Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea |
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| Abstract: | IntroductionDue to aging society, osteoporotic posterior ring fractures of the pelvis are gaining importance. Percutaneous iliosacral screw fixation can reduce pain if conservative therapy is not sufficient. One of the surgical complications is the malposition of the screws in neuroforamen. The aim of this study is to correlate the measured pedicle angle with the screw position in postoperative CT scans.Materials and methodsIn this retrospective study (level of evidence: III), 97 patients with posterior ring fractures were treated with 137 percutaneous iliosacral screws. The inclination angles of the S1 pedicle were measured in the preoperative pelvic CT scan of each patient. Patients were divided up into pedicle angles from 10 – 19.9° (Group 1), 20 – 29.9° (Group 2), 30 – 39.9° (Group 3) and 40 – 49.9° (Group 4). We correlated the pedicle inclination angle to radiologically described screw position in the L5/S1 neuroforamen and the need for revision because of screw malposition.ResultsA total of 10 pedicle inclination angles were from 10 – 19.9° (7.3%), 96 from 20 – 29.9° (70.1%), 28 from 30 – 39.9° (20.4%) and three from 40 – 49.9° (2.2%). Of the 137 screws used, 19 were intraforaminal (13.9%). There were no intraforaminal screws in the Group 1, eight in Group 2, 10 in Group 3 and one in Group 4. Five of the screws needed revision (3,6%). There were no revisions in Groups 1 and 4, two in Group 2 and three in Group 3. Groups 3 and 4 had a higher percentage of intraforaminal screw positions. Patients with steeper angles S1 pedicles showed a significantly higher probability of intraforaminal screw location and revision (p<0.01).DiscussionComplications such as intraforaminal screw position and revision surgery are more frequent in patients with steeper S1 pedicles, making this a detrimental prognostic marker. |
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