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Zeitschrift Fur Orthopadie Und... Oct 2021Percutaneous sacro-iliac screw osteosynthesis is considered to be standard of care for most posterior pelvic ring fractures. However, special situations require...
Percutaneous sacro-iliac screw osteosynthesis is considered to be standard of care for most posterior pelvic ring fractures. However, special situations require alternative strategies for sufficient stabilization. In these cases, stabilization can often be achieved using posterior instrumentation e.g. using SIPS-screws (spina-iliaca-posterior-superior screws). However, this often leads to implant-related aggravation of the sometimes already critical soft tissue conditions after pelvic trauma. S2-Ala-Ilium screws (S2AI screws) are a suitable alternative. The starting point lies medial of the posterior superior iliac spine below the iliac level. It is almost in line with a potential spinal instrumentation and therefore usually causes fewer soft tissue problems. Although this technique has been widely used in spinal surgery in recent years, its use in orthopaedic traumatology is largely unknown. The possibilities but also the limitations of this technique for the treatment of injuries to the pelvis are illustrated by this retrospective case series.
Topics: Bone Screws; Ilium; Retrospective Studies; Sacrum; Spinal Fusion
PubMed: 32659833
DOI: 10.1055/a-1190-5987 -
BMJ Case Reports May 2011
Topics: Female; Fractures, Stress; Humans; Magnetic Resonance Imaging; Middle Aged; Radiography; Sacrum; Spinal Fractures
PubMed: 22696748
DOI: 10.1136/bcr.12.2010.3630 -
Canadian Association of Radiologists... Oct 1989We report a patient with a stress fracture in the sacrum. This may be a cause of hip or back pain. In contrast to typically bilateral insufficiency fractures, fatigue... (Review)
Review
We report a patient with a stress fracture in the sacrum. This may be a cause of hip or back pain. In contrast to typically bilateral insufficiency fractures, fatigue fractures are usually unilateral and the appearances are not diagnostic on scintigraphy. As the plain film findings may be subtle and overlooked, computed tomography is more specific in delineating a sclerotic vertical fracture parallel to the sacroiliac joint. Recognition of the characteristic radiographic pattern in sacral fatigue fractures can avoid incorrect diagnosis and unnecessary tests or treatment.
Topics: Adult; Female; Fractures, Stress; Humans; Sacrum; Tomography, X-Ray Computed
PubMed: 2679977
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Jan 2023To evaluate the effectiveness and safety of robot-aided percutaneous triangular osteosynthesis combined with close reduction for vertically unstable sacrum fractures...
BACKGROUND
To evaluate the effectiveness and safety of robot-aided percutaneous triangular osteosynthesis combined with close reduction for vertically unstable sacrum fractures (VUSFs).
METHODS
The data on 21 patients of the VUSF were retrospectively analyzed from November 2016 to January 2021. According to Denis classification, there were 3 cases in zone I, 11 cases in zone II, and 7 case in zone III. The main perioperative indicators were recorded. The maximal angulation and displacement deviations of the screws were analyzed by comparing the planned trajectory with the actual position. Postoperative X-ray radiographs and CT scans were obtained for evaluating the reduction quality. Functional outcome was scored with Majeed criterion.
RESULTS
Fourteen patients of the unilateral VUSF and 7 patients of the bilateral VUSF underwent unilateral and bilateral triangular osteosynthesis with robotic assistance, respectively. No intraoperative neurovascular injuries and postoperative infection occurred. All patients were followed up for at least 12 months. The average operation time of posterior pelvic ring was 111.4 min, with the mean intraoperative bleeding of 110.5 ml. A total of 58 pedicle and iliosacral screws were implanted with robotic assistance. Of those, 52 screws were in the cancellous bone except 4 pedicle and 2 iliosacral screws cutting the cortical bone. The angulation and displacement deviations of the screws were 4.2° ± 2.5° and 1.7 ± 0.9 mm, respectively. The average displacement of the sacral fracture was reduced from 19.7 mm preoperatively to 3.1 mm postoperatively. According to Matta's criterion, the reduction quality was graded as "excellent" in 13 patients and "good" in 8. All sacral fractures healed within 6 months except one fracture with nonunion. The mean Majeed score at the last follow-up was 89.6.
CONCLUSIONS
Robot-aided triangular osteosynthesis combined with close reduction provide a safe and reliable option for percutaneous treatment of the fresh VUSF, with a high accuracy of iliosacral and pedicle screw implantation except insertion of iliac screws. Meanwhile, the technique may help to reduce incision-related complications.
Topics: Humans; Sacrum; Retrospective Studies; Robotic Surgical Procedures; Robotics; Spinal Fractures; Fracture Fixation, Internal; Fractures, Bone; Pedicle Screws; Pelvic Bones
PubMed: 36597117
DOI: 10.1186/s13018-022-03489-4 -
Journal of Orthopaedic Research :... Mar 2019(1) Can iliosacral osseous corridor diameters in sacral dysmorphism be enlarged by in-out-in screw placement at the posterior iliosacral recessus? (2) Are lumbosacral...
(1) Can iliosacral osseous corridor diameters in sacral dysmorphism be enlarged by in-out-in screw placement at the posterior iliosacral recessus? (2) Are lumbosacral transitional vertebra (LSTV) the anatomical cause for sacral dysmorphism? (3) Are there sex-specific differences in sacral dysmorphism? 594 multislice CT scans were screened for sacral dysmorphism and 55 data-sets selected. Each pelvis was segmented manually and cylindrical iliosacral corridors (on the level of S1 and S2 vertebra) were semi-automatically determined. Corridor trajectories, -diameters and -lengths were measured. LSTV (Castellvi-type IIIb and IV) were found in 3 of 55 pelves and these lumbosacral variations are therefore not the anatomical basis for sacral dysmorphism. The prevalence of transsacral osseous corridors with diameters of <7.5 mm in axial CT images correlates with qualitative and quantitative criteria of sacral dysmorphism. Enlarging the osseous corridor diameters by penetration of the posterior iliosacral recessus increase the safe corridor diameters (females versus males) by 26% versus 15% at the level of S1- and 50% versus 48% at the level of S2-vertebra. Sex-specific differences for both corridors (osseous and in-out-in) were only found for the osseous corridor diameters at the level of S1 vertebra, being smaller in females (females versus males: 13.3 ± 3.6 mm versus 15.5 ± 3.8 mm, p = 0.04). Dysmorphic sacra can be reliably detected on standard axial CT slice images. Modified in-out-in corridors on the level of S1-vertebra allow screw placement in all patients, but is still demanding compared to non-dysmorphic sacra, due to the oblique corridor axis. Recommendations for intraoperative orientation for oblique screw placement are defined. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Topics: Adult; Aged; Aged, 80 and over; Anatomic Variation; Bone Screws; Female; Humans; Male; Middle Aged; Orthopedic Procedures; Reference Values; Sacrum; Sex Characteristics; Young Adult
PubMed: 30537046
DOI: 10.1002/jor.24199 -
AJR. American Journal of Roentgenology Dec 1982The sacrum of a disarticulated pelvis was scanned with a Pfizer 0450 computed tomographic scanner using contiguous 5 mm sections to display the normal computed... (Comparative Study)
Comparative Study
The sacrum of a disarticulated pelvis was scanned with a Pfizer 0450 computed tomographic scanner using contiguous 5 mm sections to display the normal computed tomographic anatomy of the sacrum. These anatomic sections were then compared with normal sacrums. In analyzing the computed tomographic anatomy, emphasis was placed on the central canal and sacral foramina, in that these landmarks are important in determining not only the presence but also the type of pathology involving the sacrum.
Topics: Cadaver; Humans; Sacrococcygeal Region; Sacrum; Tomography, X-Ray Computed
PubMed: 6983265
DOI: 10.2214/ajr.139.6.1183 -
European Spine Journal : Official... Apr 2002The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral...
The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip.
Topics: Adolescent; Adult; Aged; Aging; Child; Female; Humans; Infant; Male; Middle Aged; Radiography; Sacrum; Spondylolisthesis
PubMed: 11956917
DOI: 10.1007/s00586-001-0349-7 -
Journal of Anatomy Feb 1989An attempt has been made to find the route and relative magnitude of weight passing through different components of the sacrum. In 44 adult male dry sacra, the combined...
An attempt has been made to find the route and relative magnitude of weight passing through different components of the sacrum. In 44 adult male dry sacra, the combined surface area of the body and the two facets was compared with the combined surface area of the two auricular surfaces. It was found that the forces acting on the body and articular facets, at the upper end of the sacrum, are ultimately transmitted through the two auricular surfaces with an appreciable part of the load passing directly from the transverse process of the fifth lumbar vertebra to the ala of the sacrum through the lumbosacral ligament. The direction of the trabecular bone indicates the route of load transmission in the sacrum. From the various parts of the sacrum (body, facets, alae and laminae) distinct sets of trabeculae extend towards the auricular surface. Observations on the sacra with the anomalous articular processes provided strong evidence for the role of the neural arch elements in the load transmission. In specimens where the articular facet was absent on one or both sides, there was always an accessory facet on the ala of the sacrum so that the load was transmitted to this facet from the transverse process of the fifth lumbar vertebra.
Topics: Adult; Biomechanical Phenomena; Body Weight; Humans; Male; Sacrum
PubMed: 2808126
DOI: No ID Found -
Der Unfallchirurg Nov 2020Sacral U‑shaped fractures are rare but severe injuries. Due to the resulting spinopelvic dissociation they are highly unstable. Reduction and stabilization are usually...
BACKGROUND
Sacral U‑shaped fractures are rare but severe injuries. Due to the resulting spinopelvic dissociation they are highly unstable. Reduction and stabilization are usually required and decompression may be necessary due to frequent concomitant neurological injuries. In the literature there is no consensus with respect to the selection of the surgical approach.
CASE PRESENTATIONS
After a road traffic accident an 18-year-old woman suffered a U-fracture of the sacrum type II according to Roy-Camille and was treated with bilateral double sacroiliac screw osteosynthesis and sacral laminectomy. A 76-year-old man with a U‑fracture type I according to Roy-Camille after falling down the stairs was treated by lumbopelvic fixation. A 24-year-old man with U‑fracture type II according to Roy Camille after a road accident was treated with triangular vertebropelvic stabilization and sacral laminectomy. For all patients the outcome was good.
CONCLUSION
Surgical treatment is necessary, with minimally invasive techniques offering advantages over open surgery. A distinction must be made between lumbopelvic fixation and posterior pelvic ring fixation. Multiple aspects must be taken into consideration of the indications when selecting the surgical technique.
Topics: Adolescent; Aged; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Pelvic Bones; Sacrum; Spinal Fractures; Young Adult
PubMed: 32676724
DOI: 10.1007/s00113-020-00842-2 -
Physical Medicine and Rehabilitation... Feb 2018The presence of a lumbosacral transitional vertebrae (LSTV) should prompt a more detailed preprocedural evaluation of the vertebral column to accurately determine spinal... (Review)
Review
The presence of a lumbosacral transitional vertebrae (LSTV) should prompt a more detailed preprocedural evaluation of the vertebral column to accurately determine spinal levels. An LSTV should prompt the use of corroborating intraprocedural imaging to verify morphology. The most important factors in treating lumbosacral transitional segments are communication among treating physicians to ensure segmental enumeration consistency and associated appropriate patient treatment.
Topics: Biological Variation, Individual; Humans; Injections, Epidural; Lumbar Vertebrae; Sacrum; Steroids
PubMed: 29173663
DOI: 10.1016/j.pmr.2017.08.004