ILIOSACRAL SCREW FIXATION - EARLY COMPLICATIONS OF THE PERCUTANEOUS TECHNIQUE

Objective: To report on the early complications related to the percuta neous placement of iliosacral screws for the operative treatment of di splaced posterior pelvic ring disruptions. Study Design: Prospective, consecutive. Setting: Level-one trauma center. Patients: One hundred s eventy-seven consecutive patients with unstable pelvic ring fractures. One hundred two male and seventy-five female patients ranging in age from eleven to seventy-eight years (mean, thirty-two years). Intervent ions: Operative procedures were performed urgently according to the pa tient's clinical condition. Anterior pelvic reductions and fixations w ere performed by using internal and external fixation techniques. Accu rate closed or open reductions of the posterior pelvic ring disruption s were accomplished by using a variety of surgical techniques dependen t on the specific pattern of pelvic ring disruption. Closed manipulati ve reductions of the posterior pelvic ring were attempted for all pati ents. Open reductions were necessary in those patients with unacceptab le closed manipulative reductions as assessed fluoroscopically at the time of operation (more than one centimeter in any field of fluoroscop ic imaging). Main Outcome Measures: Plain inlet and outlet radiographs were obtained postoperatively at six weeks, three months, and twelve months. A pelvic computed tomography scan was performed postoperativel y to assess fracture or dislocation reduction and the implant safety. Annual follow-up pelvic radiographs were obtained. Residual pelvic def ormities were quantified based on these imaging modalities. Results: T here were no posterior pelvic infections. Minimal blood loss was assoc iated with this technique. Complications occurred due to inadequate im aging, surgeon error, and fixation failure. Fluoroscopic imaging was i nadequate due to obesity or abdominal contrast in eighteen patients. F ive screws were misplaced due to surgeon error. One misplaced screw pr oduced a transient L5 neuropraxia. Fixation failures related to either crandiocerebral trauma, delayed union, noncompliance, and a deep ante ror pelvic polymicrobial infection secondary to a urethral tear occurr ed in seven patients. There were two sacral nonunions that required de bridement, bone grafting, and repeat fixation prior to healing. Conclu sions: Iliosacral screw fixation of the posterior pelvis is difficult. The surgeon must understand the variability of sacral anatomy. Qualit y triplanar fluoroscopic imaging of the accurately reduced posterior p elvic ring should allow for safe iliosacral screw insertions. Anticipa ted noncompliant patients or those with craniocerebral trauma may need supplementary posterior pelvic fixation. Low rates of infection, bloo d loss, and nonunion can be expected.