[Arthrography of the iliosacral joint]

We anatomically dissected four pelvic bones without damaging any ligaments, and tried to find a dorsal approach to arthrograph the sacroiliac joint. The joint could not be punctured through its proximal two-thirds: on the one hand, because of its overall angulated orientation, on the other hand, because of the significant overhang of the spina iliaca posterior superior, medially, and the impossibility to make further needle corrections through the very strong ligaments. The only possible approach was situated one finger's width medially to the spina iliaca posterior inferior, with the needle directed laterally at an angle of 20 degrees to the horizontal. Only 0.1-0.2 ml of contrast fluid could be injected. The arthrographic information was reduced to only determining the form of the joint; the state of the cartilage and integrity of the capsule could not be assessed. The best image exposure had to be determined individually and for each case under fluoroscopy, with, unfortunately, a certain level of irradiation. In vivo, the puncture of the lower third of the joint is impossible; the concept of "intraarticular injection of the sacroiliac joint" must be abandoned, as this joint can hardly be punctured dorsally.