Retrieval of broken iliosacral screws: the power of a push screw

Percutaneous iliosacral screw fixation is a common technique that is widely used for unstable posterior pelvic ring disruptions. Complications of posterior percutaneous iliosacral screw fixation include implant malpositioning and hardware failure. Removal of iliosacral screws in broken or symptomatic hardware is sometimes necessary. To our knowledge, there are few reports addressing pelvic implant removal, and most of those report on anterior pelvic implants and symphyseal plates. There are no reports describing techniques for retrieval of broken iliosacral screws. We present two cases involving removal of broken sacroiliac screws, review the literature regarding iliosacral implant extraction, and identify important aspects of safe extraction of iliosacral screws and the potential complications associated with their retrieval. We further describe a novel and powerful technique to facilitate percutaneous removal of broken screw fragments, using a "push screw" to drive a broken screw fragment from a position buried in bone.