Fluoroscopic iliosacral screw placement made safe.

Area of Science:

• Orthopedic surgery
• Radiology
• Trauma care

Background:

• Percutaneous iliosacral screwing is key for unstable posterior pelvic ring injuries.
• Intraoperative fluoroscopy, particularly inlet and outlet views, is crucial for successful screw placement.
• Interpreting fluoroscopic views can be challenging due to patient anatomy and C-arm positioning.

Purpose of the Study:

• To demonstrate how preoperative CT scans can predict optimal intraoperative fluoroscopic views.
• To anticipate patient positioning and avoid operating table obstacles during pelvic stabilization.
• To improve the safety and efficiency of percutaneous iliosacral screw placement.

Main Methods:

• Analysis of 30 pelvic CT scans with sagittal reconstructions.
• Calculation of inlet and outlet angles to determine optimal fluoroscopic views.
• Determination of the minimum required C-arm free space under the operating table.

Main Results:

• CT analysis revealed average inlet view angles of 22.3° and outlet view angles of 42.3°.
• Anatomic variations necessitate patient-specific C-arm angulation, differing from traditional 45° settings.
• A minimum of 145cm free space under the operating table is required for unobstructed C-arm tilting.

Conclusions:

• Preoperative CT aids in planning patient positioning and C-arm angulation for iliosacral screw placement.
• Significant anatomical variations require individualized fluoroscopic angles, moving beyond standard protocols.
• Ensuring adequate C-arm clearance (≥145cm) is vital to prevent intraoperative complications.