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Posterior pelvic ring bone density with implications for percutaneous screw fixation.

Jonathan G Eastman1, Trevor J Shelton1, Milton Lee Chip Routt2

  • 1Department of Orthopaedic Surgery, Davis Medical Center, University of California, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|September 9, 2020
PubMed
Summary

Posterior ilium and sacroiliac joint bone density is higher than sacral body bone density at all levels. The S2 posterior ilium/sacroiliac joint offers superior bone density for pelvic fixation.

Keywords:
IliosacralPosterior pelvic ring bone densityS3Third sacral segmentTranssacral

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Radiology

Background:

  • Sacral fixation is crucial for posterior pelvic ring stability.
  • The S2 sacral body has lower bone density, raising concerns for screw fixation.
  • Transiliac-transsacral screws may utilize denser posterior pelvic bone.

Purpose of the Study:

  • To compare bone density between the posterior ilium/sacroiliac joint (PISJ) and sacral body (SB) at S1, S2, and S3 levels.
  • To evaluate the potential for improved screw purchase in posterior pelvic fixation.

Main Methods:

  • Retrospective analysis of 100 patient CT scans without prior pelvic trauma.
  • Measurement of PISJ and SB bone density using Hounsfield units (HU) at S1, S2, and S3.
  • Inclusion of patients with available fixation pathways at all sacral levels.

Main Results:

  • PISJ bone density was significantly higher than SB bone density at all sacral levels (p < 0.0001).
  • Average S2 PISJ bone density (320.1 HU) was significantly higher than S1 (286.5 HU) and S3 (278.9 HU) PISJ.
  • S1 SB bone density (231.1 HU) was significantly higher than S2 (182.1 HU) and S3 (126.8 HU) SB.

Conclusions:

  • The posterior ilium/sacroiliac joint provides superior bone density compared to the sacral body for fixation.
  • S2 PISJ offers the highest bone density, potentially enhancing screw purchase in posterior pelvic ring constructs.
  • Findings have implications for optimizing screw placement and stability in pelvic fracture fixation.