Removal, Refixation, and Augmentation of a Broken Iliosacral Screw: A Percutaneous Surgical Technique

The management of a broken iliosacral screw in an anterior-posterior compression (APC)-type pelvic ring injury presents a surgical challenge, particularly in cases requiring removal and refixation without navigation assistance.

This study describes a step-by-step surgical technique for safely removing a fractured S1 cannulated iliosacral screw and replacing it with a larger-diameter screw, supplemented with additional fixation (e.g., S2 screw or iliosacral fixation) to enhance stability.

The procedure involves careful fluoroscopy-guided extraction of the broken screw, followed by reaming and placement of a larger screw for improved fixation. Supplementary stabilization (e.g., S2 screw or transiliac-transsacral fixation) is then added to reinforce the construct.

This technique provides a reliable solution for managing broken iliosacral screws in APC pelvic injuries, even without navigation, while optimizing biomechanical stability through larger screw replacement and supplemental fixation.