Iliosacral Screw Fixation for Treating Sacral Fractures: A Modified Pedicle-Guided Fixation Technique in Prone...

Sacral fractures are posterior pelvic ring injuries which mechanisms range from high-energy trauma to low-energy falls in osteoporotic patients. In surgical treatment, percutaneous approaches have demonstrated significant shorter operation time and less soft tissue damage. In this study, we present a method of iliosacral (SI) screw insertion in prone position, with modified pedicle-guided technique.

The present study is a retrospective case series of 22 patients for SI screw fixation from February 2019 to September 2023 under our method. Surgical technique was described in detail with images. Perioperative clinical parameters were analyzed. Activity status, complications, data of 10-point visual analogue scale (VAS) for pain and further functional outcomes using the Majeed Pelvic Score (MPS) were recorded. In addition, computed tomography (CT) was routinely performed at 6 months postsurgery to inspect the quality of screws position.

Excellence rate of screw position was 97% upon CT. Two patients had screws partially contacting the cortical bone but not violating sacral foramen, and no neurological symptoms were noted. All screws were secure from possible iatrogenic nerve injuries. VAS scores improved significantly over time and most patients recorded excellent functional recovery. One untoward complication occurred involving unexpected cement extravasation after sacroplasty. No associated neurologic compromise, or clinical evidence of venous emboli thrombosis was reported.

Our method aims at reducing operation time and radiation exposure to surgeons as conventional two-dimensional fluoroscopy was enough to identify safe insertion corridors in SI screw placement. Performing SI fixation in prone position is also advantageous when dealing with obese patients and concomitant spinal injuries.