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Arch Orthop Trauma Surg. 2019 Oct;139(10):1385-1391. doi: 10.1007/s00402-019-03204-9. Epub 2019 May 21.

Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning.

Author information

1
Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. wagner.daniel@gmx.ch.
2
AO Research Institute Davos, Davos, Switzerland.
3
Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
4
Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan.
5
Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.

Abstract

INTRODUCTION:

The use of trans-sacral implants to treat fractures of the sacrum is limited by the variable pelvic anatomy. We were interested in how many trans-sacral implants can be placed per pelvis? If a trans-sacral implant cannot be placed in S1, where is the cortex perforated, and is the use of sacroiliac screws safe in these pelves?

MATERIALS AND METHODS:

3D pelvic models were created from CT scans of 156 individuals without fractures (92 European and 64 Japanese, 79 male and 77 female, mean age 66.7 ± 13.7 years). Trans-sacral implants with a diameter of 7.3 mm were positioned virtually with and without a surrounding safe zone of 12 mm diameter.

RESULTS:

Fifty-one percent of pelves accommodated trans-sacral implants in S1 with a safe zone. Twenty-two percent did not offer enough space in S1 for an implant even when ignoring the safe zone. Every pelvis had sufficient space for a trans-sacral implant in S2, in 78% including a safe zone as well. In S1, implant perforation was observed in the sacral ala and iliac fossa in 69%, isolated iliac fossa perforation in 23% and perforation of the sacral ala in 8%. Bilateral sacroiliac screw placement was always possible in S1.

CONCLUSIONS:

The use of trans-sacral implants in S1 requires meticulous preoperative planning to avoid injury of neurovascular structures. S2 more consistently offers space for trans-sacral implants.

KEYWORDS:

Fracture; Iliosacral screw; Pelvis; Sacrum; Trans-sacral; Virtual implant

PMID:
31111201
DOI:
10.1007/s00402-019-03204-9

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