CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws Oliver Pieske a, *, Christoph Landersdorfer b , Christoph Trumm c , Axel Greiner b , Jens Wallmichrath b , Oliver Gottschalk b , Bianka Rubenbauer b a Department of Traumatology, Orthopaedics and Sport Injury, Evangelisches Krankenhaus, Campus University of Oldenburg, Steinweg 13-17, 26123 Oldenburg, Germany b Department of Trauma-, Hand- and Plastic-Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany c Department of Clinical Radiology, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany Background UPPRI should be stabilised to avoid dislocation, chronic pain and consecutive immobilisation [1]. In the past, the open technique with direct visualisation of the injury and implant was applied [2]. Since this method was associated with a high risk of neurovascular complications the minimal-invasive, sacroiliac percutaneous screw placement (SPSP) was introduced by Matta Injury, Int. J. Care Injured 46 (2015) 333–339 A R T I C L E I N F O Article history: Accepted 14 November 2014 Keywords: Pelvis Injury Trauma Sacroiliac-screw CT-guided operation Minimally invasive surgery Complication Percutaneous A B S T R A C T Background: Sacroiliac-percutaneous-screw-placement (SPSP) for unstable-posterior-pelvic-ring-inju- ries (UPPRI) might be associated with severe neurovascular complications because of screw-mal- position. The aim of the present study was to analysis the effectivity of computer-tomography-guided (CTG)-SPSP including accuracy of screw-placement, quality of injury-reduction and documentation of perioperative-complications. Additionally, procedure-dependent radiation-dose and outcome should be analysed. Methods: A consecutive cohort of 71 patients with UPPRI was operated by CTG-SPSP at a single trauma level 1 hospital. 136 sacroiliac screws were inserted to S1 and S2. Postoperatively, by the use of a computerised-radiologic-work-station all screws were visualised three-dimensionally. Their distan- ces min to the sacral-borders in anterior-posterior and cranio-caudal direction as well as to the neuroforamen S1/S2 were determined. After CTG-SPSP, injury-dislocation in anterior-posterior and cranio-caudal direction was quantified. Local and general complications were documented during the 30-day-period. In 55 patients (77.5%) a follow-up-investigation (29.1  19.1 months) was performed. Results: 132 screws (97.1%) were placed completely intraosseous, 3 screws (2.2%) perforated up to 1.0 mm (n (S1) = one screw; n (S2) = two screws), and one screw (0.7%) extended 2.2 mm into the S2- neuroforamen without contact to neural structures. Postoperative dislocation anterior-posterior was 1.3  0.9 mm and dislocation cranio-caudal 1.5  0.9 mm. No procedure-associated-complication was observed. Operation time showed a significant ‘‘learning curve’’ during the six-year study period (initially: 88.6  60.3 min; finally: 44.3  24.6 min). Perioperative effective-radiation-dose for patients male was 5.9  3.1 mSv and for patients female 8.7  4.5 mSv. All injuries healed and 33 patients (46.5%) had metal removal after 11.0 (4.9) months. Only two (5.0%) out of 40 patients complained persistent UPPRI-related pain so they were not able to restart work. Conclusions: The CTG-SPSP is a safe procedure for UPPRI-stabilisation especially in S1 but also in S2. Injury reduction was excellent and no procedure associated complications were observed. ß 2014 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +49 441 236 350/1. E-mail addresses: Oliver.Pieske@evangelischeskrankenhaus.de (O. Pieske), Christoph.Landersdorfer@gmx.de (C. Landersdorfer), Christoph.Trumm@med.uni-muenchen.de (C. Trumm), Axel.Greiner@med.uni-muenchen.de (A. Greiner), Jens.Wallmichrath@med.uni-muenchen.de (J. Wallmichrath), Oliver.Gottschalk@med.uni-muenchen.de (O. Gottschalk), Bianka.Rubenbauer@med.uni-muenchen.de (B. Rubenbauer). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2014.11.009 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.