Injury · 2026
Fluoroscopy-assisted percutaneous management of posterior pelvic ring injuries via multiple transsacral and iliosacral screws in the supine position.
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Zheng Libin, Shen Xionghai, Huang Xiaokang, Chen Jinwu, Cao Wei, Yu Lai, Yang Guangming, Pan Yongwei
Аннотация
INTRODUCTION: When patients are positioned supine for percutaneous screw insertion to achieve posterior pelvic ring fixation, the edge of the operating table can impede screw insertion trajectories, thereby increasing the risk of cortical perforation, especially during iliosacral screw (ISS) placement. Multiple screw insertion might also potentially increase the risk of cortical perforation. The aim of this study was to evaluate the feasibility, safety, and efficacy of inserting multiple (≥2) transsacral screw (TSS) and ISS in the supine position via the application of specific surgical strategies and techniques developed in our institution.
PATIENTS AND METHODS: Patients who underwent stabilization of posterior pelvic ring injuries via percutaneous insertion of multiple TSS and/or ISS in the supine position between May 2018 and December 2025 were included in this study. Distinct screw insertion combination patterns at different vertebral levels, which were primarily determined by the variable anterior-posterior width of the transverse osseous pathway at the first sacrum, were employed for posterior pelvic ring fixation. Wound infection and neurovascular complications associated with screws insertion procedure were recorded. Postoperative CT scans were performed to assess the position of the screws. At follow-up, radiographic evaluations were performed to evaluate the complications including screw loosening, screw breakage, and non-union.
RESULTS: A total of 149 large-diameter (≥7 mm) screws, including 123 TSSs and 26 ISSs, were inserted in a total of 69 consecutive patients. No wound infection and neurovascular complication associated with the screw insertion procedure were found postoperatively. Postoperative CT imaging demonstrated that all inserted screws were intraosseous. All patients were followed for an average of 19.5 months (range, 6.6-38 months). Only one screw (S2 TSS) breakage was noted, and no screw loosening and no bone nonunion occurred.
CONCLUSIONS: Fluoroscopy-assisted percutaneous multiple large-diameter screws (TSS and ISS) insertion for posterior pelvic ring injuries with the patient positioned supine has been confirmed to be a feasible, safe, and effective surgical procedure.
PATIENTS AND METHODS: Patients who underwent stabilization of posterior pelvic ring injuries via percutaneous insertion of multiple TSS and/or ISS in the supine position between May 2018 and December 2025 were included in this study. Distinct screw insertion combination patterns at different vertebral levels, which were primarily determined by the variable anterior-posterior width of the transverse osseous pathway at the first sacrum, were employed for posterior pelvic ring fixation. Wound infection and neurovascular complications associated with screws insertion procedure were recorded. Postoperative CT scans were performed to assess the position of the screws. At follow-up, radiographic evaluations were performed to evaluate the complications including screw loosening, screw breakage, and non-union.
RESULTS: A total of 149 large-diameter (≥7 mm) screws, including 123 TSSs and 26 ISSs, were inserted in a total of 69 consecutive patients. No wound infection and neurovascular complication associated with the screw insertion procedure were found postoperatively. Postoperative CT imaging demonstrated that all inserted screws were intraosseous. All patients were followed for an average of 19.5 months (range, 6.6-38 months). Only one screw (S2 TSS) breakage was noted, and no screw loosening and no bone nonunion occurred.
CONCLUSIONS: Fluoroscopy-assisted percutaneous multiple large-diameter screws (TSS and ISS) insertion for posterior pelvic ring injuries with the patient positioned supine has been confirmed to be a feasible, safe, and effective surgical procedure.