Summary The iFuse TORQ TNT® Implant System is indicated for pelvic fracture fixation and sacroiliac joint fusion to address acute or non-traumatic fractures and chronic joint dysfunction. It achieves this through a cannulated, pin-based workflow utilizing a 3D-printed porous threaded implant designed for transiliac-transsacral trajectories to maximize osseointegration and pelvic ring stability. This versatile platform provides immediate mechanical fixation with TORQLock™ hooked threads while leveraging navigation or fluoroscopic guidance to navigate narrow sacral corridors. Related Implants iFuse TORQ® Implant Family iFuse Implant System® Family Sacropelvic Solutions™ Portfolio Indications Pelvic fracture fixation fracture fixation of the pelvis acute fractures non-acute fractures non-traumatic fractures Sacroiliac joint fusion sacroiliac joint fusion for sacroiliac joint dysfunction sacroiliac joint disruption degenerative sacroiliitis Anatomy Osteology posterior pelvic ring includes sacrum, ilium, and sacroiliac articulation sacral ala and sacral body define the osseous corridor for S1 or S2 fixation sacral canal, sacral foramina, anterior sacral cortex, and iliac cortices define key safety boundaries Muscles gluteal musculature and posterior soft tissues are traversed or dilated gluteus maximus fibers may be spread during blunt dissection Ligaments anterior sacroiliac ligaments interosseous sacroiliac ligaments posterior sacroiliac ligaments Nerves sacral nerve roots are at risk during pin, drill, tap, and implant advancement S1 foramen is a key fluoroscopic landmark for S1 corridor placement S2 foramen is relevant for outlet view assessment and S2 corridor planning Blood supply superior gluteal artery and surrounding neurovascular structures are at risk during incision and deep dissection iliolumbar and lateral sacral vascular branches may be encountered near posterior pelvic ring corridors Approach Positioning supine or prone positioning may be used keep SI joint neutral without extreme hip flexion or extension Preoperative planning CT is recommended for preoperative planning assess sacral corridor width, sacral dysmorphism, foraminal position, sacral canal, and fracture morphology Fluoroscopic imaging inlet view optimizes visualization of anterior sacral cortex and S1 body alignment outlet view optimizes visualization of S1 and S2 neuroforamina Skin marking mark a line from ASIS toward the floor in supine position mark a transverse line in line with the center of the femur extending posteriorly Sacral style trajectory placed in transverse orientation oriented orthogonal to a vertical sacral fracture SI style trajectory placed orthogonal to the SI joint commonly starts posterior-superior on the ilium commonly terminates in anterior-inferior sacrum Technique First pin placement insert preferred 2.5 mm pin into ilium to desired depth advance under alternating inlet and outlet views ensure pin crosses fracture site when fixing fracture to reduce displacement risk during implant insertion Dilation and implant length determination slide and rotate Dilator over pin until distal tip contacts ilium avoid aggressive insertion to reduce instrument, bone, or tissue damage STP and drill sleeve placement press Drill Sleeve into STP until seated slide STP with Drill Sleeve over Dilator until STP tip contacts ilium remove Dilator after STP and Drill Sleeve are in position maintain STP position through drilling, tapping, and implantation Drill sleeve removal remove Drill Sleeve from STP before implant insertion press gold tabs to release Drill Sleeve maintain STP position while removing Drill Sleeve Implant transfer confirm implant size from tube label maintain sterility of threaded implant tube and TPU sleeve advance outer sleeve onto implant using two-finger tightness remove loaded Driver-Implant assembly from TPU sleeve Implant insertion advance implant on Locking Driver using power with Quarter Inch to Tri-Lobe Adapter or by hand with T-Handle or Inline Handle final implant seating should be performed manually use laser mark on Driver relative to proximal STP to estimate head position when Driver and STP are used together if SI joint fusion is desired, place iFuse TORQ TNT® along with one or more additional implants across SI joint if implant becomes difficult to advance in hard bone, remove implant and drill and tap to prepare bone channel Final fluoroscopic confirmation obtain final inlet, outlet, and lateral views confirm fracture implant has adequately crossed fracture site Closure close using standard technique Implant removal clear debris obstructing implant T40 Torx head place pin through implant insert driver over pin and engage implant Technical specifications Implant geometry major diameter 8.7 mm minor diameter 6.9 mm inner diameter 2.7 mm head diameter 10.5 mm lengths 70-170 mm Washers outer diameters are 16.0 mm and 21.0 mm inner diameter is 10.3 mm 16.0 mm washer 21.0 mm washer Drills and taps Cannulated Drill Bit 4.5 x 280 mm 5.5 x 280 mm 5.5 x 375 mm Tap 8.0 x 275 mm Design features FuSIon 3D™ surface is a 3D-printed porous lattice designed for osseointegration variable thread heights and leads are tailored to posterior pelvis and designed to reduce loosening through pelvis-specific fixation TORQLock™ hooked thread profile is designed to reduce toggle pelvis-specific 8.7 mm diameter is described by manufacturer as fitting most suitable S1 transsacral screw corridors Pin Types Pin Type Available Sizes (Diameter x Length) Image Trocar 2.0 mm x 250 mm 2.0 mm x 330 mm 2.5 mm x 330 mm 2.5 mm x 450 mm Reverse Threaded 2.5 mm x 330 mm 2.5 mm x 450 mm Drill 2.5 mm x 330 mm 2.5 mm x 450 mm Blunt 2.5 mm x 330 mm 2.5 mm x 450 mm