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Review Question - QID 3453

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QID 3453 (Type "3453" in App Search)
A 23-year-old male is an unrestrained driver in a motor vehicle accident and sustains an unstable pelvic ring fracture. During fluoroscopic-aided fixation, a lateral sacral view is used for proper placement of which of the following fixation methods?

Anterior column percutaneous screw placement

1%

58/4471

Posterior column percutaneous screw placement

3%

119/4471

Posterior iliosacral plating

2%

71/4471

Supra-acetabular pin placement

2%

79/4471

Percutaneous iliosacral screw placement

92%

4118/4471

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The lateral sacral view is used to place percutaneous iliosacral screws. Sacral alar morphology has been shown to be variable from patient to patient. Therefore, intraoperative fluoroscopy is recommended. During placement of the screws, the L5 nerve root is at risk.

Routt et al (1997) examined the sacral slope and sacral alar anatomy in cadavers and a series of patients. They determined that the pelvic outlet and lateral sacral plain films provide the best plain radiographic view of the sacral ala. They recommended routine usage of these views intraoperatively to guide screw placement.

Routt et al (2000) reported on the early complications of percutaneous placement of iliosacral screws for treatment of posterior pelvic ring disruptions. While technically challenging, this technique leads to less blood loss and lower rates of infection compared to traditional open techniques.

Barei et al described methods of anterior and posterior pelvic ring disruptions. They determined that successful placement depends on accurate closed reduction, excellent intraoperative fluoroscopic imaging, and detailed preoperative planning. Early treatment decreased hemorrhage, provides patient comfort, and allows early mobilization.

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