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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(01): s00441800947
DOI: 10.1055/s-0044-1800947
Artigo Original

Transiliac-transsacral Screws: What is the Required Implant Length for Adequate Percutaneous Fixation of the Posterior Pelvic Ring?

Article in several languages: português | English
Leonardo Comerlatto 
1   Serviço de Ortopedia e Traumatologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
,
Natália Henz Concatto 
2   Serviço de Radiologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
,
Marcus Vinícius Crestani 
1   Serviço de Ortopedia e Traumatologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
,
Tauã Brum Silva 
2   Serviço de Radiologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
,
Carlos Roberto Galia 
1   Serviço de Ortopedia e Traumatologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
,
Marco Aurélio Telöken 
1   Serviço de Ortopedia e Traumatologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
› Author Affiliations Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

Objective Brazilian orthopedic surgeons experience the unavailability of long screws allowing percutaneous fixation of the posterior pelvic ring in transiliac-transsacral (TI-TS) configuration. The objective of the present study is to measure the lenght of the osseous fixation pathways available for TI-TS fixation in a population sample to infer the required implant length.

Methods We retrospectively assessed patients undergoing computed tomography (CT), initially identifying the existence of a potential osseous fixation pathway (POFP) in S1, S2 and S3. Each POFP was measured from the external cortex of the iliac bone to the external cortex of the contralateral iliac bone on axial CT images.

Results The analysis comprised a sample of 180 cases. A POFP was identified in S1 in 116 (64.4%) cases, in S2 in 178 (98.9%) cases, and in S3 in 16 (8.9%) cases. The median (interquartile range – IQR) POFP measurement in S1 was 153 (148–161) mm, ranging from 135 mm to 179 mm. In S2, the median (IQR) POFP measurement was 136 (131–144) mm, ranging from 114 to 160 mm. In S3, the median (IQR) POFP measurement was 120.5 (115–126) mm, ranging from 110 to 131 mm.

Conclusions We demonstrated that the maximum lengths of the osseous fixation pathways identified in our sample would require screws up to 180 mm in length, with a clear dissociation between the values measured and the longer screws currently commercialized in our setting.

Keywords

bone screws - fracture fixation, internal - fractures, bone - pelvic bones

Work carried out at the Orthopedics and Traumatology Service, Hospital Moinhos de Vento, Porto Alegre, Brazil.




Publication History

Received: 21 June 2024

Accepted: 02 October 2024

Article published online:
28 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Leonardo Comerlatto, Natália Henz Concatto, Marcus Vinícius Crestani, Tauã Brum Silva, Carlos Roberto Galia, Marco Aurélio Telöken. Parafusos transilíaco-transacrais: Qual o comprimento necessário dos implantes para uma adequada fixação percutânea do anel pélvico posterior? . Rev Bras Ortop (Sao Paulo) 2025; 60: s00441800947.
DOI: 10.1055/s-0044-1800947
 

  • Referências

  • 1 Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 1989; (242) 83-97
    PubMedSearch in Google Scholar
  • 2 Routt ML, Meier MC, Kregor PJ, Mayo KA. Percutaneous iliosacral screws with the patient supine technique. Oper Tech Orthop 1993; 3 (01) 35-45
    Search in Google Scholar
  • 3 Routt Jr ML, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 1995; 9 (03) 207-214
    CrossrefPubMedSearch in Google Scholar
  • 4 Nork SE, Jones CB, Harding SP, Mirza SK, Routt Jr ML. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma 2001; 15 (04) 238-246
    PubMedSearch in Google Scholar
  • 5 Calafi LA, Routt Jr ML. Posterior iliac crescent fracture-dislocation: what morphological variations are amenable to iliosacral screw fixation?. Injury 2013; 44 (02) 194-198
    PubMedSearch in Google Scholar
  • 6 Saiz Jr AM, Kellam PJ, Amin A. et al. Percutaneous sacral screw fixation alone sufficient for mildly displaced U-type sacral fractures with preserved osseous fixation pathways. Eur J Orthop Surg Traumatol 2023;
    CrossrefPubMedSearch in Google Scholar
  • 7 Cintean R, Fritzsche C, Zderic I, Gueorguiev-Rüegg B, Gebhard F, Schütze K. Sacroiliac versus transiliac-transsacral screw osteosynthesis in osteoporotic pelvic fractures: a biomechanical comparison. Eur J Trauma Emerg Surg 2023; 49 (06) 2553-2560
    CrossrefPubMedSearch in Google Scholar
  • 8 Bishop JA, Routt Jr ML. Osseous fixation pathways in pelvic and acetabular fracture surgery: osteology, radiology, and clinical applications. J Trauma Acute Care Surg 2012; 72 (06) 1502-1509
    PubMedSearch in Google Scholar
  • 9 Kaiser SP, Gardner MJ, Liu J, Routt Jr ML, Morshed S. Anatomic Determinants of Sacral Dysmorphism and Implications for Safe Iliosacral Screw Placement. J Bone Joint Surg Am 2014; 96 (14) e120
    PubMedSearch in Google Scholar
  • 10 Tabaie SA, Bledsoe JG, Moed BR. Biomechanical comparison of standard iliosacral screw fixation to transsacral locked screw fixation in a type C zone II pelvic fracture model. J Orthop Trauma 2013; 27 (09) 521-526
    PubMedSearch in Google Scholar
  • 11 Salazar D, Lannon S, Pasternak O. et al. Investigation of bone quality of the first and second sacral segments amongst trauma patients: concerns about iliosacral screw fixation. J Orthop Traumatol 2015; 16 (04) 301-308
    PubMedSearch in Google Scholar
  • 12 Gardner MJ, Routt Jr ML. Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma 2011; 25 (06) 378-384
    PubMedSearch in Google Scholar
  • 13 Eastman JG, Shelton TJ, Routt Jr MLC, Adams MR. Posterior pelvic ring bone density with implications for percutaneous screw fixation. Eur J Orthop Surg Traumatol 2021; 31 (02) 383-389
    PubMedSearch in Google Scholar
  • 14 Beaulé PE, Antoniades J, Matta JM. Trans-sacral fixation for failed posterior fixation of the pelvic ring. Arch Orthop Trauma Surg 2006; 126 (01) 49-52
    PubMedSearch in Google Scholar
  • 15 Chang G, Fram B, Sobol K, Krieg JC. Two Transiliac-Transsacral Screws in a Single Sacral Level: Surgical Technique and Patient Outcomes. Tech Orthop 2021; 36 (01) 50
    Search in Google Scholar
  • 16 Lucas JF, Routt Jr ML, Eastman JG. A Useful Preoperative Planning Technique for Transiliac-Transsacral Screws. J Orthop Trauma 2017; 31 (01) e25-e31
    PubMedSearch in Google Scholar
  • 17 Eastman JG, Adams MR, Frisoli K, Chip Routt Jr ML. Is S3 a Viable Osseous Fixation Pathway?. J Orthop Trauma 2018; 32 (02) 93-99
    PubMedSearch in Google Scholar
  • 18 Zhao Y, Zhang S, Sun T. et al. Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis. Orthop Traumatol Surg Res 2013; 99 (05) 601-606
    PubMedSearch in Google Scholar
  • 19 Min KS, Zamorano DP, Wahba GM, Garcia I, Bhatia N, Lee TQ. Comparison of two-transsacral-screw fixation versus triangular osteosynthesis for transforaminal sacral fractures. Orthopedics 2014; 37 (09) e754-e760
    PubMedSearch in Google Scholar
  • 20 Chen PH, Chen CY, Lin KC, Hsu CJ. Quantification of the Safe Zone of the First to Third Sacral Segments for Transiliac-Transsacral Screw Fixation in Normal and Dysmorphic Sacra. Orthopedics 2024; 47 (01) e13-e18
    PubMedSearch in Google Scholar
  • 21 Jazini E, Klocke N, Tannous O. et al. Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model. J Orthop Trauma 2017; 31 (01) 37-46
    PubMedSearch in Google Scholar
  • 22 Gonçalves RM, Freitas A, Aragão VAD. et al. Comparison of sacroiliac screw techniques for unstable sacroiliac joint disruptions: a finite element model analysis. Injury 2023; 54 (Suppl. 06) 110783
    PubMedSearch in Google Scholar
  • 23 Collinge CA, Crist BD. Combined Percutaneous Iliosacral Screw Fixation With Sacroplasty Using Resorbable Calcium Phosphate Cement for Osteoporotic Pelvic Fractures Requiring Surgery. J Orthop Trauma 2016; 30 (06) e217-e222
    PubMedSearch in Google Scholar
  • 24 Schultz BJ, Mayer RM, Phelps KD. et al. Assessment of sacral osseous fixation pathways for same-level dual transiliac-transsacral screw insertion. Arch Orthop Trauma Surg 2023; 143 (10) 6049-6056
    PubMedSearch in Google Scholar
  • 25 Miller AN, Routt Jr ML. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 2012; 20 (01) 8-16
    CrossrefPubMedSearch in Google Scholar
  • 26 Gardner MJ, Morshed S, Nork SE, Ricci WM, Chip Routt Jr ML. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma 2010; 24 (10) 622-629
    CrossrefPubMedSearch in Google Scholar
  • 27 Conflitti JM, Graves ML, Chip Routt Jr ML. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma 2010; 24 (10) 630-636
    PubMedSearch in Google Scholar
  • 28 Hwang JS, Reilly MC, Shaath MK. et al. Safe Zone Quantification of the Third Sacral Segment in Normal and Dysmorphic Sacra. J Orthop Trauma 2018; 32 (04) 178-182
    PubMedSearch in Google Scholar
  • 29 Shaw J, Gary J, Ambrose C, Routt MC. Multidimensional pelvic fluoroscopy: A new and novel technique for assessing safety and accuracy of percutaneous iliosacral screw fixation. J Orthop Trauma 2020; 34 (11) 572-577
    PubMedSearch in Google Scholar
  • 30 Warner SJ, Haase DR, Chip Routt ML, Eastman JG, Achor TS. Use of 3D Fluoroscopy to Assist in the Reduction and Fixation of Pelvic and Acetabular Fractures: A Safety and Quality Case Series. J Orthop Trauma 2023; 37 (11S): S1-S6
    PubMedSearch in Google Scholar