Daniel Wagner1, Lukas Kamer2, Takeshi Sawaguchi3, Hansrudi Noser2, Masafumi Uesugi4, Andreas Baranowski5, Dominik Gruszka5, Pol M Rommens5. 1. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. wagner.daniel@gmx.ch. 2. AO Research Institute Davos, Davos, Switzerland. 3. Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan. 4. Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan. 5. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Abstract
INTRODUCTION: The use of trans-sacral implants to treat fractures of the sacrum is limited by the variable pelvic anatomy. We were interested in how many trans-sacral implants can be placed per pelvis? If a trans-sacral implant cannot be placed in S1, where is the cortex perforated, and is the use of sacroiliac screws safe in these pelves? MATERIALS AND METHODS: 3D pelvic models were created from CT scans of 156 individuals without fractures (92 European and 64 Japanese, 79 male and 77 female, mean age 66.7 ± 13.7 years). Trans-sacral implants with a diameter of 7.3 mm were positioned virtually with and without a surrounding safe zone of 12 mm diameter. RESULTS: Fifty-one percent of pelves accommodated trans-sacral implants in S1 with a safe zone. Twenty-two percent did not offer enough space in S1 for an implant even when ignoring the safe zone. Every pelvis had sufficient space for a trans-sacral implant in S2, in 78% including a safe zone as well. In S1, implant perforation was observed in the sacral ala and iliac fossa in 69%, isolated iliac fossa perforation in 23% and perforation of the sacral ala in 8%. Bilateral sacroiliac screw placement was always possible in S1. CONCLUSIONS: The use of trans-sacral implants in S1 requires meticulous preoperative planning to avoid injury of neurovascular structures. S2 more consistently offers space for trans-sacral implants.
INTRODUCTION: The use of trans-sacral implants to treat fractures of the sacrum is limited by the variable pelvic anatomy. We were interested in how many trans-sacral implants can be placed per pelvis? If a trans-sacral implant cannot be placed in S1, where is the cortex perforated, and is the use of sacroiliac screws safe in these pelves? MATERIALS AND METHODS: 3D pelvic models were created from CT scans of 156 individuals without fractures (92 European and 64 Japanese, 79 male and 77 female, mean age 66.7 ± 13.7 years). Trans-sacral implants with a diameter of 7.3 mm were positioned virtually with and without a surrounding safe zone of 12 mm diameter. RESULTS: Fifty-one percent of pelves accommodated trans-sacral implants in S1 with a safe zone. Twenty-two percent did not offer enough space in S1 for an implant even when ignoring the safe zone. Every pelvis had sufficient space for a trans-sacral implant in S2, in 78% including a safe zone as well. In S1, implant perforation was observed in the sacral ala and iliac fossa in 69%, isolated iliac fossa perforation in 23% and perforation of the sacral ala in 8%. Bilateral sacroiliac screw placement was always possible in S1. CONCLUSIONS: The use of trans-sacral implants in S1 requires meticulous preoperative planning to avoid injury of neurovascular structures. S2 more consistently offers space for trans-sacral implants.
Authors: Daniel Wagner; Miha Kisilak; Geoffrey Porcheron; Sven Krämer; Isabella Mehling; Alexander Hofmann; Pol M Rommens Journal: Sci Rep Date: 2021-07-09 Impact factor: 4.379
Authors: Moritz F Lodde; J Christoph Katthagen; Clemens O Schopper; Ivan Zderic; R Geoff Richards; Boyko Gueorguiev; Michael J Raschke; René Hartensuer Journal: Medicina (Kaunas) Date: 2021-12-16 Impact factor: 2.430
Authors: Pol Maria Rommens; Eva Mareike Nolte; Johannes Hopf; Daniel Wagner; Alexander Hofmann; Martin Hessmann Journal: Eur J Trauma Emerg Surg Date: 2020-04-15 Impact factor: 3.693