Corridor-diameter-dependent angular tolerance for safe transiliosacral screw placement: an anatomic study of 433 pelves

Background The purpose of this study was to determine the angular tolerance of the S1 and S2 segments to accommodate a transiliosacral screw across both sacroiliac joints. Hypothesis We hypothesized that the angular tolerance for transiliosacral screw placement would be more constrained than the ang...

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Bibliographic Details
Published in:European journal of orthopaedic surgery & traumatology 2021-10, Vol.31 (7), p.1485-1492
Main Authors: McLaren, D. Alex, Busel, Gennadiy A., Parikh, Harsh R., Only, Arthur, Patterson, Jason, Gaston, Brandon T., McLemore, Ryan, Cunningham, Brian
Format: Article
Language:English
Subjects:
Biomechanics
Bone Screws
Female
Fracture Fixation, Internal
Humans
Ilium - surgery
Medicine
Medicine & Public Health
Original Article
Orthopedics
Pelvis
Retrospective Studies
Sacrum - surgery
Surgery
Surgical Orthopedics
Traumatic Surgery
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Summary:Background The purpose of this study was to determine the angular tolerance of the S1 and S2 segments to accommodate a transiliosacral screw across both sacroiliac joints. Hypothesis We hypothesized that the angular tolerance for transiliosacral screw placement would be more constrained than the angular tolerance for iliosacral fixation in pelves where a safe osseous corridor was measured. Materials and methods The cortical boundaries of the S1 and S2 sacral segments in 433 pelvic CTs were digitally mapped. A straight-line path was placed within each osseous corridor and extended across both SI joints past the outer iliac cortices. The diameter of the path was increased until it breached the cortex, geometrically determining maximum diameter (Dmax). Angular tolerance for screw placement was calculated with trigonometric analysis of the Dmax value of the corridor, and the average distance from the termination of the osseous corridor to the site of percutaneous insertion. Gender, age, and BMI were evaluated as independent predictors using binomial logistic regression. Results The transiliosacral angular tolerance for the S1 and S2 osseous corridors was 1.53 ± 0.57 degrees and 1.02 ± 0.33 degrees, respectively. 68.9% of S1 corridors and 81.1% of S2 corridors had a safe zone (corridor diameter ≥ 10 mm) for transiliosacral placement, 48.3% of the pelves had a safe zone for both corridors, while 5.1% had no safe zones. Females had a less frequent Dmax ≥ 10 mm at S1, 52% vs 67% ( p  = 0.001), and at S2, 64% vs 86% ( p  
ISSN:1633-8065
1432-1068
DOI:10.1007/s00590-021-02913-5