51. Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning.
- Author
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Wagner D, Kamer L, Sawaguchi T, Noser H, Uesugi M, Baranowski A, Gruszka D, and Rommens PM
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Ilium surgery, Male, Middle Aged, Tomography, X-Ray Computed, Bone Screws, Fracture Fixation, Internal methods, Hip Fractures surgery, Imaging, Three-Dimensional methods, Sacrum surgery, Surgery, Computer-Assisted methods
- 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.
- Published
- 2019
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