Erschienen in:
21.05.2019 | Trauma Surgery
Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning
verfasst von:
Daniel Wagner, Lukas Kamer, Takeshi Sawaguchi, Hansrudi Noser, Masafumi Uesugi, Andreas Baranowski, Dominik Gruszka, Pol M. Rommens
Erschienen in:
Archives of Orthopaedic and Trauma Surgery
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Ausgabe 10/2019
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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.