Feasibility of iliosacral screw placement in patients with upper sacral dysplasia.
Adult
Bone Diseases, Developmental
/ diagnostic imaging
Bone Screws
/ standards
Clinical Decision-Making
/ methods
Cohort Studies
Feasibility Studies
Female
Fractures, Bone
/ diagnostic imaging
Humans
Ilium
/ diagnostic imaging
Male
Middle Aged
Preoperative Care
/ methods
Retrospective Studies
Sacrum
/ diagnostic imaging
Young Adult
Iliosacral screw placement
Pelvic ring injury
Radiographic signs
Sacral dysmorphism
Safety
Upper sacral dysplasia
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
09 Dec 2019
09 Dec 2019
Historique:
received:
21
08
2019
accepted:
13
11
2019
entrez:
11
12
2019
pubmed:
11
12
2019
medline:
22
5
2020
Statut:
epublish
Résumé
Exact knowledge of the sacral anatomy is crucial for the percutaneous insertion of iliosacral screws. However, dysplastic anatomical patterns are common. In addition to a preoperative computed tomography (CT) analysis, conventional radiographic measures may help to identify upper sacral dysplasia and to avoid damage to surrounding structures. Aiming to further increase safety in percutaneous iliosacral screw placement in the presence of sacral dysmorphism, this study examined the prevalence of previously established radiographic signs and, in addition, defined the "critical SI angle" as a new radiographic criterion. Pelvic CT scans of 98 consecutive trauma patients were analysed. Next to assessment of established signs indicating upper sacral dysplasia, the critical sacroiliac (SI) angle was defined in standardized pelvic outlet views. The critical SI angle significantly correlates with the presence of mammillary bodies and an intraarticular vacuum phenomenon. With a cut-off value of - 14.2°, the critical SI angle detects the feasibility of a safe iliosacral screw insertion in pelvic outlet views with a sensitivity of 85.9% and a specificity of 85.7%. The critical SI angle can support the decision-making when planning iliosacral screw fixation. The clinical value of the established signs of upper sacral dysplasia remains uncertain.
Sections du résumé
BACKGROUND
BACKGROUND
Exact knowledge of the sacral anatomy is crucial for the percutaneous insertion of iliosacral screws. However, dysplastic anatomical patterns are common. In addition to a preoperative computed tomography (CT) analysis, conventional radiographic measures may help to identify upper sacral dysplasia and to avoid damage to surrounding structures. Aiming to further increase safety in percutaneous iliosacral screw placement in the presence of sacral dysmorphism, this study examined the prevalence of previously established radiographic signs and, in addition, defined the "critical SI angle" as a new radiographic criterion.
METHODS
METHODS
Pelvic CT scans of 98 consecutive trauma patients were analysed. Next to assessment of established signs indicating upper sacral dysplasia, the critical sacroiliac (SI) angle was defined in standardized pelvic outlet views.
RESULTS
RESULTS
The critical SI angle significantly correlates with the presence of mammillary bodies and an intraarticular vacuum phenomenon. With a cut-off value of - 14.2°, the critical SI angle detects the feasibility of a safe iliosacral screw insertion in pelvic outlet views with a sensitivity of 85.9% and a specificity of 85.7%.
CONCLUSIONS
CONCLUSIONS
The critical SI angle can support the decision-making when planning iliosacral screw fixation. The clinical value of the established signs of upper sacral dysplasia remains uncertain.
Identifiants
pubmed: 31818320
doi: 10.1186/s13018-019-1472-7
pii: 10.1186/s13018-019-1472-7
pmc: PMC6902468
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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