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Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning

  • Trauma Surgery
  • Published:
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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.

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Acknowledgements

We thank Thomas Heldstab for his technical assistance. Some data based on previous research, which has been co-funded by the TK System of the AO Foundation, Davos, Switzerland, and by Depuy Synthes company, Zuchwil, Switzerland. We would like to thank Depuy Synthes to provide us with a virtual screw template.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Daniel Wagner, Andreas Baranowski, Dominik Gruszka & Pol M. Rommens

  2. AO Research Institute Davos, Davos, Switzerland

    Lukas Kamer & Hansrudi Noser

  3. Department of Orthopedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan

    Takeshi Sawaguchi

  4. Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan

    Masafumi Uesugi

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  1. Daniel Wagner
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  5. Masafumi Uesugi
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Correspondence to Daniel Wagner.

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Conflict of interest

Author Wagner, Author Kamer, Author Sawaguchi, Author Noser, Author Uesugi, Author Baranowski, Author Gruszka, and Author Rommens declare that they have no conflict of interest.

Ethical approval

The database of the AO Research Institute Davos is registered at the “Eidgenössischer Öffentlichkeits- und Datenschutzbeauftragter” (EDÖP, Bern, Switzerland, No. 200700006). All patients agreed to anonymous use of their CT data for research purposes. For the Japanese data, ethical approval was given by the institutional review board of the Tsukuba Medical Center (No. 2012-013).

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Wagner, D., Kamer, L., Sawaguchi, T. et al. Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning. Arch Orthop Trauma Surg 139, 1385–1391 (2019). https://doi.org/10.1007/s00402-019-03204-9

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