Use of the Lateral Fluoroscopic View to Identify a Safe Starting Point and Trajectory Lines When Placing Percutaneous Iliosacral Screws

Safe percutaneous placement of iliosacral screws remains a challenge given the close proximity to neurovascular structures. Because of the concerns with safe placement, surgeons have explored the use of three-dimensional fluoroscopy and intraoperative computed tomography–guided screw placement with success; however, these intraoperative aids are not readily available and, in some cases, are cost prohibitive. The authors present a surgical technique that varies from the standard technique for placement of percutaneous iliosacral screws by utilizing the lateral sacral view at the start of the procedure to identify the appropriate starting point and trajectory lines, which aid in obtaining fluoroscopic imaging and guiding pin advancement. Use of this technique has resulted in the safe placement (no cortical breach) of 97.5% of iliosacral screws. (Journal of Surgical Orthopaedic Advances 24(2):147–150, 2015) Key words: iliosacral screw, pelvic fracture, posterior pelvic fixation, SI screw