Iliosacral Screw Fixation for Treating Sacral Fractures: A Modified Pedicle‐Guided Fixation Technique in Prone Position
5 affiliations
- 1Department of Orthopedics, Shuang Ho Hospital Taipei Medical University New Taipei City Taiwan
- 2Department of Biomedical Engineering, College of Medicine and College of Engineering National Taiwan University Taipei Taiwan
- 3Department of Orthopaedics, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- 4School of Biomedical Engineering Taipei Medical University New Taipei City Taiwan
- 5Department of Orthopedics, Hsin Kuo Min Hospital Taipei Medical University Taipei Taiwan
Abstract
Background: Sacral fractures are posterior pelvic ring injuries which mechanisms range from high‐energy trauma to low‐energy falls in osteoporotic patients. In surgical treatment, percutaneous approaches have demonstrated significant shorter operation time and less soft tissue damage. In this study, we present a method of iliosacral (SI) screw insertion in prone position, with modified pedicle‐guided technique.
Methods: The present study is a retrospective case series of 22 patients for SI screw fixation from February 2019 to September 2023 under our method. Surgical technique was described in detail with images. Perioperative clinical parameters were analyzed. Activity status, complications, data of 10‐point visual analogue scale (VAS) for pain and further functional outcomes using the Majeed Pelvic Score (MPS) were recorded. In addition, computed tomography (CT) was routinely performed at 6 months postsurgery to inspect the quality of screws position.
Results: Excellence rate of screw position was 97% upon CT. Two patients had screws partially contacting the cortical bone but not violating sacral foramen, and no neurological symptoms were noted. All screws were secure from possible iatrogenic nerve injuries. VAS scores improved significantly over time and most patients recorded excellent functional recovery. One untoward complication occurred involving unexpected cement extravasation after sacroplasty. No associated neurologic compromise, or clinical evidence of venous emboli thrombosis was reported.
Conclusion: Our method aims at reducing operation time and radiation exposure to surgeons as conventional two‐dimensional fluoroscopy was enough to identify safe insertion corridors in SI screw placement. Performing SI fixation in prone position is also advantageous when dealing with obese patients and concomitant spinal injuries.
Related
- Modified fourth-generation minimally invasive technique with a modified K-wire fixation technique for hallux valgus: a biomechanical and clinical study.
- Modified suture bridge technique with tension-reducing suture for adolescent tibial tubercle avulsion fractures: a retrospective analysis
- Double Tension Band Wiring Versus Plating for Internal Fixation of Distal Humeral Fractures
- Femoral allograft augmentation in addition to locking plate fixation in displaced proximal humerus fractures: a retrospective case-series
- Transfascial Paraspinal Versus Conventional Open Posterior Pedicle Screw Fixation for Thoracolumbar Fractures: A Randomized Controlled Trial
BibTeX
@article{liu2026iliosacral,
title = {{Iliosacral Screw Fixation for Treating Sacral Fractures: A Modified Pedicle‐Guided Fixation Technique in Prone Position}},
author = {Ben‐Mao Liu and Yu‐Hsin Liu and Ting‐Shuo Hsu and Chih‐Yu Chen and Chang‐Jung Chiang and Yueh‐Ying Hsieh},
journal = {Orthopaedic Surgery},
year = {2026},
month = sep,
doi = {10.1111/os.70439},
url = {https://doi.org/10.1111/os.70439},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Iliosacral Screw Fixation for Treating Sacral Fractures: A Modified Pedicle‐Guided Fixation Technique in Prone Position
AU - Ben‐Mao Liu
AU - Yu‐Hsin Liu
AU - Ting‐Shuo Hsu
AU - Chih‐Yu Chen
AU - Chang‐Jung Chiang
AU - Yueh‐Ying Hsieh
PY - 2026
DA - 2026/09/21
JO - Orthopaedic Surgery
DO - 10.1111/os.70439
UR - https://doi.org/10.1111/os.70439
AB - Background: Sacral fractures are posterior pelvic ring injuries which mechanisms range from high‐energy trauma to low‐energy falls in osteoporotic patients. In surgical treatment, percutaneous approaches have demonstrated significant shorter operation time and less soft tissue damage. In this study, we present a method of iliosacral (SI) screw insertion in prone position, with modified pedicle‐guided technique. Methods: The present study is a retrospective case series of 22 patients for SI screw fixation from February 2019 to September 2023 under our method. Surgical technique was described in detail with images. Perioperative clinical parameters were analyzed. Activity status, complications, data of 10‐point visual analogue scale (VAS) for pain and further functional outcomes using the Majeed Pelvic Score (MPS) were recorded. In addition, computed tomography (CT) was routinely performed at 6 months postsurgery to inspect the quality of screws position. Results: Excellence rate of screw position was 97% upon CT. Two patients had screws partially contacting the cortical bone but not violating sacral foramen, and no neurological symptoms were noted. All screws were secure from possible iatrogenic nerve injuries. VAS scores improved significantly over time and most patients recorded excellent functional recovery. One untoward complication occurred involving unexpected cement extravasation after sacroplasty. No associated neurologic compromise, or clinical evidence of venous emboli thrombosis was reported. Conclusion: Our method aims at reducing operation time and radiation exposure to surgeons as conventional two‐dimensional fluoroscopy was enough to identify safe insertion corridors in SI screw placement. Performing SI fixation in prone position is also advantageous when dealing with obese patients and concomitant spinal injuries.
SN - 1757-7853
SN - 1757-7861
ER -