Z Orthop Unfall 2021; 159(05): 522-532
DOI: 10.1055/a-1190-5987
Original Article/Originalarbeit

The S2-Alar-Iliac Screw for Pelvic Trauma

Article in several languages: English | deutsch
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
,
Niklas Grüneweller
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
,
Moritz Friedrich Lodde
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
,
Julia Evers
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
,
Oliver Riesenbeck
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
,
Michael Raschke
Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster
› Author Affiliations

Abstract

Percutaneous sacro-iliac screw osteosynthesis is considered to be standard of care for most posterior pelvic ring fractures. However, special situations require alternative strategies for sufficient stabilization. In these cases, stabilization can often be achieved using posterior instrumentation e.g. using SIPS-screws (spina-iliaca-posterior-superior screws). However, this often leads to implant-related aggravation of the sometimes already critical soft tissue conditions after pelvic trauma. S2-Ala-Ilium screws (S2AI screws) are a suitable alternative. The starting point lies medial of the posterior superior iliac spine below the iliac level. It is almost in line with a potential spinal instrumentation and therefore usually causes fewer soft tissue problems. Although this technique has been widely used in spinal surgery in recent years, its use in orthopaedic traumatology is largely unknown. The possibilities but also the limitations of this technique for the treatment of injuries to the pelvis are illustrated by this retrospective case series.



Publication History

Article published online:
13 July 2020

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  • References/Literatur

  • 1 Culemann U, Tosounidis G, Reilmann H. et al. [Injury to the pelvic ring. Diagnosis and current possibilities for treatment]. Unfallchirurg 2004; 107: 1169-1181
  • 2 Eckardt H, Egger A, Hasler RM. et al. Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: assessment of complications and factors influencing failure. Injury 2017; 48: 2717-2723
  • 3 Hoffmann MF, Dudda M, Schildhauer TA. [Unilateral triangular lumbopelvic stabilization: indications and techniques]. Unfallchirurg 2013; 116: 985-990
  • 4 Gruneweller N, Raschke MJ, Zderic I. et al. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res 2017; 35: 1485-1493
  • 5 Lehmann W, Hoffmann M, Briem D. et al. Management of traumatic spinopelvic dissociations: review of the literature. Eur J Trauma Emerg Surg 2012; 38: 517-524
  • 6 Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma 2006; 20: S44-51
  • 7 Koller H, Zenner J, Hempfing A. et al. Reinforcement of lumbosacral instrumentation using S1-pedicle screws combined with S2-alar screws. Oper Orthop Traumatol 2013; 25: 294-314
  • 8 Lattig F, Weckbach S. [S2-Ala-iliac screws for extended pelvic fixation in longer lumbar instrumentations: description of a freehand technique]. Oper Orthop Traumatol 2017; 29: 360-372
  • 9 Hasan MY, Liu G, Wong HK. et al. Postoperative complications of S2AI versus iliac screw in spinopelvic fixation: a meta-analysis and recent trends review. Spine J 2020; 20: 964-972 doi:10.1016/j.spinee.2019.11.014
  • 10 Burns CB, Dua K, Trasolini NA. et al. Biomechanical comparison of spinopelvic fixation constructs: iliac screw versus S2-alar-iliac screw. Spine Deform 2016; 4: 10-15
  • 11 Mazur MD, Ravindra VM, Schmidt MH. et al. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine 2015; 23: 67-76
  • 12 Elder BD, Ishida W, Lo SL. et al. Use of S2-alar-iliac screws associated with less complications than iliac screws in adult lumbosacropelvic fixation. Spine (Phila Pa 1976) 2017; 42: E142-E149
  • 13 Liu G, Hasan MY, Wong HK. Subcrestal iliac-screw: a technical note describing a free hand, in-line, low profile iliac screw insertion technique to avoid side-connector use and reduce implant complications. Spine (Phila Pa 1976) 2018; 43: E68-E74
  • 14 OʼBrien JR, Yu W, Kaufman BE. et al. Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation. Spine (Phila Pa 1976) 2013; 38: E1250-E1255
  • 15 Shillingford JN, Laratta JL, Tan LA. et al. The free-hand technique for S2-alar-iliac screw placement: a safe and effective method for sacropelvic fixation in adult spinal deformity. J Bone Joint Surg Am 2018; 100: 334-342
  • 16 OʼBrien JR, Matteini L, Yu WD. et al. Feasibility of minimally invasive sacropelvic fixation: percutaneous S2 alar iliac fixation. Spine (Phila Pa 1976) 2010; 35: 460-464
  • 17 Phan K, Li J, Giang G. et al. A novel technique for placement of sacro-alar-iliac (S2AI) screws by K-wire insertion using intraoperative navigation. J Clin Neurosci 2017; 45: 324-327
  • 18 Funao H, Kebaish KM, Isogai N. et al. Utilization of a technique of percutaneous S2 alar-iliac fixation in immunocompromised patients with spondylodiscitis. World Neurosurg 2017; 97: 757.e11-757.e18 doi:10.1016/j.wneu.2016.10.018
  • 19 Wiltse LL, Bateman JG, Hutchinson RH. et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 1968; 50: 919-926
  • 20 Ray WZ, Ravindra VM, Schmidt MH. et al. Stereotactic navigation with the O-arm for placement of S-2 alar iliac screws in pelvic lumbar fixation. J Neurosurg Spine 2013; 18: 490-495
  • 21 Kach K, Trentz O. [Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis]. Unfallchirurg 1994; 97: 28-38
  • 22 Letournel E. [Fractures of the cotyloid cavity, study of a series of 75 cases]. J Chir (Paris) 1961; 82: 47-87
  • 23 Tsuchiya K, Bridwell KH, Kuklo TR. et al. Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976) 2006; 31: 303-308
  • 24 Guerado E, Andrist T, Andrades JA. et al. [Spinal arthrodesis. Basic science]. Rev Esp Cir Ortop Traumatol 2012; 56: 227-244
  • 25 Guerado E, Fuerstenberg CH. What bone graft substitutes should we use in post-traumatic spinal fusion?. Injury 2011; 42 (Suppl. 02) S64-S71
  • 26 Guerado E, Cervan AM, Cano JR. et al. Spinopelvic injuries. Facts and controversies. Injury 2018; 49: 449-456
  • 27 Wahnert D, Raschke MJ, Fuchs T. Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum: a new method using modified implants. Int Orthop 2013; 37: 1147-1150
  • 28 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013; 44: 1733-1744