Download PDF
Vet Comp Orthop Traumatol 2019; 32(06): 467-474
DOI: 10.1055/s-0039-1693471
Original Research
Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Fluoroscopic-Guided Closed Reduction versus Open Reduction of Sacroiliac Fracture-Luxations Stabilized with a Lag Screw

Amanda Rollins
1   VCA Animal Specialty and Emergency Center, Los Angeles, California, United States
2   Department of Surgery, The Animal Medical Center, New York, New York, United States
,
Raviv Balfour
1   VCA Animal Specialty and Emergency Center, Los Angeles, California, United States
,
David Szabo
1   VCA Animal Specialty and Emergency Center, Los Angeles, California, United States
,
Christina M. Chesvick   †
1   VCA Animal Specialty and Emergency Center, Los Angeles, California, United States
› Author Affiliations Funding None.
Further Information

Publication History

16 October 2018

05 June 2019

Publication Date:
27 August 2019 (online)

    Permissions and Reprints

Abstract

Objective The aim of this study was to compare radiographic outcomes of open reduction versus fluoroscopic-guided closed reduction (FGCR) of sacroiliac fracture-luxations stabilized with a lag screw, as well as peri- and postoperative complications.

Study Design Medical records (2010–2015) and radiographs of dogs and cats diagnosed with sacroiliac fracture-luxation that underwent open reduction without fluoroscopic guidance (n = 24) or FGCR (n = 17) were retrospectively reviewed to assess sacroiliac fracture-luxation reduction and lag screw placement, and lag screw loosening on follow-up radiographs (range, 1–8 weeks postoperatively) when available. Peri- and postoperative complications were also recorded.

Results Optimal screw depth to sacral body width ratio (>60%) was achieved in a significantly higher proportion of FGCR cases than openly reduced fracture-luxations. A significantly lower rate of lag screw loosening was found for FGCR cases. Few peri- and postoperative complications were noted across both groups. Four out of 17 FGCR cases requiring conversion to an open approach were excluded from data analysis; they had a longer duration from trauma to surgical repair than the median duration from trauma to surgical repair for cases successfully reduced in closed fashion.

Conclusion Fluoroscopic-guided closed reduction of sacroiliac fracture-luxations leads to consistently more optimal screw placement, as well as a lower incidence of lag screw loosening on follow-up radiographs. However, for cases with a longer duration from trauma to surgical repair, one should be prepared to convert to an open approach if a closed approach is not amenable to adequate reduction and lag screw placement.

Keywords

sacroiliac fracture-luxation - fluoroscopic-guided closed reduction - lag screw fixation - dog - cat

Note

This manuscript is dedicated to the memory of Dr. Christina Chesvick, whose collaboration and impact on the veterinary field will be greatly missed.


Author Contribution

All author s contributed to conception of study, study design, acquisition of data and data analysis and interpretation. A. Rollins, R. Balfour and D. Szabo drafted, revised and approved the submitted manuscript.


† Dr. Chesvick passed away while this manuscript was being drafted.


Supplementary Material

 

  • References

  • 1 DeCamp CE. Principles of pelvic fracture management. Semin Vet Med Surg (Small Anim) 1992; 7 (01) 63-70
    PubMedGoogle Scholar
  • 2 DeCamp CE, Braden TD. Sacroiliac fracture-separation in the dog: a study of 92 cases. Vet Surg 1985; 14: 127-130
    CrossrefPubMedGoogle Scholar
  • 3 Jacobson A, Schrader SC. Peripheral nerve injury associated with fracture or fracture-dislocation of the pelvis in dogs and cats: 34 cases (1978-1982). J Am Vet Med Assoc 1987; 190 (05) 569-572
    PubMedGoogle Scholar
  • 4 Tomlinson JL, Cook JL, Payne JT, Anderson CC, Johnson JC. Closed reduction and lag screw fixation of sacroiliac luxations and fractures. Vet Surg 1999; 28 (03) 188-193
    CrossrefPubMedGoogle Scholar
  • 5 Tomlinson J. Minimally invasive repair of sacroiliac luxation in small animals. Vet Clin North Am Small Anim Pract 2012; 42 (05) 1069-1077 , viii
    CrossrefPubMedGoogle Scholar
  • 6 Tonks CA, Tomlinson JL, Cook JL. Evaluation of closed reduction and screw fixation in lag fashion of sacroiliac fracture-luxations. Vet Surg 2008; 37 (07) 603-607
    CrossrefPubMedGoogle Scholar
  • 7 Leasure CS, Lewis DD, Sereda CW, Mattern KL, Jehn CT, Wheeler JL. Limited open reduction and stabilization of sacroiliac fracture-luxations using fluoroscopically assisted placement of a trans-iliosacral rod in five dogs. Vet Surg 2007; 36 (07) 633-643
    CrossrefPubMedGoogle Scholar
  • 8 McCartney WT, Comiskey D, MacDonald B. Use of transilial pinning for the treatment of sacroiliac separation in 25 dogs and finite element analysis of repair methods. Vet Comp Orthop Traumatol 2007; 20 (01) 38-42
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Raffan PJ, Joly CL, Timm PG, Miles JE. A tension band technique for stabilisation of sacroiliac separations in cats. J Small Anim Pract 2002; 43 (06) 255-260
    CrossrefPubMedGoogle Scholar
  • 10 Shuler TE, Boone DC, Gruen GS, Peitzman AB. Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 1995; 38 (03) 453-458
    CrossrefPubMedGoogle Scholar
  • 11 Sciulli RL, Daffner RH, Altman DT, Altman GT, Sewecke JJ. CT-guided iliosacral screw placement: technique and clinical experience. AJR Am J Roentgenol 2007; 188 (02) W181-92
    PubMedGoogle Scholar
  • 12 Smith AG, Capobianco R, Cher D. , et al. Open versus minimally invasive sacroiliac joint fusion: a multi-center comparison of perioperative measures and clinical outcomes. Ann Surg Innov Res 2013; 7 (01) 14
    CrossrefPubMedGoogle Scholar
  • 13 Ledonio CG, Polly Jr DW, Swiontkowski MF. Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?. Clin Orthop Relat Res 2014; 472 (06) 1831-1838
    CrossrefPubMedGoogle Scholar
  • 14 Liu HS, Duan SJ, Liu SD, Jia FS, Zhu LM, Liu MC. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot 2018; 14 (05) e1927
    CrossrefPubMedGoogle Scholar
  • 15 DeCamp CE, Braden T. The surgical anatomy of the canine sacrum for lag screw fixation of the sacroiliac joint. Vet Surg 1985; 14: 131-134
    CrossrefPubMedGoogle Scholar
  • 16 Burger M, Forterre F, Brunnberg L. Surgical anatomy of the feline sacroiliac joint for lag screw fixation of sacroiliac fracture-luxation. Vet Comp Orthop Traumatol 2004; 17: 146-151
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Bowlt KL, Shales CJ. Canine sacroiliac luxation: anatomic study of the craniocaudal articular surface angulation of the sacrum to define a safe corridor in the dorsal plane for placement of screws used for fixation in lag fashion. Vet Surg 2011; 40 (01) 22-26
    CrossrefPubMedGoogle Scholar
  • 18 Shales CJ, Langley-Hobbs SJ. Canine sacroiliac luxation: anatomic study of dorsoventral articular surface angulation and safe corridor for placement of screws used for lag fixation. Vet Surg 2005; 34 (04) 324-331
    CrossrefPubMedGoogle Scholar
  • 19 Joseph R, Milgram J, Zhan K, Shahar R. In vitro study of the ilial anatomic landmarks for safe implant insertion in the first sacral vertebra of the intact canine sacroiliac joint. Vet Surg 2006; 35 (06) 510-517
    CrossrefPubMedGoogle Scholar
  • 20 Radasch RM, Merkley DF, Hoefle WD, Peterson J. Static strength evaluation of sacroiliac fracture-separation repairs. Vet Surg 1990; 19 (02) 155-161
    CrossrefPubMedGoogle Scholar
  • 21 Déjardin LM, Marturello DM, Guiot LP, Guillou RP, DeCamp CE. Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation. Vet Comp Orthop Traumatol 2016; 29 (04) 290-297
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Johnson KA. Piermattei’s Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 5th ed.. St. Louis: Elsevier Saunders; 2014: 312-315
    Google Scholar
  • 23 Tomlinson JL. Fractures of the pelvis. In: Slatter DH. , ed. Textbook of Small Animal Surgery. 3rd ed. Philadelphia: Saunders; 2003: 1189-2001
    Google Scholar
  • 24 Moens NMM, DeCamp CE. Fractures of the pelvis. In: Johnston SA, Tobias KM. , eds. Veterinary Surgery: Small Animal. 2nd ed. St. Louis: Elsevier, Inc.; 2018
    Google Scholar
  • 25 Heiney J, Capobianco R, Cher D. A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique. Int J Spine Surg 2015; 9: 40
    CrossrefPubMedGoogle Scholar
  • 26 Pieske O, Landersdorfer C, Trumm C. , et al. CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries: accuracy of screw position, injury reduction and complications in 71 patients with 136 screws. Injury 2015; 46 (02) 333-339
    CrossrefPubMedGoogle Scholar
  • 27 Tonetti J, Carrat L, Lavalleé S, Pittet L, Merloz P, Chirossel JP. Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop Relat Res 1998; (354) 103-110
    PubMedGoogle Scholar
  • 28 Wang H, Wang F, Leong AP, Xu L, Chen X, Wang Q. Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study. Int Orthop 2016; 40 (09) 1941-1947
    CrossrefPubMedGoogle Scholar
  • 29 Cher DJ, Frasco MA, Arnold RJ, Polly DW. Cost-effectiveness of minimally invasive sacroiliac joint fusion. Clinicoecon Outcomes Res 2015; 8: 1-14
    PubMedGoogle Scholar
  • 30 Shales C, Moores A, Kulendra E, White C, Toscano M, Langley-Hobbs S. Stabilization of sacroiliac luxation in 40 cats using screws inserted in lag fashion. Vet Surg 2010; 39 (06) 696-700
    PubMedGoogle Scholar
  • 31 Averill SM, Johnson AL, Schaeffer DJ. Risk factors associated with development of pelvic canal stenosis secondary to sacroiliac separation: 84 cases (1985-1995). J Am Vet Med Assoc 1997; 211 (01) 75-78
    PubMedGoogle Scholar
  • 32 Déjardin LM, Fauron AH, Guiot LP, Guillou RP. Minimally invasive lag screw fixation of sacroiliac luxation/fracture using a dedicated novel instrument system: apparatus and technique description. Vet Surg 2018; 47 (01) 93-103
    CrossrefPubMedGoogle Scholar