A New Modified Method for Inserting Iliosacral Screw versus the Conventional Method

Study DesignMethodological study.PurposeTo our knowledge, this is the first study to introduce a new modified method for inserting iliosacral screws and to compare its results with those of a conventional method.Overview of LiteraturePrevious techniques, such as open reduction and internal fixation, are associated with perioperative hemorrhage, postoperative infection, and neurological deficits. Although percutaneous iliosacral screw insertion confers the advantage of being minimally invasive, leading to less blood loss and a low postoperative infection rate, it harbors the risk of screw malpositioning due to narrow sacral proportions and a high interindividual variability.MethodsNine cadaveric pelvises were included in this study, with one hemipelvis of each being assigned to the new modified method and the other to the conventional iliosacral screw insertion method. In the new modified method, the guidewire entry point was determined using a lateral sacral X-ray. To do so, we first identified the anterosuperior quadrant of the S1 body on one hemipelvis. The anterosuperior quadrant was further divided into four imaginary quadrants, and the guidewire was inserted into the posteroinferior quadrant. The guidewire trajectory was perpendicular to the sagittal plane so that the guidewire resembled a single point in the lateral sacral view. Guidewires were inserted into corresponding hemipelves using the conventional method as described in the literature. Subsequently, an axial computed tomography scan with 1-mm fine cuts was obtained, and sagittal and coronal views were reconstructed. The distance of the guidewire from the sacral canal, anterior sacral cortex, and first sacral foramen was measured in axial, sagittal, and coronal views. The minimum measurement among different views was defined as the safety index of the insertion methods. The conventional and new modified methods were then compared in terms of safety and duration of the procedure.ResultsThe minimum distance of the guidewire from the S1 foramen and anterior sacral cortex was not significantly different between the two methods. However, the minimum distance between the guidewire and sacral canal was significantly greater in the new modified method than in the conventional method. The duration of guidewire insertion was significantly shorter in the new modified method than in the conventional method.ConclusionsThis new modified method of iliosacral screw insertion could be safely and simply implemented while taking less surgical time than the conventional methods

Incidence of Orthopedic Trauma Patients at Sina Orthopedic Emergency Clinic (Review of 796 Trauma Victims at Sina Hospital)

Objective: To evaluate incidence of emergency cases at orthopedic trauma clinic. The major objection was planning of Sina orthopedic trauma clinic's equipment and facilities. Summary of background data: Sina orthopedic trauma clinic is a referral trauma center with vascular surgery, Hand and plastic surgery and spine surgery facilities. Many patients from Tehran and other cities come to this clinic and want good services without attention to limited available materials, equipment and staff at this hospital. Materials & Methods: A case series descriptive study was achieved at orthopedic trauma clinic of Sina hospital. Every patient that came to orthopedic trauma clinic was included in this study. One trained GP physician with help of residents of orthopedic surgery gathered data of patients. Then analysis on data was performed by SPSS-9.01. Results: Seven hundreds ninety six patients came at three last months of 1998, of them, 78' were male and mean age of them was 28.8 years. Five hundred thirty had bone fracture, 49 of them had dislocation, 84 of them had crushing injury, and other had ligamentous damage. Falling was the major cause of trauma (30%), other causes were pedestrian trauma (22%), motorcycle injury (5%) and so on. Two hundreds of these patients were admitted. Conclusion: Planning of hospital staff, equipment, usable material is very important factor to prepare excellent service for patients and the only method to assessment of needs is correct available data in every area or state of a city or country. This study is the beginning of this project