Investigation of bone quality of the first and second sacral segments amongst trauma patients: concerns about iliosacral screw fixation Journal Article


Authors: Salazar, D; Lannon, S.; Pasternak, O.; Schiff, A; Lomasney, L; Mitchell, E; Stover, M.
Article Title: Investigation of bone quality of the first and second sacral segments amongst trauma patients: concerns about iliosacral screw fixation
Abstract: BACKGROUND: Iliosacral screw fixation has become a common method for surgical stabilization of acute disruptions of the pelvic ring. Placement of iliosacral screws into the first sacral (S1) body is the preferred method of fixation, but size limitations and sacral dysmorphism may preclude S1 fixation. In these clinical situations, fixation into the second sacral (S2) body has been recommended. The objective of this study was to evaluate the bone quality of the S1 compared to S2 in the described safe zone of iliosacral screw fixation in trauma patients. MATERIALS AND METHODS: The pelvic computed tomography scans of 25 consecutive trauma patients, ages 18-49, at a level 1 trauma center were prospectively analyzed. Hounsfield units, a standardized computed tomography attenuation coefficient, was utilized to measure regional cancellous bone mineral density of the S1 and S2. No change in the clinical protocol or treatment occurred as a consequence of inclusion in this study. RESULTS: A statically significant difference in bone quality was found when comparing the first and second sacral segment (p = 0.0001). Age, gender, or smoking status did not independently affect bone quality. CONCLUSION: In relatively young, otherwise healthy trauma patients there is a statistically significant difference in the bone density of the first sacral segment compared to the second sacral segment. This study highlights the need for future biomechanical studies to investigate whether this difference is clinically relevant. Due to the relative osteopenia in the second sacral segment, which may impact the quality of fixation, we feel this technique should be used with caution. LEVEL OF EVIDENCE: III.
Journal Title: Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
ISSN: 1590-9999; 1590-9921
Publisher: Unknown  
Date Published: 2015
Language: ENG
DOI/URL:
Notes: LR: 20150529; JID: 101090931; 2014/11/14 [received]; 2015/05/10 [accepted]; 2015/05/28 [aheadofprint]; aheadofprint
LUC Authors
  1. Adam Schiff
    15 Schiff
  2. Dane Salazar
    32 Salazar
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