Posterior pelvic ring bone density with implications for percutaneous screw fixation
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ORIGINAL ARTICLE
Posterior pelvic ring bone density with implications for percutaneous screw fixation Jonathan G. Eastman1 · Trevor J. Shelton1 · Milton Lee Chip Routt Jr.2 · Mark R. Adams3 Received: 14 May 2020 / Accepted: 28 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Although the second (S2) and third (S3) sacral segments have been established as potential osseous fixation pathways for screw fixation, the S2 body has been demonstrated to have inferior bone density when compared to the body of the first (S1) sacral segment. Caution regarding the use of iliosacral screws at this level has been advised as a result. As transiliac–transsacral screws traverse the lateral cortices of the posterior pelvis, they may be relying on bone with superior density for purchase, which could obviate this concern. The objective of this study was to compare the bone density of the posterior ilium and sacroiliac joint to that of the sacral body at the first (S1), second (S2), and third (S3) sacral levels. Materials and methods A retrospective case series was performed, reviewing the CT scans of 100 patients without prior pelvic trauma. Each CT was confirmed to have available osseous fixation pathways at the first (S1), second (S2), and third (S3) sacral segments. The bone density of the posterior ilium/sacroiliac joint (PISJ) and sacral body (SB) was measured using the embedded standardized Hounsfield units (HU) tool at each sacral level. Results The average S2 PISJ bone density (320.1) was significantly higher than the S1 (286.5) and S3 (278.9) PISJ (p
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