Percutaneous Placement of Iliosacral Screws

Abstract

This is the case of a 46-year-old male who fell 20 ft from a roof while putting up Christmas lights and landed on the driveway, partially striking a car on the way. He suffered numerous injuries including a pelvic “U” fracture or spinopelvis dissociation. The fracture involved the pedicle on the right at L5 as the plane of injury extended up from the sacral ala and into the spine creating a combined lumbar spine and pelvic fracture (Fig. 30.1). This typical pattern benefits from a combined posterior approach to address the spinal and pelvic components. The spine is fixed to the pelvis with lumbosacral fixation (this construct included L4 to span the right pedicle fracture at L5) including iliac wing screws and the fixation between the iliac wings and the sacral vertebrae is reinforced with iliosacral screws placed percutaneously (Fig. 30.2).