Orthopedics
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Clinical Trial
Posterior stabilization of unstable sacroiliac injuries with the Texas Scottish Rite Hospital spinal instrumentation.
This article describes a new alternative technique for stabilization of unstable sacroiliac injuries using the Texas Scottish Rite Hospital (TSRH) instrumentation. The TSRH instrumentation was applied in 14 consecutive patients with unstable posterior pelvic ring disruptions. ⋯ No pressure sores, infection, significant loss of correction, or hardware failures were observed postoperatively. The use of the TSRH instrumentation for stabilization of sacroiliac injuries offered sufficient stabilization of the posterior pelvic ring and permitted early mobilization without loss of correction.
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Seven adult cadaver lumbopelvises were harvested to study the anatomic relationship of the L4 and L5 nerves to S1 dorsal screw placement and the location of the L4, L5, and S1 nerves on plain radiographs. The mean lateral angle of S1 screw trajectory toward the L4 nerve was 31+/-8 degrees, and the mean screw trajectory length was 53+/-8 mm. The mean lateral angle of the screw trajectory toward the L5 nerve was 21+/-8 degrees, and the mean screw trajectory length was 38+/-4 mm. ⋯ The L5 nerve coursed over the inner third of the superior ala and inner third of the lateral mass. On the lateral view, the mean distances from the sacral promontory to the L4, L5, and S1 nerves along the anterior border of the sacrum were 4+/-7 mm, 12+/-5 mm, and 28+/-8 mm, respectively. This study suggests that S1 sacral screws be directed between 30 degrees and 40 degrees lateral to avoid compromising the lumbosacral trunk and sacroiliac joint.