• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.495-498
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• 2007

Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.210-217
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• 2020

Objective : To analyze the accuracy of iliac screws using freehand technique performed by the same surgeon. We also analyzed how the breach of iliac screws was related to the clinical symptoms resulting in revision surgery. Methods : From January 2009 to November 2015, 100 patients (193 iliac screws) were analyzed using postoperative computed tomography scans. The breaches were classified based on the superior, inferior, lateral, and medial iliac wall violation by the screw. According to the length of screw extrusion, the classification grades were as follows : grade 1, screw extrusion <1 cm; grade II, 1 cm ≤ screw extrusion <2 cm; grade III, 2 cm ≤ screw extrusion <3 cm; and grade IV, 3 cm ≤ screw extrusion. We also reviewed the revision surgery associated with iliac screw misplacement. Results : Of the 193 inserted screws, 169 were correctly located and 24 were misplaced screws. There were eight grade I, six grade II, six grade III, and four grade IV screw breaches, and 11, 8, 2, and 3 screws violated the medial, lateral, superior, and inferior walls, respectively. Four revision surgeries were performed for the grade III or IV iliac screw breaches in the lateral or inferior direction with respect to its related symptoms. Conclusion : In iliac screw placement, 12.4% breaches developed. Although most breaches were not problematic, symptomatic violations (2.1%) could result in revision surgery. Notably, the surgeon should keep in mind that lateral or inferior wall breaches longer than 2 cm can be risky and should be avoided.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.578-581
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• 2015

A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.347-353
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• 2010

Objective : Iliac screw fixation has been used to prevent premature loosening of sacral fixation and to provide more rigid fixation of the sacropelvic unit. We describe our technique for iliac screw placement and review our experience with this technique. Methods : Thirteen consecutive patients who underwent spinopelvic fixation using iliac screws were enrolled. The indications for spinopelvic fixation included long segment fusions for spinal deformity and post-operative flat-back syndrome, symptomatic pseudoarthrosis of previous lumbosacral fusions, high-grade lumbosacral spondylolisthesis, lumbosacral tumors, and sacral fractures. Radiographic outcomes were assessed using plain radiographs, and computed tomographic scans. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and questionnaire about buttock pain. Results : The median follow-up period was 33 months (range, 13-54 months). Radiographic fusion across the lumbosacral junction was obtained in all 13 patients. The average pre- and post-operative ODI scores were 40.0 and 17.5, respectively. The questionnaire for buttock pain revealed the following : 9 patients (69%) perceived improvement; 3 patients (23%) reported no change; and 1 patient (7.6%) had aggravation of pain. Two patients complained of prominence of the iliac hardware. The complications included one violation of the greater sciatic notch and one deep wound infection. Conclusion : Iliac screw fixation is a safe and valuable technique that provides added structural support to S1 screws in long-segment spinal fusions. Iliac screw fixation is an extensive surgical procedure with potential complications, but high success rates can be achieved when it is performed systematically and in appropriately selected patients.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.75-80
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• 2018

Objective : Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique. Methods : S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance. The gearshift was advanced to make a pilot hole passing through the sacroiliac joint and directing the anterior inferior iliac spine. A K-wire was placed through the pilot hole. After introducing a cannulated tapper along with the K-wire, a cannulated S2AI screw was installed over the K-wire. Results : Thirty-three S2AI screws were placed in sixteen consecutive patients. Thirty-two screws were cannulated screws, and one screw was a conventional non-cannulated screw. Thirty out of 32 (93.8%) cannulated screws were accurately positioned, whereas two cannulated screws and one non-cannulated screw violated lateral cortex of the ilium. Conclusion : The technique using K-wire and cannulated screw can provide accurate placement of free hand S2AI screw.

• Archives of Craniofacial Surgery
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• v.21 no.6
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• pp.384-386
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• 2020

This report describes osteotomy and iliac bone graft for malunion caused by failed mandibular fracture reduction. A 27-year-old man was referred 3 months after a motor vehicle accident. At another hospital, two operations had been performed for symphyseal fracture using two resorbable plates. Malocclusion was noted, and panoramic radiography and computed tomography revealed a misaligned dental arch, with a 9.37-mm gap between the central and the lateral incisor of the left mandible. A wafer was made from the patient's dental model, and a maxillary arch bar was applied. Through a lower gingivolabial incision, osteotomy was performed between the malunited symphyseal fracture segments. Both segments were reduced to their original position using the wafer and fixed with titanium miniplates via intermaxillary fixation (IMF). The intersegmental gap was filled with cancellous bone from the iliac crest. The gingival defect was covered with a mucosal transposition flap from the gingivolabial sulcus. IMF and the wafer were maintained for 5 and 9 weeks, respectively. At postoperative week 13, the screws were removed from the mandible and satisfactory occlusion was noted. His mouth opening improved from 2.5 to 3 finger breadths (40 mm). This case demonstrates the need for sufficient IMF when using resorbable plates.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.140-145
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• 2010

Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient's satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.278-282
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• 2012

An esophageal perforation following anterior cervical fusion is rare. Early development of an esophageal perforation after anterior cervical fusion is usually due to iatrogenic injury from retraction, injury associated with the original traumatic incident, improperly placed instruments or a bone graft. A 31-year-old man had a cervical dislocation and spinal cord injury because of severe cervical trauma after a traffic accident. He was quadriplegic and had no feeling below T4 dermatome. Anterior decompression of the cervical spine and anterior fusion with mesh with autobone were performed. An esophagocutaneous fistula occurred 7 days after anterior cervical surgery. A second anterior surgery was done because of pus drainage. The mesh was changed with an iliac bone graft, and the esophagocutaneous fistula site was primary repaired, but pus continued to drain. Conservative treatment, which consisted of wound drainage and intravenous administration of antibiotics, was tried, but was unsuccessful. After all, we removed the plate and screws, but did not removed the iliac bone graft, We closed the esophageal fistula, and transposed the sternocleidomastoid muscle flap to the interspace between the esophagus and the cervical spine. The wound to the esophagus was well repaired. In conclusion, precautionary measures are needed to avoid the complication, and adequate treatment is necessary to resolve those complications when they occur.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.33-38
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• 2016

Background: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. Methods: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3-4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. Results: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7-32 months). The mean follow-up period was 20.1 months (8-56 months), and the mean duration until union was 11.2 weeks (8-16 weeks). All clinical scores were improved at the final follow-up (p<0.001). The mean segmental defect was $3.3{\pm}2.6mm$ (1-18 mm); and the difference in clavicular length between operative and non-operative site was $5.9{\pm}6.9mm$. Conclusions: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.32-36
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• 2012

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures. Material and Methods: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed. Results: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection. Conclusion: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.