Technical TrickTransiliac–Transsacral Screws for Posterior Pelvic StabilizationGardner, Michael J MD*; Routt, M L Chip Jr MD†Author Information From the *Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; and †Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA. This study was performed at Harborview Medical Center. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Reprints: Michael J. Gardner, MD, Washington University School of Medicine, Department of Orthopaedic Surgery, 660 S Euclid Avenue, Campus Box 8233, St. Louis, MO 63110 (e-mail: [email protected]). Journal of Orthopaedic Trauma: June 2011 - Volume 25 - Issue 6 - p 378-384 doi: 10.1097/BOT.0b013e3181e47fad Buy Metrics Abstract Typical posterior pelvic fixation constructs use one or more large screws inserted from the lateral iliac cortex into the safe upper sacral ala or body. As a result of the deforming forces acting perpendicular to the implant axis, routine iliosacral screw fixation may not provide adequate stabilization, especially in certain unstable injuries. Longer iliosacral screws that traverse the entire upper sacrum and exit the contralateral iliac cortex may improve holding power and also stabilize concomitant contralateral posterior pelvic injuries. These transiliac-transsacral screws are reliably safe to insert using routine intraoperative fluoroscopy, and they provide durable fixation. These screws require careful preoperative planning and more precise technical attention during insertion because they pass through both sacral alar zones. Transiliac-transsacral screws may be particularly useful in the presence of osteoporosis, significant posterior pelvic instability including spinopelvic dissociation, patient obesity, anticipated noncompliant behavior, bilateral posterior pelvic injuries, and nonunion procedures. © 2011 Lippincott Williams & Wilkins, Inc.