Special Technical ArticlesTwo Transiliac-Transsacral Screws in a Single Sacral Level: Surgical Technique and Patient OutcomesChang, Gerard MD*; Fram, Brianna MD*; Sobol, Keenan BS†; Krieg, James C. MD‡Author Information *Department of Orthopaedic Surgery, Thomas Jefferson University Hospital †Sidney Kimmel Medical College, Thomas Jefferson University ‡Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA J.C.K. reports personal fees from Seaburg Medical, personal fees from DePuy Synthes CMF, personal fees from BioStar Venture, personal fees from DePuy Synthes, personal fees from MDLive, personal fees from Franklin BioSciences, personal fees from Trice Medical, personal fees from Conventus, personal fees from SMV Medical, outside the submitted work. The remaining authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact James C. Krieg, MD, at [email protected] or by mail at Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St. 5th Floor, Philadelphia, PA 19107. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: March 2021 - Volume 36 - Issue 1 - p 50-56 doi: 10.1097/BTO.0000000000000369 Buy Metrics Abstract Percutaneous fixation of posterior pelvic injuries is increasingly common. Use of transiliac-transsacral (TI-TS) screws can provide improved fixation, relative to standard iliosacral screws. In certain circumstances, utilizing 2 TI-TS screws may confer greater stability and strength, and there may be a need or desire to place them both in a single sacral level safe zone. We describe a technical guide on how to preoperatively assess if the S1 or S2 corridor can safely accommodate 2 TI-TS screws, and how to execute the technique using intraoperative fluoroscopy. We also report our institutional experience of 20 patients who were treated with 2 TI-TS screws for both high-energy and fragility posterior pelvic ring injuries. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.