Hip Pelvis.  2015 Mar;27(1):57-62. 10.5371/hp.2015.27.1.57.

Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report

• Kang S
• Chung PH
• Kim JP
• Kim YS
• Lee HM
• Eum GS

• KMID: 2156022
• DOI: http://doi.org/10.5371/hp.2015.27.1.57

Abstract

Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.

Keyword

Pelvic fracture; Percutaneous iliosacral screw fixation; Superior gluteal artery injury; Arterial embolization

MeSH Terms

Arteries*
Humans

Figure

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  Fig. 1 Initial AP pelvic X-ray of a 68-year-old man showing bilateral vertical fracture at Zone II of the first sacrum and bilateral transverse process fracture of the fifth lumbar vertebra.

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  Fig. 2 Three-dimension reconstruction computed tomography showing the U-shaped spino-pelvic dissociation fracture of the first sacrum.

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  Fig. 3 Percutaneous iliosacral screw fixation was performed under fluoroscopic guidance. (A) Lateral view of sacrum showing the left side first guide pin is placed at the postero-inferior aspect of the iliac cortical density of the body of S1. (B) The right side second guide pin is placed 7 mm postero-inferior to the first pin. (C) Both guide pins are inserted through the opposite side of the body of S1. (D) Drilling is done with a cannulated drill through the guide pin. (E, F) Full threaded cannulated screws are inserted.

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  Fig. 4 (A) Angiography showed the bleeding at the superior division of the deep branch of the right superior gluteal artery (arrow). (B) Angiography after embolization of the deep branch of the superior gluteal artery (arrowhead) showed no active bleeding.

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  Fig. 5 Post-operative radiographs showing well positioned iliosacral screws. (A) AP pelvic view, (B) inlet view, (C) outlet view, and (D) lateral view.

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  Fig. 6 Post-operative three-dimension reconstructed computed tomography angiography showed the relationship between screw and superior gluteal artery (R: right, L: left). (A) Right side screw head is very closely placed to the deep branch of the superior gluteal artery. (B) There is some distance between the screw head and deep branch of the superior gluteal artery at the left side compared to the right side.

Reference

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