CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT.

PURPOSE: To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. MATERIAL AND METHODS: Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. RESULTS: A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1,10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14 -52 minutes) and 35 minutes (range: 21 - 60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy â€Š× â€Šcm (range: 162 - 1014 mGy  ×  cm) for the unilateral and 470 mGy  ×  cm (range: 270 - 1271 mGy  × â€Šcm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7  %). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CONCLUSION: CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

[The importance of sonography for the acute diagnosis of multiple trauma]. / Die Bedeutung der Sonographie bei der Akutdiagnostik Polytraumatisierter.

Sixty polytraumatised patients with blunt abdominal injuries were sonographically examined immediately after hospitalisation, between January 1985 and October 1988. Accumulation of free fluid in the abdominal cavity or organ injuries were directly recorded from 17 patients. Results obtained from examinations were falsely negative in three cases. The method, consequently, exhibited 0.85 in sensitivity, 1.0 in specificity, and 0.33 in prevalence. Ultrasonography is recommended as the first step to be taken for diagnosis, preceded only by clinical check-up and parallel shock therapy. It may be followed by peritoneal lavage, yet only in the event of dubious findings.