{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:49:52Z","timestamp":1774450192646,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>There are many advantages to stabilize the posterior pelvic ring injuries with a transiliac\u2010transsacral (TITS) screw percutaneously. To identify the correct entry point and insert a guidewire accurately for a TITS screw, we propose a method of specifying the optimal entry point, and introduce a technique of enabling freehand placement of a guidewire with fluoroscopic guidance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, 116 patients who underwent pelvic CT scans and pelvic lateral radiographs at our institution from January 2020 to April 2022 were enrolled. The optimal entry point for a TITS screw was formulated in the strict mid\u2010sagittal CT plane, and then transferred to the pelvic lateral radiograph relying on the sacral cortexes which were easily visible even in the poor fluoroscopy. The relative position of this point to other anatomical markers was checked to confirm its feasibility as an entry point. With the method to locate the entry point, 18 patients suffered the posterior pelvic ring injuries were treated with TITS screws through hammering a reverse Kirschner wire (K\u2010wire) to insert a guidewire assisted by a canula, followed by the validation of the screw placement accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The transferred point in radiograph was consistently beneath the sacral alar slope, and located posteroinferior to the iliac cortical density (ICD) and anterosuperior to the sacral nerve root tunnel in all 116 patients. In clinical practice, 18 TITS screws were successfully placed in 18 patients without cortex violation. The average operative time for each screw was 20.11\u2009\u00b1\u20096.29\u2009min, with an average of 14.11\u2009\u00b1\u20096.81 fluoroscopic shots per screw. At the 3\u2010month follow\u2010up, fracture healing was confirmed in all patients. The average Majeed score was 89.61\u2009\u00b1\u20096.90 at the final follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It's feasible to identify an entry point for a TITS screw based on the sacral cortexes, and hammering a reverse K\u2010wire assisted by a percutaneous kyphoplasty (PKP) canula is a safe and practical technique for guidewire insertion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14326","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T03:50:28Z","timestamp":1735271428000},"page":"781-789","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Freehand Placement of a Transiliac\u2010Transsacral Screw for Fixation of Posterior Pelvic Ring Injuries"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4363-8368","authenticated-orcid":false,"given":"Guangping","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"},{"name":"Department of Orthopaedics Zibo Central Hospital  Zibo China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiguang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhao","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yubo","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-6065","authenticated-orcid":false,"given":"Jiaqi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"He","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changda","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-6742","authenticated-orcid":false,"given":"Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peifu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Fourth Medical Center, Chinese PLA General Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-023-02341-6"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001724"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181dc50cd"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-020-02782-4"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13763"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001047"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181e47fad"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20230531-06"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001243"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111378"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000622"},{"issue":"9","key":"e_1_2_9_13_1","first-page":"16","article-title":"Transsacral Versus Modified Pelvic Landmarks for Percutaneous Iliosacral Screw Placement\u2014a Computed Tomographic Analysis and Cadaveric Study","volume":"29","author":"Day C. 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