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Case Reports
. 2020 Dec 10:31:100380.
doi: 10.1016/j.tcr.2020.100380. eCollection 2021 Feb.

Delayed lower extremity paresis following iliosacral screws: Atypical complication and treatment

A Garín  1 , S Abara  2   3 , C Herrera  2 , I Acuña  4 , J Cancino  4 , S Bettancourt  3 , J Alvarez  3 , C Vigueras  4 , J Lara  2 , J Del Río  2   4
Affiliations
Case Reports

Delayed lower extremity paresis following iliosacral screws: Atypical complication and treatment

A Garín et al. Trauma Case Rep. .

Erratum in

Abstract

Percutaneous iliosacral screw placement has become the technique of choice for treating injuries to the posterior pelvis. However, the technique requires an understanding of the anatomy surrounding the bone corridors to avoid complications and detect them early if they occur. We present the clinical case of a patient with a U-shaped fracture of the sacrum that evolves with gluteal pain and left foot equine paresis after percutaneous fixation with iliosacral screws. Angio-CT of the pelvis shows active arterial bleeding from the superior gluteal artery associated to extensive hematoma in the thickness of the gluteus medius muscle. Emergency embolization is performed by installing coil and gelatin. Successful control of bleeding is achieved. To avoid this complication, a complete imaging study is recommended in planning the surgery and to avoid multiple repositioning of the guide or screw. Arterial injury should be suspected in case of increasing pain despite analgesia, functional impairment or neurological deficit and the angiographic study and resolution by selective embolization of the bleeding vessels must be performed.

Keywords: Embolization; Percutaneous iliosacral screw; Vessel injury.

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Figures

Fig. 1
Fig. 1
a) X-ray at first admission, b) X-ray at second admission due persistent pain, c–d) CT shows U-shaped sacrum fracture.
Fig. 2
Fig. 2
a–b) Pelvic angiography shows active arterial bleeding from the superior gluteal artery associated with extensive hematoma in the thickness of the gluteus medius muscle, c–d) Embolization performed installing coil and gelatin achieving bleeding control.
Fig. 3
Fig. 3
a) X-ray day after surgery, b) X-ray at 12 months follow-up.
See this image and copyright information in PMC

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