Jawaher Mohammed Alkhateeb

Percutaneous sacroiliac fixation is an effective minimally invasive method for posterior pelvic ring stabilization. Screw misplacement, and subsequent neurologic injury are two well described complications. Managing those complications however is under-reported. A young female, sustained an unstable pelvic ring injury as a victim of motor vehicle collision. Following percutaneous sacroiliac screw fixation, she complained of L5 nerve root radiculopathy, and muscle weakness. Percutaneous removal of the screw after a wait period for fracture union resulted in immediate symptoms relief. Safe sacroiliac screw placement is technically demanding requiring good understanding of sacral complex morphology and its anatomic variants. Risk of screw misplacement, and potential neurologic injury increases in dysmorphic sacra, or with inaccurate fracture reduction. Advances in intraoperative imaging modalities have been introduced in an attempt to improve accurate screw insertion. Literature is scarce with reports discussing removal of sacroiliac screw. Technique of screw retrieval is also controversial. This case addresses management of an iatrogenic neurologic complication following percutaneous sacroiliac screw fixation. Our experience showed that, percutaneous retrieval of an intact misplaced sacroiliac screw is achievable, resulting in complete resolution of neurologic symptoms.

Introduction: Neck of femur fracture in osteogenesis imperfecta is rarely reported. The management is uncertain and always reported as difficult. Clinical outcomes are not well described. Case presentation: A teenage girl, who is known to have osteogenesis imperfecta, sustained neck of femur fracture in the presence of a previously inserted implant. She was treated by percutaneous screw fixation. In both immediate and long term follow up, our patient had satisfactory outcome and return to pre-fracture functional status. Discussion: Dealing with fragility fracture in small abnormal hips is challenging especially, in the presence of a retained implant in- situ. Intra-operative difficulty were encountered during positioning, reduction, and screw insertion attempt. Conclusion: This rare case illustrates the anticipated difficulties in managing neck of femur fracture in osteogenesis imperfect patients. It also emphasize on the importance of surgical fixation to control pain and allow for healing in anatomically functional position. Highlights: