The optimal radiographic intraoperative assessment in the placement of sacroiliac joint screws

Stabilization of the sacroiliac (SI) joint is often required in the treatment of unstable pelvic injuries. However, most surgeons are inexperienced with the technique of transarticular SI joint fixation. The authors present a reliable, reproducible technique for the placement of SI joint screws based on the relationship of the gross and radiographic anatomy. The lateral lumbosacral view, caudal oblique view, and cephalad oblique view are used in combination to direct accurate screw placement in the body of the first sacral vertebrae while maintaining position anterior to the spinal canal and cephalad to the first sacral foramen. This technique demands excellent quality image intensification to permit an appreciation of proper screw placement and direction based on bony anatomy.