Two Transiliac-Transsacral Screws in a Single Sacral Level: Surgical Technique and Patient Outcomes

Percutaneous fixation of posterior pelvic injuries is increasingly common. Use of transiliac-transsacral (TI-TS) screws can provide improved fixation, relative to standard iliosacral screws. In certain circumstances, utilizing 2 TI-TS screws may confer greater stability and strength, and there may be a need or desire to place them both in a single sacral level safe zone. We describe a technical guide on how to preoperatively assess if the S1 or S2 corridor can safely accommodate 2 TI-TS screws, and how to execute the technique using intraoperative fluoroscopy. We also report our institutional experience of 20 patients who were treated with 2 TI-TS screws for both high-energy and fragility posterior pelvic ring injuries.