Variations in sacral morphology and implications for iliosacral screw fixation

Anna N. Miller, Milton L.Chip Routt

Research output: Contribution to journalReview articlepeer-review

190 Scopus citations


Posterior pelvic percutaneous fixation following either closed or open reduction is a popular procedure. Knowledge of the posterior pelvic anatomy, its variations, and related imaging is critical to performing reproducibly safe surgery. The dysmorphic sacrum has several key characteristics. The upper portion of the sacrum is relatively colinear with the iliac crests on the outlet radiographic view. Other characteristics include the presence of mammillary bodies (ie, underdeveloped transverse processes) at the sacral mid-alar area, anterior upper sacral foramina that are not circular, residual upper sacral disks, an acute alar slope oriented from cranial-posterior-central to caudal-anterior-lateral on the outlet and lateral views of the sacrum, a tongue-in-groove sacroiliac joint surface visualized on CT, and cortical indentation of the anterior ala on the inlet radiographic view. The surgeon must be knowledgeable about individual patient anatomy to ensure safe iliosacral screw placement.

Original languageEnglish
Pages (from-to)8-16
Number of pages9
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number1
StatePublished - Jan 2012


Dive into the research topics of 'Variations in sacral morphology and implications for iliosacral screw fixation'. Together they form a unique fingerprint.

Cite this