Veterinary Surgery

36:633–643, 2007

Limited Open Reduction and Stabilization of Sacroiliac

Fracture-Luxations Using Fluoroscopically Assisted Placement
of a Trans-Iliosacral Rod in Five Dogs

CHRISTOPHER S. LEASURE, DVM, DANIEL D. LEWIS, DVM, Diplomate ACVS,

COLIN W. SEREDA, DVM, MS, Diplomate ACVS, KARA L. MATTERN, DVM, Diplomate ACVS, CARL T. JEHN, DVM, MS, and
JASON L. WHEELER, DVM, MS, Diplomate ACVS

Objective—To describe percutaneous fluoroscopically assisted placement of a trans-iliosacral rod to

stabilize sacroiliac fracture-luxations after limited open reduction.
Study Design—Retrospective clinical case series.
Animals—Dogs (n ¼ 5) with sacroiliac fracture-luxations.
Methods—Medical records and radiographs were reviewed to evaluate implant placement, fracture
reduction, pelvic canal diameter ratio, maintenance of reduction, implant stability, assessment of
union, and to identify any complications. Owners were contacted to obtain long-term assessment of
limb function.
Results—Dogs weighed between 6 and 31 kg. Trans-iliosacral rods were placed correctly traversing
the sacral body. Mean (
SD) percent reduction of the sacroiliac joint was 92.9
6.6%. Pelvic
canal diameter ratio did not differ significantly between time periods. With the exception of 1 dog,
which died in the early postoperative period, all sacroiliac fracture-luxations healed without ap-
preciable complications. Three dogs were sound and 1 dog had a subtle lameness at final physical
and radiographic examination (mean
SD: 217
205 days). Owners assessed their dog’s limb
function (mean
SD: 355
205 days) as good or excellent.
Conclusions—Trans-iliosacral rods can be accurately placed using intraoperative fluoroscopy after
limited open reduction of sacroiliac fracture-luxations. Trans-iliosacral rods provided bilateral se-
cure fixation, allowed early weight-bearing and dogs consistently had good long-term clinical results.
Clinical Relevance—Trans-iliosacral rods are suitable implants for the stabilization of sacroiliac
fracture-luxations, particularly in dogs with bilateral fracture-luxations and/or concurrent muscu-
loskeletal injuries.
r Copyright 2007 by The American College of Veterinary Surgeons

INTRODUCTION dogs with unilateral sacroiliac fracture-luxations had

associated pelvic fractures.1 Whereas dogs with isolated

S ACROILIAC FRACTURE LUXATION is a trau-

matic separation of the ilial wing from the sacrum
that occurs most frequently after motor vehicular trau-
ma.1,2 Fracture-luxations of the sacroiliac joint may be
unilateral or bilateral and often occur in association
with other pelvic fractures.2 In 1 case series, 93% of
or minimally displaced sacroiliac fracture-luxations can
be managed appropriately without surgical interven-
tion,1,2 many dogs with sacroiliac fracture-luxations,
particularly dogs with major concurrent orthopedic in-
juries, have difficulty ambulating and surgical interven-
tion is warranted.1

From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL.
Presented at the Veterinary Orthopedic Society Conference, Sun Valley, ID, March 3–10, 2007.
Reprints not available. Address correspondence to: Christopher S. Leasure, DVM, The Animal Medical Center, 510 East 62nd Street,
New York, NY 10065-8314. E-mail: Chris.Leasure@amcny.org.
Submitted February 2007; Accepted June 2007
r Copyright 2007 by The American College of Veterinary Surgeons

0161-3499/07
doi:10.1111/j.1532-950X.2007.00315.x
633
634 TRANS-ILIOSACRAL ROD IN FIVE DOGS
Fixation by insertion of screws in lag fashion is gen-
erally advocated for the surgical stabilization of sacroiliac
fracture-luxations.1–10 Implant loosening and subsequent
loss of reduction is the most common complication after
stabilization by screws inserted in lag fashion.1 In a large
retrospective study, screw loosening occurred in 38% of
the dogs with sacroiliac fracture-luxations stabilized using
fixation by screws inserted in lag fashion.1 Accurate screw
placement and sufficient screw depth within the sacral
body were important variables lowering the incidence of
implant failure.1
Trans-ilial rods have recently been produced for the
primary or adjunctive stabilization of unilateral and bi-
lateral sacroiliac fracture-luxations. The trans-ilial rod
was designed to be placed through both ilial wings dorsal
to the seventh lumbar vertebrae as a trans-ilial brace.
Paired nuts are applied to each end of the rod to provide
locked fixation against the lateral surface of each ilium
therefore decreasing postoperative complications, specifi-
cally implant loosening and subsequent loss of reduction.
Fully threaded stainless-steel trans-ilial rods with a single
trocar point are available in 3.2 mm (125 mm in length),
4.0 mm (155 mm in length) and 4.7 mm (175 mm in
length) diameters (Fig 1).
Tomlinson et al10 described use of intraoperative flu-
oroscopy to assist with insertion of screws in lag fashion
after closed reduction of sacroiliac fracture-luxations. We
have used intraoperative fluoroscopy to facilitate place-
ment of a trans-ilial rod through both ilia while traversing
the body of the sacrum (hereafter referred to as a trans-
Fig 1. Photograph (from left to right) of 3.2 mm nuts and 3.2,
4.0 and 4.7 mm diameter fully threaded stainless-steel trans-
ilial rods with a single trocar point. Note the two 4.7 mm nuts
in locked position on the 4.7 mm diameter rod (insert).
iliosacral rod) to stabilize sacroiliac fracture-luxations af-
ter limited open reduction. Our purpose is to describe the
clinical and radiographic outcomes of this technique in
5 dogs with sacroiliac fracture-luxations.
MATERIALS AND METHODS
Inclusion Criteria
Medical records (May 2005–September 2006) and radio-
graphs of 5 dogs with sacroiliac fracture-luxations stabilized
with a trans-iliosacral rod were reviewed. Each dog’s signal-
ment, body weight, and pertinent medical history, including
the traumatic event causing injury, presence of concomitant
musculoskeletal or soft tissue injuries, the dog’s limb function
and neurologic status before surgery, the duration of time
elapsed between injury and surgery, and total days hospital-
ized were recorded.
Preoperative Radiographic Assessment
Preoperative radiographs were reviewed to document
whether the sacroiliac fracture-luxation was unilateral or bi-
lateral, identify the presence of concurrent pelvic trauma and
measure the pelvic canal diameter ratio. Pelvic canal diameter
was estimated from measurements made on ventrodorsal
radiographic projections at the level of the sacrum and
acetabulum. The distance between the caudal aspect of the
sacroiliac joint surface at the level of the sacral wings and the
distance between the medial aspect of each acetabulum at a
point corresponding to the craniodorsal aspect of the ace-
tabulum were measured.10,11 When the preoperative pelvic
displacement was severe and asymmetrical, a line was drawn
from the dorsal spinous processes of the sacrum axially
through the first 2 or 3 coccygeal vertebrae. A line was then
drawn from the craniodorsal aspect of each acetabulum as
described above, perpendicular to the axial line and these
distances were totaled to obtain the distance between the me-
dial aspect of the acetabulae. Pelvic canal diameter was
expressed as a ratio of the pelvic canal width at the medial
aspect of the acetabulae divided by the width of the caudal
sacrum (Fig 2).10,11
Surgical Technique
Under general anesthesia, the dog’s pelvic region was
clipped and prepared for aseptic surgery. The dog was posi-
tioned in sternal recumbency with the hind limbs hanging off
the end of a radiolucent surgical table. A wedge-shaped foam
pad was placed under the dog’s caudal abdomen. A sterile
cover was applied to the fluoroscope arm (C arm) of the flu-
oroscopic unit (Siremobil Compact Fluoroscope; Siemens, Is-
elin, NJ), which was used to obtain intraoperative lateral and
dorsoventral images of the pelvic region. A 2–3 cm dorsal in-
cision was made over each displaced ilial wing. The fascia was
incised longitudinally adjacent to each exposed ilial wing.
Bone holding forceps were placed on the dorsal aspect of each
 LEASURE ET AL
Fig 2. Preoperative ventrodorsal pelvic radiograph illustrat-
ing the points used to calculate the pelvic canal diameter ratio.
A line was drawn from the sacral spine axially through the first
several coccygeal vertebrae (axial line). The distance between
the caudal aspect of the sacroiliac joint surface at the level of
the sacral wings was measured (AB). A line was then drawn
from the medial aspect of each acetabulae at a point corre-
sponding to the craniodorsal aspect of the acetabulum perpen-
dicular to the axial line and these distances were totaled to
obtain the distance between the medial aspect of the acetabulae
(CD and DE). Pelvic canal diameter was expressed as a ratio of
the pelvic canal width at the medial aspect of the acetabulae
(CD þ DE) divided by the width of the caudal sacrum (AB).10,11
displaced ilial wing and the sacroiliac luxation was manually
reduced by applying caudoventral pressure to the ilium.
Assessment of reduction was judged by alignment of the
ilial wings with the articular surface of the sacrum in the do-
rsoventral fluoroscopic image in dogs with unilateral and bi-
lateral sacroiliac fracture-luxations and superimposition of the
displaced hemipelvis over the contralateral hemipelvis using
the lateral beam fluoroscopic image in dogs with a unilateral
sacroiliac fracture-luxation. Once reduction was confirmed, a
lateral image of the pelvis was obtained with the sacrum cen-
tered in the fluoroscopic field. A 1 mm Kirschner wire (K-wire)
was inserted percutaneously from lateral-to-medial through
the gluteal muscles until the wire contacted the ilium. Custom-
designed radiolucent forceps12 were used to hold the K-wire
while its position was confirmed by fluoroscopy. If the wire
was not positioned over the center of the body of the sacrum,
the wire was removed, replaced, and its position reassessed.
Once correctly positioned, a pneumatic drill (Mini-Driver;
3M, Irvine, CA) was used to drive the wire through the ipsi-
lateral ilium, sacral body, and contralateral ilium (Fig 3).
A second 1 mm K-wire was inserted through the ilium and
into the body of the sacrum adjacent and parallel to the 1st wire
635
to maintain reduction throughout the remainder of the proce-
dure. A 2 cm incision was created to release the skin surround-
ing the K-wire and the underlying soft tissues were bluntly
dissected to the level of each ilial wing. A 2.0, 2.7 or 3.2 mm
diameter cannulated drill bit (Cannulated Drill Bits; Synthes
USA, Paoli, PA) was used to drill over the K-wire positioned in
the center of the sacral body (Fig 4) to accommodate a 3.2, 4.0,
or 4.7 mm trans-ilial rod, respectively. Trans-ilial rod (IM-
EXTM Veterinary Inc., Longview, TX) diameter selection was
based on the dog’s body weight and the size of the sacral body
as determined from the preoperative lateral radiograph and
intraoperative fluoroscopy. A glide hole, equal to the core di-
ameter of the trans-ilial rod, was then drilled through each
unstable ilial wing. The distance that the glide hole was drilled
was visualized using the dorsoventral fluoroscopic image. Two
nuts were placed on the trans-ilial rod  2 cm from the rod’s
blunt end. The trocar tip of the rod was placed through the
glide hole in the ipsilateral ilium and the rod was threaded
through the pilot hole in the body of the sacrum and out of the
contralateral ilium until the axially positioned nut contacted the
lateral surface of the ilium. Two additional nuts were placed on
the trocar end of the rod and threaded down the rod until the
axially positioned nut contacted the lateral surface of the ilium.
All nuts were tightened using a cannulated tubular socket
wrench (Box spanner; Stahlwille Tools North America, Inc.,
Sarasota, FL). The abaxial nut on either side was tightened
individually against the axial nut to lock the nuts in place.
Final evaluation of reduction of the sacroiliac joint and
correct nut placement was confirmed using fluoroscopy and
the 2nd K-wire was removed (Fig 5). Each end of the rod was
trimmed as close to the paired nuts as possible using a bolt
cutter. All incisions were closed in layers. Concomitant or-
thopedic injuries requiring surgical intervention were treated
during the same anesthetic episode.
Radiographic Assessment of Reduction
Postoperative orthogonal view radiographs were reviewed
to retrospectively evaluate reduction of the sacroiliac joint as
well as the pelvic canal diameter ratio (Fig 6). Reduction of
the sacroiliac joint was evaluated by calculating the percentage
of the cranial-to-caudal length of the ilium that was in contact
with the articular surface of the sacrum, measured on the
ventrodorsal radiograph.1,10 The pelvic canal diameter ratio
was measured from the immediate postoperative ventrodorsal
radiographs as described above.
Postoperative Care
Morphine (0.5 mg/kg, intravenously [IV], every 4–6 hours)
or hydromorphone (0.05–0.15 mg/kg, IV, every 4–6 hours) or
a morphine (0.1 mg/kg/h), lidocaine (25 mg/kg/min) and keta-
mine (5 mg/kg/min) continuous rate infusion was used for the
first 24 hours after surgery to provide analgesia. Cefazolin
(22 mg/kg IV, every 6 hours) was administered for 24 hours
and was only continued if there were concomitant injuries
warranting antimicrobial therapy. Carprofen (2 mg/kg, orally
every 12 hours) and/or tramadol (2 mg/kg, orally every 8
636 TRANS-ILIOSACRAL ROD IN FIVE DOGS

Fig 3. Lateral and ventrodorsal intraoperative fluoroscopic images of a dog with bilateral sacroiliac fracture-luxations. The bone
holding forceps have been used to reduce the luxation and a Kirschner wire has been placed through the sacral body and each ilia.

hours) was administered for 2–4 weeks to provide postoper-
ative analgesia during convalescence at the discretion of the
attending clinician. Dogs were discharged to the owner with
the recommendation to restrict activity (leash walks with lim-
ited access to stairs and uneven ground) and to perform pas-
sive range of motion exercises for 4–6 weeks.
Long-Term Clinical Assessment
Owners were requested to return their dog for long-term
clinical evaluation and radiographs; recommended intervals
were 1, 2, and 3 months after surgery. Medical records and
radiographs were reviewed to determine duration of time until
the dog began weight-bearing on the affected limb(s), lame-
ness grade, maintenance of reduction, implant stability, as-
sessment of fracture healing, pelvic canal diameter ratio and to
identify any postoperative complications at each of the follow-
up evaluations. Lameness was graded at a walk on a scale of
0–4 (0 ¼ no lameness; 1 ¼ subtle weight-bearing lameness;
2 ¼ obvious weight-bearing lameness; 3 ¼ intermittent non-
weight-bearing lameness; 4 ¼ consistent non-weight-bearing
lameness).13
The pelvic limbs were palpated to determine if pain could
be elicited during coxofemoral joint manipulation or direct
palpation over the region of the trans-iliosacral rod and for
any complications associated with implant placement. Rectal
examination was performed to rule out the presence of pelvic
canal stenosis. Dogs were sedated with acepromazine maleate
(0.02 mg/kg IV) and butorphanol tartrate (0.2 mg/kg IV)
for radiography. Pelvic radiographs were reviewed and com-
pared with radiographs obtained immediately after surgery to

Fig 4. Ventrodorsal intraoperative fluoroscopic image illus- Fig 5. Ventrodorsal intraoperative fluoroscopic image ob-
trating the cannulated drill bit being used to drill through the tained after both pairs of nuts have been tightened and locked
sacral body over the previously placed Kirschner wire. in position.
 LEASURE ET AL 637

Fig 6. Preoperative and immediate postoperative lateral and ventrodorsal pelvic radiographs in a dog with bilateral sacroiliac
fracture-luxations and right coxofemoral luxation repaired with a 3.2 mm diameter trans-iliosacral rod and toggle pin, respectively.

determine if there had been any implant loosening, loss of RESULTS

reduction, change in pelvic canal diameter and/or any other
radiographically evident complications. All radiographic mea-
surements were obtained by a single investigator (CL). The
Wilcoxon signed-rank test was used to analyze comparison
of mean pelvic canal diameter ratio for preoperative to im-
mediate postoperative values and for immediate postoperative
to final follow-up values. A value of Po.05 was considered
significant.
Long-Term Assessment of Limb Function
Final attempts were made to contact each dog’s owner by
telephone to obtain long-term assessment of limb function.
Owners were asked to classify the dog’s function of the hind
limbs as excellent (normal limb function), good (slight lame-
ness only after extensive exercise), fair (slight-to-moderate
lameness, but consistently weight-bearing), or poor (consistent
non-weight-bearing lameness).14
Dogs (n ¼ 5) were aged from 12–90 months
(mean
SD, 52.4
34.0 months; Table 1) and weighed
6–31 kg (mean, 18.6
11.8 kg); 3 dogs were males and 2
were females. Sacroiliac fracture-luxations occurred from
motor vehicular trauma in 4 dogs and was unknown in 1
dog. On preoperative radiographic evaluation, 3 dogs
had bilateral sacroiliac fracture-luxations. Preoperative
pelvic canal diameter ratio ranged from 1.15–1.40 (mean,
1.28
0.10; Table 2). All dogs had additional orthopedic
injuries and 3 dogs had concurrent neurologic abnormal-
ities. All dogs were non-weight-bearing on the affected
limb(s) before surgery.
Elapsed time from injury to trans-iliosacral rod place-
ment ranged from 3 to 6 days (mean, 4.2
1.6 days).
Hospitalization ranged from 4 to 20 days (mean,
10.6
6.4 days). All dogs had a trans-ilial rod placed
through the sacrum for the primary stabilization of the
 Table 1. Clinical and Radiographic Summary of Five Dogs with Sacroiliac Fracture-Luxations Stabilized with Trans-Iliosacral Rods

638
Weight- Lameness Score (Days Af- Owner
Concomitant Bearing ter Surgery) Assessment
Musculoskeletal Time from on Affected of Limb
Signalment Sacroiliac and Soft Tissue Injury to Pelvic Limb(s) Complications Function
and Body Fracture- Injuries (Surgical Neurological Primary/Adjunctive Surgery Hospitalization (Days After First Second Final (Days After (Days After
Dog # Weight Luxation(s) Intervention) Abnormalities Sacroiliac Fixation (Days) (Days) Surgery) Recheck Recheck Recheck Surgery) Surgery)

1 29-month-old, Bilateral Right acetabular Absent sciatic and 3.2-mm-diameter 3 14 39 Grade 4 NA Grade 1 Kirschner wire Good (650)
6 kg, female fracture and right femoral reflexes right trans-iliosacral (27) (523) migration (523)
intact Jack coxofemoral luxation hind limb, decreased rod/two 1.6 mm
Russell (femoral head and neck sciatic and femoral Kirschner wires
Terrier ostectomy), bilateral reflexes left hind limb, through ilial
pubic and ischial absent deep pain right wings and L7
fractures, physiologic hind limb, flaccid body
degloving, right anus
inguinal hernia
2 47-month-old, Right Left coxofemoral Mild conscious 4.7-mm-diameter 6 20 1 Grade 2 Grade 0 Grade 0 None Excellent (341)
31 kg, male luxation (toggle pin), proprioception trans-iliosacral (26) (61) (98)
intact left pubic and ischial deficits in the left rod/4.0 mm
Labrador fractures hind limb cancellous lag
Retriever screw, 4.7 mm
transilial brace
3 90-month-old, Bilateral Right coxofemoral Deep pain perception 3.2-mm-diameter 3 8 4 Grade 1 NA Grade 0 Seroma around Excellent (219)
8 kg, male luxation (iliofemoral absent in the right trans-iliosacral (32) (116) end of rod (32)
intact Jack suture), right pubic hind limb rod
Russell and ischial fractures,
Terrier maxillary fracture
(dental bonding),
prepubic tendon
avulsion and urinary
bladder herniation,
pneumothorax
4 12-month-old, Right Left femoral neck None 4.0-mm diameter 6 7 1 NA NA Grade 0 None Excellent (212)
30 kg, female fracture & left trans-iliosacral (130)
TRANS-ILIOSACRAL ROD IN FIVE DOGS

intact Great traumatic medial patella rod

Pyrenees luxation & left greater
trochanter avulsion
fracture (hind limb
amputation), right
abaxial sacral fracture,
left pubic and ischial
fractures
5 84-month-old, Bilateral Right coxofemoral None 3.2-mm-diameter 3 4 1 NA NA NA Cardiopulmonary NA
18 kg, male luxation (toggle pin), trans-iliosacral arrest (3)
castrated right pubic and ischial rod
American fractures
Cocker
Spaniel

NA, not available.

 LEASURE ET AL 639

Table 2. Radiographic Parameters Assessed in Five dogs with Sacroiliac Fracture-Luxations Stabilized with Trans-Iliosacral Rods
Reduction
Immediate Final Evaluation
(%)
Signalment and Sacroiliac Preoperative Postoperative PCD Ratio (Days
Dog# Body Weight Fracture-Luxation(s) PCD Ratio Right Left PCD Ratio After Surgery)

1 29-month-old, 6 kg, female Bilateral 1.25 86.1 83.1 1.51 1.20 (523)
intact Jack Russell Terrier
2 47-month-old, 31 kg, male Right 1.35 96.0 NA 1.23 1.13 (98)
intact Labrador Retriever
3 90-month-old, 8 kg, male Bilateral 1.26 87.1 93.8 1.20 1.17 (116)
intact Jack Russell Terrier
4 12-month-old, 30 kg, female Right 1.15 98.1 NA 1.21 1.22 (130)
intact Great Pyrenees
5 84-month-old, 18 kg, male Bilateral 1.40 100.0 99.2 1.12 NA
castrated American Cocker Spaniel

PCD, pelvic canal diameter; NA, not available.

fracture-luxation(s) and adjunctive fixation was used in 2
dogs. In dog 2, the sacroiliac fracture-luxation was ini-
tially stabilized with 2 screws inserted in lag fashion after
closed reduction with fluoroscopic assistance. The screws
backed out and reduction was lost at 4 days. During this
dog’s revision surgery, 1 screw was replaced with a trans-
iliosacral rod. A single cancellous screw was placed in the
sacral body and a 2nd rod was inserted through both ilial
wings dorsal to the 7th lumbar vertebrae as a transilial
brace15 to provide additional fixation.
In dog 1, two 1.6 mm Kirschner wires were inserted
through both ilial wings and the body of the 7th lumbar
vertebrae to provide rotational stability. Procedures
performed to address concurrent orthopedic injuries at
the time of the sacroiliac fracture-luxation stabilization
included toggle-pin placement (2 dogs) and iliofemoral
suture placement (1 dog) for coxofemoral joint luxations.
Dog 4, with a unilateral sacroiliac fracture-luxation and
multiple concurrent orthopedic injuries, had the con-
tralateral hind limb amputated. The amputation was
performed at the insistence of the owners despite a rec-
ommendation to surgically repair each of the concomi-
tant orthopedic injuries.
Postoperative Evaluation
Reduction of the sacroiliac joint on the immediate
postoperative radiographs ranged from 83.1–100%
(mean, 92.9
6.6%). Mean pelvic canal diameter ratio
measured from the immediate postoperative radiographs
ranged from 1.12–1.51 (mean, 1.25
0.15). All trans-il-
iosacral rods were placed in an appropriate location tra-
versing the sacral body as determined from the immediate
postoperative lateral and ventrodorsal radiographs. Res-
toration of dorsal coverage of the femoral head by the
acetabulum was achieved in all dogs except in the dog
that had a hind limb amputation and the dog with the
acetabular fracture that was not surgically addressed.
Dog 5 died of pulmonary thromboembolism believed
to be caused by preexisting heartworm disease 3 days
after surgery. Three dogs (including the 1 that died) were
able to bear weight on the operated limb(s) the day after
surgery. Dog 3 lacked unilateral deep pain perception
preoperatively and began to bear weight on the affected
limbs at 4 days. Owner compliance with returning for
scheduled monthly follow-up examinations was variable:
3 dogs returned for 1 month follow-up examination and
radiographs, 1 dog returned for 2-month follow-up ex-
amination, and 4 dogs returned for follow-up examina-
tion and radiographs 43 months postoperatively.
Dog 1, with severe bilateral neurologic impairment,
was non-weight-bearing in both pelvic limbs when first
reevaluated 27 days after stabilization of the dog’s sa-
croiliac fracture-luxation and had a mild persistent bilat-
eral sciatic and femoral neuropathy. The dog’s non-
weight-bearing lameness was ascribed to an untreated
acetabular fracture and a femoral head and neck ostec-
tomy was performed. According to the owner, this dog
began to bear weight on both pelvic limbs 39 days after
surgery. At the final recheck examination (523 days),
neurologic function was normal with a subtle weight-
bearing lameness in the hind limb that had the acetabular
fracture and subsequent femoral head and neck excision.
Excluding the dog that died, all sacroiliac fracture-
luxations healed without appreciable complications.
Three dogs had no apparent lameness and 1 dog had a
subtle weight-bearing lameness at final examination.
Minor complications were noted in 2 dogs during fol-
low-up. Dog 3 developed a seroma around each end of
the trans-iliosacral rod at 32 days; however, pressure
applied to the ends of the rod did not elicit a pain
response and treatment was not required. Seromas had
resolved at the final recheck examination (116 days). One
640 TRANS-ILIOSACRAL ROD IN FIVE DOGS
K-wire used in dog 1 to provide adjunctive rotational
stability migrated out of 1 ilial wing by final radiographic
evaluation (523 days), without apparent clinical conse-
quence.
Time to final radiographic follow-up evaluation
ranged from 98–523 days (mean, 217
205 days; medi-
an, 123 days). Mean pelvic canal diameter ratio measured
from radiographs obtained at the final evaluation ranged
from 1.13–1.22 (mean, 1.18
0.04). None of the nuts had
loosened from their position on the lateral surface of the
ilia. The mean immediate postoperative pelvic canal di-
ameter ratio was not significantly different from the mean
preoperative pelvic canal diameter ratio (P ¼ .625). There
was no significant difference in the mean immediate
postoperative pelvic canal diameter ratio and the mean
pelvic canal diameter ratio measured from the radio-
graphs obtained at the final follow-up evaluation
(P ¼ .250).
Long-Term Outcome
Owners of the 4 surviving dogs were contacted by
telephone regarding their dog’s long-term clinical out-
come. Time from surgery to final follow-up ranged from
212–650 days (mean, 355
205 days; median, 280 days).
Limb function was assessed as excellent in 3 dogs and
good in 1 dog.
DISCUSSION
Our results corroborate that accurate reduction of sa-
croiliac fracture-luxations can consistently be achieved
using limited open reduction techniques with fluoroscopic
assistance. We obtained anatomic or near anatomic re-
duction (range, 83–100%; mean, 93%) of the sacroiliac
fracture-luxation similar to other reports where closed10
or open15 reduction techniques were used. Tomlinson
et al10 reported that closed reductions facilitated by
intraoperative fluoroscopy were 80–100% (mean 92%)
accurate as measured on immediate postoperative vent-
rodorsal radiographs. These results are similar to those
achieved with open reduction (range, 74–100%; mean,
94%) of sacroiliac fracture-luxations.15
All of our dogs were positioned in sternal recumbency.
Tomlinson et al10 positioned dogs in lateral recumbency
while performing closed fluoroscopic-assisted lag screw
placement. Positioning dogs in sternal recumbency al-
lowed simultaneous access to both hemipelvis and negat-
ed the need to reposition the dogs intraoperatively. The
weight of the dogs’ hind limbs hanging off the end of the
surgery table pulled the displaced pelvis caudoventrally,
thus facilitating reduction. Placing a thick radiolucent,
wedge-shaped foam pad under the dog’s caudal abdomen
augmented this effect and also simplified imaging of the
pelvic region in the smaller dogs.
Positioning the dog in sternal recumbency also allowed
the body of the sacrum to be clearly identified on lateral
fluoroscopic images facilitating precise implant place-
ment. Previous studies have shown accurate implant
placement within the sacral body to be a critical variable
in preventing screw loosening.1,3,10 In 1 retrospective
study, 50% of inappropriately positioned screws loos-
ened, whereas screws placed accurately within the sacral
body had only a 12% incidence of loosening.1 Although
the anatomic landmarks guiding appropriate implant
placement are well described,16–19 only 33% of screws
were correctly placed into the sacral body in 1 retrospec-
tive study evaluating open surgical reduction of sacroiliac
fracture-luxations.1 We found that with the dog correctly
positioned on the surgery table and correct centering of
the sacrum within the fluoroscopic field, a K-wire could
be consistently and accurately placed through the body of
the sacrum. Holding the K-wire in place with custom-
designed radiolucent forceps12 allowed us to confirm the
wire’s position fluoroscopically before implantation.
When the K-wire was centered and positioned parallel
to the X-ray beam, the wire had the appearance of a
radiopaque dot centered over the body of the sacrum.
Once positioned correctly, the K-wire was driven through
both ilia, traversing the sacrum. Cannulated drill bits
were used to drill over the K-wire which contributed to
the ease and accuracy of the procedure.
Obtaining sufficient purchase in the sacral body is an-
other important variable which influences the incidence
of screw loosening and subsequent loss of reduction.1 A
screw or screws placed with a cumulative sacral purchase
 60% of the width of the sacrum have a lower prob-
ability of loosening.1 Trans-iliosacral application of a
trans-ilial rod as we describe maximizes sacral purchase
by increasing the surface area of contact between the
cancellous bone and the implant’s threads. In addition,
both cortices of the sacral body are engaged. Kaderly3
described open reduction and placement of a single trans-
sacral lag screw for the stabilization of bilateral sacroiliac
fracture-luxations in dogs and cats. Although the trans-
sacral screw traversed the entire width of the sacrum and
engaged both ilia, the fixation only produced unilateral
compression of the sacroiliac joint subjacent to the head
of the screw.3 Although none of the animals in Kaderly’s
report had appreciable loss of reduction or change in the
position of the screw at the time of the final radiographic
evaluation performed 3–6 months after surgery, the width
of the joint space which was not compressed by the head
of the screw had increased in 2 cats.3
Compression of the sacroiliac joint is important to
provide increased frictional stability to the fixation.3 The
locked nuts on the trans-iliosacral rod provide bilateral
 LEASURE ET AL 641

compression, therefore decreasing the possibility of

implant loosening and subsequent loss of reduction.
Although there was no apparent radiographic loss of
postoperative reduction, we were unable to accurately
measure percent reduction on the final follow-up radio-
graphs. The landmarks used to calculate this variable
were obscured by callus formation, negating our ability
to make accurate calculations of reduction, as was re-
ported in another study.15 The position of the trans-
iliosacral rod and nuts did not change on follow-up ra-
diographic evaluations. The distance from the lateral
surface of each pair of nuts to the end of the rod was
identical as measured on both the immediate postoper-
ative and the final follow-up radiographs. Our mean time
to final radiographic evaluation ranged from 98 to 523
days (mean, 217
205), which is similar to other re-
ports.3,10,15,20 Although 6–8 weeks has been cited as
sufficient time for the supportive structures of the sacro-
iliac joint to regain stability,2 it is plausible that addi-
tional long-term complications associated with trans-
iliosacral rod placement could develop.
Limited open reduction followed by trans-iliosacral
rod stabilization reestablished the weight-bearing axis
and facilitated an early return of limb function. Three
dogs were able to bear weight on the ipsilateral hind
limb(s) which had the sacroiliac fracture-luxation stabi-
lized the day after surgery. A 4th dog, which lacked deep
pain perception unilaterally before surgery, began to bear
weight on both hind limbs at 4 days. All of these dogs had
been unable to bear weight on the affected limb(s) before
surgery. The 5th dog, which had severe neurologic im-
pairment and an untreated unilateral acetabular fracture, Fig 7. Lateral and ventrodorsal pelvic radiographs taken 130
did not begin to bear weight until 39 days after surgery. days postoperatively of a Great Pyrenees dog that had a right
All dogs had concurrent orthopedic injuries which sacroiliac luxation and right abaxial sacral fracture. The con-
placed additional stress on the trans-iliosacral rod. Three tralateral hind limb was amputated because of severe concur-
dogs had severely displaced bilateral sacroiliac fracture- rent orthopedic injuries. The sacroiliac fracture-luxation had
luxations. Dog 2 had a unilateral sacroiliac fracture- healed and there were no complications associated with the
luxation, which had been previously stabilized with 2 lag placement of the trans-iliosacral rod. The radiopaque material
screws that subsequently failed. Dog 4, a 30 kg Great in the colon is sand that the dog had eaten a few days earlier;
Pyrenees dog, which had a unilateral sacroiliac luxation the dog did not have difficulty defecating.
and an ipsilateral abaxial caudal sacral fracture, had the
contralateral hind limb amputated because of presence of wings and dorsal to the 7th lumbar vertebrae, functioning
multiple concurrent orthopedic injuries in that limb. This as a trans-ilial brace,15 was used as adjunctive fixation in
dog refused to walk before surgery, but walked on its dog 2. Implant migration did not occur in dog 2 and
remaining 3 limbs the day after surgery. At the final fol- placement of a 2nd trans-ilial rod as a trans-ilial brace
low-up, this dog had excellent limb function, the nuts on would appear to be a more effective method of providing
rod had not loosened and there were no complications adjunctive stabilization.
associated with implant placement (Fig 7). Pelvic canal diameter ratio was calculated to verify
The trans-iliosacral rod was the only implant used to whether the width of pelvic canal was reestablished after
stabilize the sacroiliac joint in 3 dogs; adjunctive fixation surgery and to determine if this value changed signifi-
was used in 2 dogs. Two K-wires were used in dog 1 to cantly after the sacroiliac fracture-luxation had healed.
provide rotational stability to the hemipelvis; however, The normal pelvic canal diameter ratio is  1.10 and
one K-wire had migrated by final radiographic evaluation ratios of 0.61–1.36 after healing of sacroiliac fracture-
(523 days). A trans-ilial rod placed through both ilial luxations were not associated with clinical signs of pelvic
642 TRANS-ILIOSACRAL ROD IN FIVE DOGS
canal stenosis.11 In our dogs, the pelvic canal was not
compromised (diameter ratio  1.10) preoperatively,
immediate postoperatively, or at the time of the final ra-
diographic evaluation. Mean pelvic canal diameter ratio
was not statistically different at any time point. In con-
trast to previous studies,10,11 the immediate postoperative
mean pelvic canal diameter ratio (mean, 1.25
0.15) was
slightly less than the preoperative mean pelvic canal di-
ameter ratio (mean, 1.28
0.10), although this difference
was not significant. Dogs had lateral displacement with
widened pelvic canals and most of the pelvic canal di-
ameter ratios were decreased after reduction and stabi-
lization. Pelvic canal diameter ratio ranged from 1.13 to
1.22 at the time of final radiographic evaluation and none
of the dogs had clinical signs of pelvic canal stenosis.
This technique of reducing and stabilizing sacroiliac
fracture-luxations under fluoroscopic guidance is de-
signed to be minimally invasive and therefore limit post-
operative morbidity. A limited approach to the iliac spine
of each displaced ilial wing was made to reduce the
luxation and a limited lateral approach to both ilia was
used to allow insertion of the trans-iliosacral rod. Trim-
ming the trans-iliosacral rod adjacent to the locking nuts
with bolt cutters was difficult, particularly in large or
obese dogs, without enlarging the incision. A seroma
formed around each end of the trans-iliosacral rod in dog
3. Neither end of the rod had been cut adjacent to the
paired locking nuts and the rod extended 22 and 16 mm
beyond the lateral surface of the abaxial nuts into the
gluteal musculature. Although the seromas resolved with-
out treatment by final follow-up, this trans-iliosacral rod
may need to be removed in the future. An enclosed pin
cutter (Veterinary Instrumentation Ltd., Sheffield, UK) is
available which would allow the 3.2 and 4.0 mm diameter
rod to be trimmed consistently within 10 mm of the ab-
axial nut without enlarging the incision.
Trans-iliosacral rod diameter selection was empirical
and based on the cross-sectional area of the sacral body
as determined from the preoperative lateral view radio-
graph and intraoperative fluoroscopy. Radasch et al21
found that using larger diameter screws resulted in in-
creased fixation strength when the sacroiliac repairs were
subjected to bending, shear, and torsional forces. There-
fore, the largest diameter rod that the attending surgeon
felt could be safely implanted into the sacral body was
selected. Anatomic and biomechanical studies are war-
ranted to compare the stability afforded by trans-iliosa-
cral rods to other implants used for sacroiliac fracture-
luxation repairs, determine the contribution of adjunctive
fixation to trans-iliosacral rod stabilization, and develop
rational guidelines for appropriate implant diameter
selection.
Our results confirm that trans-iliosacral rods can be
accurately placed using fluoroscopy after limited open
reduction of sacroiliac fracture-luxations. Trans-iliosacral
rods provide stable fixation, allow early weight-bearing
and appear to be suitable implants for the stabilization of
sacroiliac fracture-luxations. Limitations of this study in-
clude the small number of dogs, the relatively short-term
follow-up and the retrospective nature in which the in-
formation was collected. A larger clinical case series,
preferably prospective, with longer follow-up evaluations
would be necessary to corroborate the efficacy of this
technique and identify additional complications associ-
ated with the trans-iliosacral rod placement.
ACKNOWLEDGMENTS
The authors would like to thank Ms. Debby Sundstrom
and Mr. James van Gilder for their assistance with data
analysis and image preparation, Ms. Linda Rose for her
assistance with word processing and Mr. Mark Hoffenberg
for photographing the implants.
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