Percutaneous iliosacral screw fixation is a widely accepted method of stabilizing the posterior pelvic ring. Recently developed tools such as 3D-navigated fluoroscopy and computed navigation seem to prevent a surgeon from conducting screw misplacement. The study aimed to comparatively assess the introduction of sacroiliac screw placement using 2D and 3D fluoroscopy in terms of accuracy and radiation exposure. Iliosacral screws were introduced in 37 patients using 2D (group N1) and in 36 patients using 3D fluoroscopy (group N2) techniques. Overall, 61 and 56 screws were introduced in groups N1 and N2, respectively. Screw placement accuracy was assessed using postoperative computed tomography and Smith’s scale. Intraoperative radiation exposure was also assessed. No differences were noted between groups in terms of screw positioning accuracy and radiation dose. Both 2D and 3D fluoroscopy provide good visualization for safely placing percutaneous iliosacral joint screws. Using 3D fluoroscopy-based navigation in comparison with 2D fluoroscopy is not advantageous.

Axial radiographic spondyloarthritis (r-axSpA) is a chronic inflammatory joint disease that leads to a considerable decline in the quality of life of patients by impairment of function and mobility, which, in turn, brings about a deterioration of both physical and mental health. Osteoporosis (OP) is a significant issue in the course of r-axSpA. Fractures resulting from OP complicate the treatment of the underlying disease and reduce the quality of life of patients. The aim of this paper is to discuss currently available diagnostic methods for OP and highlight why the gold standard for diagnosis – the assessment of bone mineral density via dual-energy X-ray absorptiometry – is not sufficient for patients with r-axSpA.

The study retrospectively determined the efficacy and safety of fixation of the pelvis (FFP) fragility fractures type IV using two tension band ilioiliac locking compression plates. Forty-one patients with FFP were treated in 2017–2020. 16 patients with FFP type IV, unable to walk weight-bearing, were treated by fixation using two tension band ilioiliac locking compression plates without fixing the anterior ring. Preoperatively and one year postoperatively, the functional outcome and performance were assessed using Pelvic Discomfort Index (PDI) and Timed Up and Go (TUG) test. Pre- and postoperative hemoglobin level was evaluated. Operation time and intra-and postoperative complications were documented. One year postoperatively, an X-ray was taken. The arithmetic mean (x) and standard deviations (±) of quantitative variables were calculated. T-test for dependent samples was used for pre-and postoperative results comparison. The PDI improved (p < 0.001) from x = 81.42 ± 4.04 to x = 36.19 ± 15.58. Preoperatively none of the patients was able to perform the TUG test. Postoperatively, the result exceeded x = 13.13 ± 3.99 s. The operation lasted x = 42.80 ± 8.90 min. Hemoglobin decreased (p < 0.001) from 11.63 ± 1.11 to 9.07 ± 1.21 g/dL. No complications nor fixation loosening were noted. The study support fixation using two tension band ilioiliac locking compression plates as an efficient and safe treatment of the FFP type IV.

Dislocations of the sacroiliac joint (SIJ) are treated with iliosacral screws or anterior plating. The study aimed to investigate the course of the lumbosacral trunk with reference to SIJ and determine whether is there sufficient space for two screws through the sacrum while performing anterior plating. Sixty patients, who underwent an MRI of the lumbar spine were included in our study. The three transverse LT—SIJ distances were measured at the three points (A, B, and C). We also analyzed 60 CT pelvic scans at points A, B, and C in order to measure: the vertebral canal–to–SIJ distance, the sacrum’s pelvic–to–dorsal surface sagittal distance, and the median plane–to–SIJ angle. The mean transverse LT–SIJ distances at points A, B, and C were 20.0 ± 3.05 mm, 17.9 ± 3.20 mm, and 12.3 ± 2.49 mm, respectively. Based on CT analyses, the vertebral canal–to–SIJ distances were 30.5 ± 7.65 mm at point A, 21.4 ± 5.05 mm at point B and 15.7 ± 6.05 mm at point C. The sacrum’s pelvic–to–dorsal surface sagittal distances reached values: 35.1 ± 11.62 mm at point A, 52.5 ± 10.58 mm at point B, and 57.5 ± 7.79 mm at point C. The median plane–to–SIJ angles measured 31.4 ± 4.82 degrees at point A, 26.6 ± 3.77 degrees at point B and 21.3 ± 3.25 mm at point C. Proximally, the safe zone for applying an anterior plate of SIJ is 20.0 mm. Since both the safe zone and safe corridor taper distally, surgeons may securely use one screw of gradually increased length towards the distal direction of SIJ, with inclination of 30 degrees in relation to the median plane of the lesser pelvis.

Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1–S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients—56 men and 47 women—were enrolled in the study and consecutively separated into two groups of different ages: 18–60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1–S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density.