Intraoperative Monitoring with Stimulus-Evoked Electromyography during Placement of Iliosacral Screws. An Initial Clinical Study* by BERTON R. MOED, B.

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Intraoperative Monitoring with Stimulus-Evoked Electromyography during Placement of Iliosacral Screws. An Initial Clinical Study* by BERTON R. MOED, B. K. AHMAD, JOSEPH G. CRAIG, GARY P. JACOBSON, and MARK J. ANDERS J Bone Joint Surg Am Volume 80(4): April 1, 1998 ©1998 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-H: Case 25, a forty-year-old man who sustained multiple injuries, including a type-C disruption27 of the pelvic ring, in a motor-vehicle accident. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B Representative computerized tomography scan, made at the second sacral level after application of the external fixator, demonstrating disruption of the right sacroiliac joint as well as some impaction injury of the sacral ala. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-C: Initial intraoperative anteroposterior (top) and outlet (bottom) fluoroscopic images of the posterior part of the pelvic ring, made with the patient supine on a radiolucent operating- room table before reduction and fixation. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-D: Inlet (top) and outlet (bottom) fluoroscopic images made after alignment and partial posterior reduction (achieved with closed manipulation combined with open reduction and internal fixation of the disrupted pubic symphysis) followed by insertion... BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-E Inlet (top) and outlet (bottom) fluoroscopic images made after the drill-bit was backed out and used as a guide for insertion of a second bit (x), beginning in a more superior and anterior location and continuing into the center of the body of the... BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-F Inlet (top) and outlet (bottom) fluoroscopic images made after insertion of the screw. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-G Anteroposterior radiograph made postoperatively, showing the reduction and fixation. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-H Computerized tomography scan (at a level similar to that in Fig. 1-B) made postoperatively, showing the anatomical reduction of the dislocation of the sacroiliac joint and the location of the screw in the body of the second sacral vertebra. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Case 1. BERTON R. MOED et al. J Bone Joint Surg Am 1998;80: ©1998 by The Journal of Bone and Joint Surgery, Inc.