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Sacroiliac Luxation/Fracture Surgery with the SILIS-MILAD

Orthopedic Surgery

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After a small dog named Biscuit was injured in a road traffic accident, Dr. Loïc M. Déjardin used the SILIS-MILAD to complete the necessary SIL/F surgery. Read on for preoperative diagnostics, the step-by-step surgical process, and outcomes.

Pre-operative diagnostic images

482474 Avant Lat Pelvis Y And R Off

Preoperative lateral view, left side: This radiograph shows the cranial translation of the pelvic bones, or two “wings,” as well as multiple minor pelvic fractures.

482474 Avant Ofa 01

Preoperative ventral-dorsal view: Biscuit’s left wing (appearing on right in image) is more severely translated forward than the right wing.
482474 Ct Avant Dv Edit Fixed

Preoperative CT scan: The red dots indicate where the wings are out of place, and the green dots indicate where the wings made contact with the sacroiliac bone prior to injury.

The surgical steps

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​The surgery begins at 4:32 p.m. This radiograph shows Biscuit’s misaligned pelvic bones (“wings”).
482474 Io C Arm Side 01 R 06
​This radiograph shows the pelvic bones back in alignment, after the injury has been reduced. During the surgery, the pelvic bones will be secured to the sacrum bone in this corrected position.
482474 Io C Arm Side 01 R 07
​The next step is to identify where to drill so the surgical nail can be placed properly. To do this, a small metal washer is placed on top of Biscuit’s skin noninvasively. The metal washer appears on the radiograph.
482474 Io C Arm Side 01 R 09
Using the radiograph for guidance, the washer is slid over and positioned to identify the sacrum bone and correct drilling site. Because Biscuit is secured in place, this enables surgeons to achieve perfect centering of the sacral body.
482474 Io C Arm Side 01 R 10
At 4:41 p.m., the MILAD scope is advanced toward the surgical site. This first positioning is approximative, or a "shot in the dark."
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Surgeons use radiographs to reposition the MILAD. This placement is better, but still not perfect.
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At 4:44 p.m., this radiograph shows perfect alignment has been achieved in less than three minutes.
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A reduction sleeve is added to the MILAD to aid in the drilling process.
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At 4:49 p.m., the ilium has been secured to the sacrum with a lag screw. Total surgery time was 17 minutes, including pauses to capture radiographs. (If the surgeons had used an open approach, the surgery would have taken between 45 and 90 minutes.)

Patient outcomes

The next three images show Biscuit’s surgical results. His pelvic bones now make correct contact with his sacrum bone, thanks to the SILIS-MILAD surgical tools and method.
482474 Poa 00W Lat Pelvis
482474 Pob 00W Ofa
Rotation Fix Silis Milad

Biscuit needed both pelvic bones to be repositioned, so the surgery was repeated on his right side, visible in images below.

482474 3 D Pelvis Red Green Screws 03 Lat L
482474 3 D Pelvis Red Green Screws 01
482474 3 D Pelvis Red Green Screws 03 Ap
482474 3 D Pelvis Red Green Screws 03 Lat R
482474 3 D Pelvis Red Green Screws 02

In the video below, Biscuit is seen walking with his owner two weeks after surgery. Two small marks on his right side are visible as he walks by the camera. These are the only incisions made during the entire surgical process with SILIS-MILAD (repeated on left side).