Removal, Refixation, and Augmentation of a Broken Iliosacral Screw: A Percutaneous Surgical Technique

Background The management of a broken iliosacral screw in an anterior–posterior compression (APC)–type pelvic ring injury presents a surgical challenge, particularly in cases requiring removal and refixation without navigation assistance. Objective This study describes a step‐by‐step surgical technique for safely removing a fractured S1 cannulated iliosacral screw and replacing it with a larger‐diameter screw, supplemented with additional fixation (e.g., S2 screw or iliosacral fixation) to enhance stability. Technique The procedure involves careful fluoroscopy‐guided extraction of the broken screw, followed by reaming and placement of a larger screw for improved fixation. Supplementary stabilization (e.g., S2 screw or transiliac–transsacral fixation) is then added to reinforce the construct. Conclusion This technique provides a reliable solution for managing broken iliosacral screws in APC pelvic injuries, even without navigation, while optimizing biomechanical stability through larger screw replacement and supplemental fixation.