- See:
-
Posterior Pelvic Injuries:
-
Sacral Fractures
-
cresent fracture: (iliac fracture):
- Fixation Techniques:
-
SI joint dislocation: posterior screw fixation:
- as pointed out by Kellum et al 1987, unstable SI joint dislocations can be expected to produce long term pain in 60% of patients who
are treated non operative treatment;
- associated leg length descrepancies only worse the symptoms;
-
anterior fixation of SI joint dislocation:
-
transiliac sacral bars:
- utilizes Harrington rods, w/ compression achieved by tightening of threaded nuts;
- advantages include technical ease of insertion and limited soft tissue dissection;
- relative contraindications include
iliac wing fractures;
- cautions: may cause over compression of sacral fractures and it can be difficult to judge adequacy of SI joint reduction;
-
4.5 mm reconstruction plate: (Albert et al 1993);
- indicated for posterior pelvic fractures as well as sacral fractures;
- reconstruction plate is placed along dorsum of the sacral and thru the posterior iliac spines (transiliac plate fixation);
- advantages:
- low profile, minimal risk to N/V structures, and no need for flouro;
- patient is placed in the prone position;
- two incisions are made over the PSIS which are perpendicular to the iliac wings, and one vertical incision is made over the base of the S1 spinous process;
- dissections are caarried down to the bony surfaces;
- predrill the PSIS to assist w/ reconstruction plate insertion;
- use the 4.5 drill to make 2-3 drill holes 1 cm lateral to the PSIS;
- an appropriately sized 4.5 mm reconstruction plate is chiseled thru the iliac spine, passed along the dorsum of the sacrum to the opposite PSIS;
- the recon plate is appropriately contoured;
- the plate is fixed to the iliac wings using 6.5 mm cancellous screws, w/ two screws inserted into each ilac wing;
- postop: patients can be bed to chair or touch down wt bearing;
-
ref:
- Posterior Pelvic Fixation Using a Transiliac 4.5 mm Reconstruction Plate: A clinical and biomechanical study.
M.J. Albert, M.E. Miller, M. MacNaughton, and W.C. Hutton. J. Orthop. Trauma. 1993. Vol 7. No 3. p 226-232.
- Hazards:
- wound infection and wound slough:
- these complications are especially common in posterior approaches to the joint when the pelvic frx has occured from crush injuries;
- carefully note skin abrasions, contussions, and ecchymosis over the PSIS;
- if the soft tissues are not optimal consider an
anterior approach to the SI joint;
- malreduction:
-
Removal of an iliosacral screw entrapping the L5 nerve root after failed posterior pelvic ring fixation: a case report.
Internal fixation of pelvic ring fractures.
Stabilization of sacroiliac joint disruption with threaded compression rods.
The Crescent Fracture: A Posterior Fracture Dislocation of the SI Joint.
J. Borrelli Jr., K.J. Koval, and D.L. Helfet. J Orthop Trauma, Vol. 10, No 3 p 165-170.
Early Results of Percutaneous Iliosacral Screws Placed with the Patient in the Supine Position.
M.L. Chip Routt, Jr, P.J. Kregor, P.T. Simonian, and K.A. Mayo. J. Orthop. Trauma. Vol 9. No 3. p 207-214.
Radiographic Recognition of the Sacral Alar Slope for Optimal Placement of Iliosacral Screws: A cadaveric and clinical study.
M.L. Chip Routt, Jr., Peter T. Simonian, S.G. Agnew, and F.A. Mann. J Orthop Trauma, Vol. 10. No 3. 1996. p 166.
The Unstable Pelvic Fracture: Operative Treatment. JF Kellum MD et al. Ortho Clinics of North America. Vol 18. No 1, Jan 1987. p 25.
The effect of sacral fracture malreduction on the safe placement of iliosacral screws.
Superior gluteal artery injury during iliosacral screw placement.
Biomechanical Comparison of Sacroiliac Screw Techniques for Unstable Pelvic Ring Fractures.
Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy.
Risks to the Superior Gluteal Neurovascular Bundle During Percutaneous Iliosacral Screw Insertion: An Anatomical Cadaver Study.
Vertically Unstable Pelvic Fractures Fixed with Percutaneous Iliosacral Screws: Does Posterior Injury Pattern Predict Fixation Failure?
Percutaneous Placement of Iliosacral Screws for Unstable Pelvic Ring Injuries: Comparison between One and Two C-arm Fluoroscopic Techniques.
S2 iliosacral screw fixation for disruptions of the posterior pelvic ring: a report of 49 cases.
Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up.
Minimum 1-Year Follow-Up for Patients With Vertical Shear Sacroiliac Joint Dislocations Treated With Iliosacral Screws: Does Joint Ankylosis or Anatomic Reduction Contribute to Functional Outcome?
