Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy

OBJECTIVE: Closed reduction and retention of translatory unstable pelvic injuries (type C injuries), in order to restore the form and function of the posterior pelvis by percutaneous iliosacral screw osteosynthesis, using conventional fluoroscopy.

INDICATIONS: Definitive treatment of the posterior pelvis in type C injuries (AO classification) with complete sacral fracture, sacroiliac joint (SI joint) dislocation, transiliac or transsacral dislocation fracture of the SI joint with insignificant small fragment and sacroiliac avulsion injuries which can be reduced almost anatomically in closed technique.

CONTRAINDICATIONS: Poor general health, local soft-tissue damage, rotationally unstable type B pelvic injuries as well as type C injuries which cannot be reduced satisfactorily in closed technique.

SURGICAL TECHNIQUE: Closed reduction, stab incision and percutaneous stabilization of the posterior pelvis by transiliosacral screw osteosynthesis, guided by fluoroscopy.

POSTOPERATIVE MANAGEMENT: Partial loading of the injured side with 15 kg for 8-12 weeks with two underarm crutches. Implant removal 6-12 months after injury.

RESULTS: 20 patients with a transforaminal sacral fracture consistent with a type C pelvic injury underwent screw fixation with fluoroscopy with 7.3-mm cannulated screws, placed in a transiliosacral position in the vertebral body of S1. The average preoperative displacement of 3.8 mm was decreased by closed reduction to 1.6 mm postoperatively. The average operating time was 55 min, the average screening time 2.22 min. Incorrect screw position with no consequences was observed in three patients; iatrogenic nerve damage was not found. All fractures healed within 3 months.