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.


METHODS
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.


METHODS
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.


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


METHODS
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.
Gänsslen
Axel
A
Unfallchirurgische Klinik, Medizinische Hochschule Hannover. gaensslen.axel@mh-hannover.de
Hüfner
Tobias
T
Krettek
Christian
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000293:injuries* / Q000601:surgery*