title: Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures.
abstract: BACKGROUND
  Fractures of the pelvic ring including disruption of the posterior elements in high-energy trauma have both high morbidity and mortality rates. For some injury pattern part of the initial resuscitation includes either external fixation or plate fixation to close the pelvic ring and decrease blood loss. In certain situations--especially when associated with abdominal trauma and the need to perform laparotomies--both techniques may put the patient at risk of either pintract or deep plate infections. We describe an operative approach to percutaneously close and stabilize the pelvic ring using spinal implants as an internal fixator and report the results in a small series of patients treated with this technique during the resuscitation phase.
  
  
  RESULTS
  Four patients were treated by subcutaneous placement of an internal fixator. Screw fixation was carried out by minimally invasive placement of two supra-acetabular iliac screws. Afterwards, a subcutaneous transfixation rod was inserted and attached to the screws after reduction of the pelvic ring. All patients were allowed to fully weight-bear. No losses of reduction or deep infections occurred. Fracture healing was uneventful in all cases.
  
  
  CONCLUSIONS
  Minimally invasive fixation is an alternative technique to stabilize the pelvic ring. The clinical results illustrate that this technique is able to achieve good results in terms of maintenance of reduction the pelvic ring. Also, abdominal surgeries no longer put the patient at risk of infected pins or plates.
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland. MaxJScheyerer@gmx.ch.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Scheyerer
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Zimmermann
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.forename: Simon
authors.initials: S
authors.lastname: Tiziani
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Clèment M L
authors.initials: CM
authors.lastname: Werner
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D015203:Reproducibility of Results; D016896:Treatment Outcome