title: Less invasive lumbopelvic fixation technique using a percutaneous pedicle screw system for unstable pelvic ring fracture in a patient with severe multiple traumas.
abstract: Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and her activities of daily life returned to preinjury status. Unstable pelvic ring fractures need to be sufficiently stabilized for good surgical outcome. However, to avoid postoperative complications, a less invasive treatment is preferred, particularly in cases with poor general condition. This procedure is less invasive and provides sufficient stabilization to the unstable pelvic ring fracture, and thus is the ideal surgical procedure for such cases.
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Sei
authors.initials: S
authors.lastname: Yano
authors.affiliation: Departments of 1 Orthopaedic Surgery and.|Departments of 2 General Medical Science and.
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Departments of 1 Orthopaedic Surgery and.|Departments of 2 General Medical Science and.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Departments of 1 Orthopaedic Surgery and.|Departments of 2 General Medical Science and.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Departments of 1 Orthopaedic Surgery and.|Departments of 2 General Medical Science and.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takazawa
authors.affiliation: Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane;
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirasawa
authors.affiliation: Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city; and.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city; and.
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.affiliation: Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city; and.
authors.forename: Yawara
authors.initials: Y
authors.lastname: Eguchi
authors.affiliation: Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city; and.
authors.forename: Takane
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city; and.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
mesh_terms: D000063:Accidents, Traffic; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D000069076:Fractures, Multiple / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D065289:Pedicle Screws; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D020127:Recovery of Function; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery
keywords: TAE = transcatheter arterial embolization; iliac screw; lumbopelvic; pelvic ring fracture; percutaneous pedicle screw; posterior fusion; surgical technique; switchback