Fixation of posterior pelvic ring disruptions through a posterior approach |
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Authors: | Bruce French Paul Tornetta MD |
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Affiliation: | (1) Boston University Medical School, 850 Harrison Avenue, 02118 Boston, MA, USA |
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Abstract: | Objective Stable internal screw fixation of posterior pelvic ring disruptions through a posterior approach. Indications Complete, unstable sacroiliac dislocations with incompetence of anterior and posterior sacroiliac ligaments. Sacroiliac fracture dislocations. Displaced vertical sacral fractures. Contraindications Damage to posterior soft tissues. Acceptable closed reduction of sacrum or sacroiliac joint. Ipsilateral acetabular fractures treated through an anterior approach. Inadequate intraoperative fluoroscopic visualization of posterior pelvis. Surgical Technique Vertical paramedian incision overlying the sacroiliac joint. Release of origin of gluteus maximus. Inspection and reduction of sacroiliac joint. Stabilization with iliosacral screws under image intensification. Secure repair of gluteal fascia. Results 107 patients with unstable pelvic ring fractures were treated with open reduction and internal fixation of which 83 had an open reduction of posterior ring injuries. Accuracy of reduction: more than 95% of patients had residual displacement of less than 10 mm. Two patients had a deep wound infection postoperatively. Two-thirds of the patients were able to resume their previous occupation. Pain was either absent or occurred only with strenuous activities. 63% had a normal gait. |
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Keywords: | Pelvic fracture Internal fixation Posterior approach Sacroiliac screws Sacroiliac joint disruption |
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