Axel Gänsslen1, Tim Pohlemann, Christian Krettek. 1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. gaensslen.axel@mh-hannover.de
Abstract
OBJECTIVE: Stabilization of the completely disrupted sacroiliac (SI) joint with two three-hole DC plates. INDICATIONS: Definitive treatment of the posterior pelvic ring in type C injuries (AO classification) with complete SI joint disruption, transiliac or transsacral fracture-dislocation of the SI joint with an insignificant, small fragment. Emergency stabilization of the SI joint following a laparotomy. CONTRAINDICATIONS: Poor general health of patient. Local soft-tissue damage. Rotationally unstable type B pelvic injuries. SURGICAL TECHNIQUE: Supine. Anterolateral approach to the iliac crest. Subperiosteal detachment of the iliac muscle. Debridement of the SI joint and reduction under direct vision. Stabilization of the SI joint with two three-hole DC plates inserted at an angle of 70-90 degrees. POSTOPERATIVE MANAGEMENT: Partial weight bearing on the injured side at 15 kg for 8-12 weeks with two forearm crutches. Implant removal 6-12 months after injury provided ankylosis has not occurred. RESULTS: In 27 patients with disruption of the SI joint consistent with a type C injury, the average displacement of the affected SI joint was 16 mm (8-30 mm). Complications relating to the osteosynthesis occurred as a deep infection in one patient, originating from a concomitant acetabular osteosynthesis. Iatrogenic nerve damage (lateral femoral cutaneous nerve) was present in two patients. 16 patients were followed up using radiologic techniques (pelvic, possibly inlet and outlet views, computed tomography). 13 SI joints healed in anatomic position. The malalignments observed were relatively slight (2-4 mm). There was no secondary implant failure. Almost all patients (n = 14) showed posttraumatic changes of the SI joint (osteophytes, arthrosis, ankylosis).
OBJECTIVE: Stabilization of the completely disrupted sacroiliac (SI) joint with two three-hole DC plates. INDICATIONS: Definitive treatment of the posterior pelvic ring in type C injuries (AO classification) with complete SI joint disruption, transiliac or transsacral fracture-dislocation of the SI joint with an insignificant, small fragment. Emergency stabilization of the SI joint following a laparotomy. CONTRAINDICATIONS: Poor general health of patient. Local soft-tissue damage. Rotationally unstable type B pelvic injuries. SURGICAL TECHNIQUE: Supine. Anterolateral approach to the iliac crest. Subperiosteal detachment of the iliac muscle. Debridement of the SI joint and reduction under direct vision. Stabilization of the SI joint with two three-hole DC plates inserted at an angle of 70-90 degrees. POSTOPERATIVE MANAGEMENT: Partial weight bearing on the injured side at 15 kg for 8-12 weeks with two forearm crutches. Implant removal 6-12 months after injury provided ankylosis has not occurred. RESULTS: In 27 patients with disruption of the SI joint consistent with a type C injury, the average displacement of the affected SI joint was 16 mm (8-30 mm). Complications relating to the osteosynthesis occurred as a deep infection in one patient, originating from a concomitant acetabular osteosynthesis. Iatrogenic nerve damage (lateral femoral cutaneous nerve) was present in two patients. 16 patients were followed up using radiologic techniques (pelvic, possibly inlet and outlet views, computed tomography). 13 SI joints healed in anatomic position. The malalignments observed were relatively slight (2-4 mm). There was no secondary implant failure. Almost all patients (n = 14) showed posttraumatic changes of the SI joint (osteophytes, arthrosis, ankylosis).