A J Stevenson1, B Swartman2, A T Bucknill3,4. 1. Pelvic Reconstruction and Trauma Fellow, Royal Melbourne Hospital, Victoria, Australia. 2. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland. 3. Pelvic Reconstruction and Trauma Fellow, Royal Melbourne Hospital, Victoria, Australia. andrew.bucknill@mh.org.au. 4. Head of Orthopaedic Surgery, The University of Melbourne, Royal Melbourne Hospital, 3050, Victoria, Australia. andrew.bucknill@mh.org.au.
Abstract
BACKGROUND: Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported. OBJECTIVES: The purpose of this article is to outline the imaging, indication, planning, equipment, surgical technique and complications of these methods. METHODS: A review of the literature is provided and the techniques for anterior and posterior pelvic stabilization are discussed. RESULTS: High-quality preoperative CT scans are essential in planning for this technique. The anterior internal fixator ("InFix") is an effective method for stabilizing the anterior ring and should be usually used in conjunction with posterior fixation. Good technique avoids neurovascular injury, which can be a devastating complication. The retrograde anterior column screw (RACS) is a technique that can be used in most patients, although in smaller patients smaller screw diameters may be needed. The entry point for the screw is more lateral in women than men. Iliosacral screws (ISS) are an effective method of posterior stabilization and can be placed using 2D or 3D fluoroscopy, computer navigation or CT navigation. CONCLUSION: Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.
BACKGROUND: Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported. OBJECTIVES: The purpose of this article is to outline the imaging, indication, planning, equipment, surgical technique and complications of these methods. METHODS: A review of the literature is provided and the techniques for anterior and posterior pelvic stabilization are discussed. RESULTS: High-quality preoperative CT scans are essential in planning for this technique. The anterior internal fixator ("InFix") is an effective method for stabilizing the anterior ring and should be usually used in conjunction with posterior fixation. Good technique avoids neurovascular injury, which can be a devastating complication. The retrograde anterior column screw (RACS) is a technique that can be used in most patients, although in smaller patients smaller screw diameters may be needed. The entry point for the screw is more lateral in women than men. Iliosacral screws (ISS) are an effective method of posterior stabilization and can be placed using 2D or 3D fluoroscopy, computer navigation or CT navigation. CONCLUSION: Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.
Authors: Mark C Reilly; Christopher M Bono; Behrang Litkouhi; Michael Sirkin; Fred F Behrens Journal: J Orthop Trauma Date: 2003-02 Impact factor: 2.512