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A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Open reduction and stabilization of dorsal pelvic ring injuries is accompanied by a high rate of soft tissue complications. Minimally invasive techniques have the potential to decrease soft tissue trauma, but the risk of iatrogenic nerve and vessel damage through the reduced surgical exposure should be considered. We treated these injuries using a transiliac internal fixator (TIFI) in a minimally invasive technique characterized by implantation of a pedicle screw and rod system, bridging the sacroiliac joints and the sacral area.

Questions/purposes

We asked whether (1) we could achieve anatomic restoration with the device, (2) specific complications were associated with this minimally invasive approach (particularly enhanced intraoperative blood loss, soft tissue complications, and iatrogenic neurovascular damage), and (3) function 3 years after trauma was comparable to that of established methods.

Methods

We retrospectively reviewed 67 patients with dorsal pelvic injuries during a 7-year period. We evaluated the (1) reduction by grading the maximal displacement measured with three radiographic views, (2) the complications during the observation period, and (3) the function with a validated questionnaire (Pelvic Outcome Score) in all but five patients at least 3 years after trauma (mean, 37 months; range, 36–42 months).

Results

At last followup we observed a secondary fracture displacement greater than 5 mm in one patient. The intraoperative blood loss was less than 50 mL in all patients. No neurovascular lesions occurred owing to implantation. Four patients had wound infections, one had loosening of a single pedicle screw, and one had an iatrogenic screw malpositioning. Thirty-five of the 62 patients achieved Pelvic Outcome Scores of either a maximum score or 6 of 7 points.

Conclusion

Our observations suggest TIFI is a reasonable alternative to other established fixation devices for injuries of the dorsal pelvic ring with minor risks of major blood loss or iatrogenic neurovascular damage.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Thomas Windisch for assistance with data collection.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Thomas Dienstknecht MD, Arne Berner MD & Michael Nerlich MD

  2. Charité, Center for Musculoskeletal Surgery, Berlin, Germany

    Bernd Fuechtmeier MD

  3. Department of Trauma Surgery, University Hospital rechts der Isar, Munich, Germany

    Andreas Lenich MD

Authors
  1. Thomas Dienstknecht MD
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  2. Arne Berner MD
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  3. Andreas Lenich MD
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  4. Michael Nerlich MD
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  5. Bernd Fuechtmeier MD
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Corresponding author

Correspondence to Thomas Dienstknecht MD.

Additional information

Each author certifies that he has no commercial association (eg, consultancy, stock ownership, equity interest, or patent/licensing arrangement) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

The work was performed at the Department of Trauma Surgery of the University Hospital, Regensburg, Germany.

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Dienstknecht, T., Berner, A., Lenich, A. et al. A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries. Clin Orthop Relat Res 469, 3209–3217 (2011). https://doi.org/10.1007/s11999-011-1922-y

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  • DOI: https://doi.org/10.1007/s11999-011-1922-y

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