Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge
Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.
Description of Technique
An incision is made over each anterior iliac crest and a 6- to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability.
A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores.
As of January 2012, 23 patients met inclusion; however, 12 patients refused participation because of the possibility of external fixation, leaving 11 patients (four male, seven female) enrolled. At 6-month followup, there was a single pin tract infection in the APEF cohort and no complications or pain in the APIF cohort.
This clinical experience lends support to the use of a new minimally invasive technique to stabilize the anterior pelvis, particularly given the resistance on the part of patients to consider external fixation.
Level of Evidence
Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
- 2.Cole PA, Gauger EM, Anavian J, Ly TV, Morgan RA, Heddings AA. Anterior Pelvic External Fixator Versus Subcutaneous Internal Fixator in the Treatment of Anterior Ring Pelvic Fractures. J Orthop Trauma. 2012 February 21 [Epub ahead of print].Google Scholar
- 5.Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27(suppl 1):SA13–SA20.Google Scholar
- 6.Gardner MJ, Mehta S, Mirza A, Ricci WM. Anterior Pelvic Reduction and Fixation Using a Subcutaneous Internal Fixator. J Orthop Trauma. 2011 October 28 [Epub ahead of print].Google Scholar
- 16.Moazzam C, Heddings A, Moodie P, Cole P. Anterior Pelvic Subcutaneous Internal Fixator Application: An Anatomic Study. J Orthop Trauma. 2012 February 14 [Epub ahead of print].Google Scholar
- 21.R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2009.Google Scholar