Skip to main content
SpringerLink
Log in

Anterior plating and percutaneous iliosacral screwing in an unstable pelvic ring injury

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

This study was carried out to evaluate the effectiveness of anterior plating with subsequent percutaneous iliosacral screwing for the management of unstable pelvic ring injuries.

Methods

Nineteen patients with unstable pelvic ring injuries were included in this retrospective study. All patients were followed up for at least 1 year, and their mean age was 43 years. According to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification, there were 5 B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by means of plating, an iliosacral screw fixation was carried out percutaneously using a C-arm fluoroscope.

Results

All fractures healed, except for 1 case of nonunion at the pubic ramus. Radiological results showed that there were 9 anatomic, 7 nearly anatomic, 2 moderate, and 1 poor reduction. Sixteen of the 19 patients had good or excellent results for function, and all these had satisfactory (anatomic or nearly anatomic) reductions. The two moderate and 1 poor result were from an unsatisfactory reduction in a type-C injury with residual neurological signs. A screw misplacement with a neurological compromise occurred in 1 patient, but there were no adverse sequelae after its removal. The complications encountered were 2 cases of screw loosening, 2 cases of anterior metal failure, and 1 deep infection.

Conclusions

Anterior plating with subsequent percutaneous iliosacral screwing may be a useful method of treatment for unstable pelvic ring injuries, and the reduction quality and residual neurological signs were important in its functional outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mears DC, Capito CP, Deleeuw H. Posterior pelvic disruptions managed by the use of the double cobra plate. Instr Course Lect 1988;37:143–150.

    CAS  PubMed  Google Scholar 

  2. Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848–856.

    Article  CAS  PubMed  Google Scholar 

  3. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 1988;70:1–12.

    CAS  PubMed  Google Scholar 

  4. Gruen GS, Leit ME, Gruen RJ, Peitzman AB. The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures. J Trauma 1994;36:706–711.

    Article  CAS  PubMed  Google Scholar 

  5. Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma 1991;31:28–31.

    Article  CAS  PubMed  Google Scholar 

  6. Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 1995;9:207–214.

    Article  PubMed  Google Scholar 

  7. Routt ML Jr, Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma 1996;10:171–177.

    Article  PubMed  Google Scholar 

  8. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.

    Article  CAS  PubMed  Google Scholar 

  9. Orthopaedic Trauma Association Committee for Coding and Classification. Fracture and dislocation compendium. J Orthop Trauma 1996;10Suppl 1:v–ix;1-54.

    Google Scholar 

  10. Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop 1988;227:67–81.

    CAS  PubMed  Google Scholar 

  11. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop 1989;242:83–97.

    PubMed  Google Scholar 

  12. Rommens PM, Hessmann MH. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma 2002;16:92–98.

    Article  CAS  PubMed  Google Scholar 

  13. Stocks GW, Gabel GT, Noble PC, Hanson GW, Tullos HS. Anterior and posterior internal fixation of vertical shear fractures of the pelvis. J Orthop Res 1991;9:237–245.

    Article  CAS  PubMed  Google Scholar 

  14. Letournel E. Pelvic fractures. Injury 1978;10:145–148.

    Article  CAS  PubMed  Google Scholar 

  15. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am 1987; 18:25–41.

    CAS  PubMed  Google Scholar 

  16. Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O’Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma 1999;13:107–113.

    Article  CAS  PubMed  Google Scholar 

  17. Leighton RK, Waddell JP. Techniques for reduction and posterior fixation through the anterior approach. Clin Orthop 1996;329:115–120.

    Article  PubMed  Google Scholar 

  18. Ragnarsson B, Olerud C, Olerud S. Anterior square-plate fixation of sacroiliac disruption: 2–8 years follow-up of 23 consecutive cases. Acta Orthop Scand 1993;64:138–142.

    CAS  PubMed  Google Scholar 

  19. Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 1993;7:107–117.

    Article  CAS  PubMed  Google Scholar 

  20. Comstock CP, van der Meulen MC, Goodman SB. Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. J Orthop Trauma 1996;10:517–522.

    Article  CAS  PubMed  Google Scholar 

  21. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 2003;17:399–405.

    Article  PubMed  Google Scholar 

  22. Collinge C, Coons D, Tornetta P, Aschenbrenner J. Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model. J Orthop Trauma 2005;19:254–258.

    Article  PubMed  Google Scholar 

  23. Gautier E, Bächler R, Heini PF, Nolte LP. Accuracy of computer-guided screw fixation of the sacroiliac joint. Clin Orthop 2001;393:310–317.

    Article  PubMed  Google Scholar 

  24. Peng KT, Huang KC, Chen MC, Li YY, Hsu RW. Percutaneous placement of iliosacral screws for unstable pelvic ring injuries: comparison between one and two C-arm fluoroscopic techniques. J Trauma 2006;60:602–608.

    Article  PubMed  Google Scholar 

  25. Ebraheim NA, Coombs R, Jackson WT, Rusin JJ. Percutaneous computed tomography-guided stabilization of posterior pelvic fractures. Clin Orthop 1994;307:222–228.

    PubMed  Google Scholar 

  26. Ziran BH, Smith WR, Towers J, Morgan SJ. Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerised tomography. J Bone Joint Surg Br 2003;85:411–418.

    Article  CAS  PubMed  Google Scholar 

  27. Tornetta P III, Dickson K, Matta JM. Outcome of rotationally unstable pelvic ring injuries treated operatively. Clin Orthop 1996;329:147–151.

    Article  PubMed  Google Scholar 

  28. Van den Bosch EW, Van der Kleyn R, Hogervorst M, Van Vugt AB. Functional outcome of internal fixation for pelvic ring fractures. J Trauma 1999;47:365–371.

    Article  PubMed  Google Scholar 

  29. Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma 2004;18:138–143.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Kyungpook National University Hospital, 50, 2-Ga, Samdok, Chunggu, Daegu, 700-721, Korea

    Chang-Wug Oh, Poong-Taek Kim, Joon-Woo Kim, Woo-Kie Min, Hee-Soo Kyuung, Shin-Yoon Kim, Soo-Hoon Oh & Joo-Chul Ihn

Authors
  1. Chang-Wug Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Poong-Taek Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joon-Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Woo-Kie Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hee-Soo Kyuung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shin-Yoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Soo-Hoon Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joo-Chul Ihn
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Oh, CW., Kim, PT., Kim, JW. et al. Anterior plating and percutaneous iliosacral screwing in an unstable pelvic ring injury. J Orthop Sci 13, 107–115 (2008). https://doi.org/10.1007/s00776-007-1201-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-007-1201-7

Keywords

Search

Navigation