UNSTABLE FRACTURES OF THE PELVIS TREATED BY PERCUTANEOUS TRANSACRAL SCREWS AND ANTERIOR FIXATION: A SERIES OF 21 CASES

Abstract

Purpose: Good functional results for unstable fractures of the pelvis require reduction and fixation of the posterior lesions. “Open” techniques are highly invasive and sacroiliac screwing is insufficient alone. We evaluated results with a strategy based on minimally invasive complete reduction and osteosynthesis allowing early mobilisation.

Material and methods: The series included 19 men and two women, mean age 30 years (17–60) operated on between 1998 and 2000. Nineteen patients had multiple injuries. The AO classification was A5 C (12 CI unilateral, 3 (2 C2, 1C3) bilateral) and 6B (4 B1, 3 B2). The patients were operated on in the supine position with traction on the lower limb to reduce the hemipelvis ascension. Displaced anterior fractures were reduced and stabilised with a pubic plate or with an anterior external fixator. The posterior fractures were fixed with a percutaneosus canulated cancellous screw measuring 7.3 mm in diameter inserted transacrally into the S1 body to reach the opposite sacroiliac joint under fluoroscopic monitoring. The radiographic results were analysed by measuring the vertical ascension of the hemipelvis at the foot of the sacroiliac and clinical results with the Majeed score.

Results: The patients were operated on day four 0–8) after trauma. Anatomic reduction was achieved in 19 cases, with a gap of 5 mm in two cases. Thirteen anterior fixations (eleven plates, two external fixators) and 21 transacral screw fixations were used to stabilise the pelvi. There were no notable complications. One patient died early from multiple injuries. All were followed for one year after the accident and no secondary dismanteling has been observed. The final mean Majeed score was 95/100.

Discussion: Reduction is best if achieved early. With the transacral screw fixation, it is achieved in the supine position which is technically difficult due to the known anatomic variability of the sacrum. It also allows simultaneous treatment of C13 and C23 comminutive fractures. Anterior fixation is complete.

Conclusions: Percutaneous transacral screw fixation and anterior osteosynthesis is a minimaly invasive technique providing reproducible and reliable results for maintaining reduction in a large number of unstable fractures of the pelvic ring. These fixations allow the upright position and mobilisation early. The good anatomic result is maintained leading to a better functional result which should be validated in a longer series.