A NEW TECHNIQUE FOR SACROILIAC FIXATION FOR TRAUMATIC FRACTURE OF THE PELVIC GIRDLE

Abstract

Purpose: Pelvic girdle fractures with vertical and horizontal instability (Tile classification class C) are classical indications for surgical stabilisation of the posterior and anterior lesions. There is general agreement concerning the anterior fixation, but several methods have been described for the posterior fixation: open or percutaneous sacroiliac screwing using fluoroscopic or computed tomographic guidance, sacral compression bar applied laterally on the posterior iliac masses, sacral screw for sacroiliac fixation using the Galveston technique, among others.

Material and methods: We propose a new sacroiliac fixation technique for fractures of the pelvic girdle associating vertical and horizontal instability (Tile classification class C). This fixation technique controls vertical displacement while authorising, if needed, a certain degree of mobility in the horizontal plane allowing easier reduction of the anterior fracture. This technique uses two sacral screws, one in S1 and the other in S2, and two iliac screws. The iliac screws are inserted in the posterior iliac crest passing through two sacroiliac connectors placed on a rod connecting the two sacral screws. Vertical displacement is controlled by blocking the two connectors on the screw heads. If needed, the connectors can be left unblocked allowing a certain degree of freedom for moving the half-pelvis in the horizontal plane.

Results: This technique was used in four cases. Anatomic reduction was achieved. There was no secondary movement of the osteosynthesis material and no secondary displacement. Because of the quality of the fixation, the sitting position was allowed rapidly as was full-weight bearing and walking. This type of fixation is reserved for type C12 fractures of the Tile classification.