J Korean Orthop Assoc.  2007 Aug;42(4):483-489. 10.4055/jkoa.2007.42.4.483.

Anterior Plating and Ilio-sacral Screwing for Unstable Pelvic Injury

• Oh CW
• Kim PT
• Park BC
• Min WK
• Lee SM
• Ihn JC
• Lee SW
• Oh SH

• KMID: 2186510
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.483

Abstract

PURPOSE: To evaluate the effectiveness of iliosacral screw fixation with anterior plating in the management of an unstable pelvic ring injury.
MATERIALS AND METHODS
Nineteen patients with an unstable pelvic ring injury were enrolled in this retrospective study. All patients were followed up for at least 1 year. The mean age of the patients was 43 years. According to the AO-OTA classification, there were five B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by plating, ilio-sacral screw fixation was performed percutaneously under the C-arm guide.
RESULTS
All cases united except for 1 case of nonunion at the pubic ramus. The radiology results showed 9, 7, 2 and 1 case of anatomic, nearly anatomic, moderate and poor reduction, respectively. Sixteen out of 19 patients had a good or excellent functional result. Two moderate and one poor result were from an unsatisfactory reduction in a type C injury with the residual neurological signs. Screw misplacement with neurological compromise occurred in one patient but there were no adverse sequelae after its removal. Regarding the complications, there were two cases of screw loosening, two cases of anterior metal failures, and 1 case of a deep infection.
CONCLUSION
Percutaneous ilio-sacral screwing with anterior plating may be a useful method for treating unstable pelvic ring injuries, and the reduction quality and neurological signs are important.

Keyword

Unstable pelvic ring injury; Ilio-sacral screwing; Anterior plating

MeSH Terms

Classification
Humans
Retrospective Studies

Figure

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  Fig. 1 A 39-year-man suffered a vertical shear injury (AO-OTA type C1 injury) of the pelvic ring with a fracture of the right femur and left acetabulum. CT scan revealed a sacral fracture of Denis type II with evident pubic rami fractures.

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  Fig. 2 Using the long reconstruction plate, the anterior disruption of pelvic ring was reduced. The posterior ring was percutaneously fixed by a 7.0 mm cannulated screw. The CT scan shows a well reduced pelvic ring and a good location of the ilio-sacral screw.

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  Fig. 3 At 2 years, all fractures healed with anatomical reduction. The patient showed excellent function (Fig. 3).

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