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Review Article Fixation Options of Unstable Posterior Pelvic Ring Disruption: Ilio-Sacral Screw Fixation, S2AI Fixation, Posterior Tension Band Plate Fixation, and Spino-Pelvic Fixation
Dong Hee Kim, Jae Hoon Jang, Myungji Shin, Gu Hee Jung
Journal of Musculoskeletal Trauma 2019;32(4):240-247.
DOI: https://doi.org/10.12671/jkfs.2019.32.4.240
Published online: October 31, 2019
1Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
2Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.
3Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea. jyujin2001@hotmail.com
4Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.

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Abstract

The fixation methods that can be used for unstable posterior pelvic ring injuries have undergone many innovative changes due to the recent development of surgical and imaging techniques. After understanding the appropriate indications of first and second sacroiliac screw fixation and spinopelvic fixation, innovative methods, including the trans-sacral screw fixation, posterior tension-band plate fixation, and the S2AI screw, would be chosen and applied. Considering the anatomical complexity and proximity to the surrounding vessels and nerves in the posterior fixation, the safe zone according to the fixation options should be well understood in preoperative planning. Moreover, the functional reduction of the posterior pelvic ring through the reduction and fixation of the anterior lesion should be achieved before placing the implant to reduce the number of malposition-related complications.


J Korean Fract Soc. 2019 Oct;32(4):240-247. Korean.
Published online Oct 28, 2019.
https://doi.org/10.12671/jkfs.2019.32.4.240
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Review

Fixation Options of Unstable Posterior Pelvic Ring Disruption: Ilio-Sacral Screw Fixation, S2AI Fixation, Posterior Tension Band Plate Fixation, and Spino-Pelvic Fixation

Dong-Hee Kim, M.D., Ph.D.,*,§ Jae Hoon Jang, M.D.,† Myungji Shin, M.D.,‡ and Gu-Hee Jung, M.D., Ph.D.‡,§
    • *Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
    • †Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.
    • ‡Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea.
    • §Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.
  • Correspondence to: Gu-Hee Jung, M.D., Ph.D. Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea. Tel: +82-55-214-3822, Fax: +82-55-214-3259, Email: jyujin2001@hotmail.com
Received October 05, 2019; Revised October 07, 2019; Accepted October 07, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The fixation methods that can be used for unstable posterior pelvic ring injuries have undergone many innovative changes due to the recent development of surgical and imaging techniques. After understanding the appropriate indications of first and second sacroiliac screw fixation and spinopelvic fixation, innovative methods, including the trans-sacral screw fixation, posterior tension-band plate fixation, and the S2AI screw, would be chosen and applied. Considering the anatomical complexity and proximity to the surrounding vessels and nerves in the posterior fixation, the safe zone according to the fixation options should be well understood in preoperative planning. Moreover, the functional reduction of the posterior pelvic ring through the reduction and fixation of the anterior lesion should be achieved before placing the implant to reduce the number of malposition-related complications.

Keywords
Pelvis, Pelvic ring injury, Fixation option, Complications

Figures

Fig. 1
(A, B) Sacral dysmorphism represents the acute angulation of sacral ala and reduced the corridor for iliosacral screw fixation. *Cortical perforation of screw.

Fig. 2
(A) Posterosuperior corners of sacrum were connected by imaginary line. Asterisks: body of 1st sacrum. (B) The virtual cylinder for ilio-sacral screw was placed according to the curve point. (C) the curve point could be visualized easily without additional support.

Fig. 3
(A) Lateral radiographs showed the safe zone of 1st and 2nd sacrum. (B, C) The conventional ilio-sacral screw was placed toward the opposite corner of superior endplate.

Fig. 4
(A–C) The trans-sacral trans-iliac screw should be placed transversely just below the ICD line. (D, E) The entry point was placed just anterior to the curve point. (F, G) The screw did not pierce the cortex around the sacral canal and foramen.

Fig. 5
(A) Unstable pelvic ring injury in a 20-year-old male showing the involvement of spinal canal and comminution of upper sacral surface. (B) The trans-sacral trans-iliac screw was performed after the anterior fixation for achieving the functional reduction of sacrum. (C) The radiographs after 12 months showed neither a loss of reduction nor screw back-out.

Fig. 6
(A, B) The variable of basal height could be measured using the three-dimensional biplanar image in the opposite side.

Fig. 7
(A, B) The safe zone of the 2nd sacrum can be observed easily in the lateral radiographs of pelvis and increased inversely according to the sacral dysmorphism.

Fig. 8
(A–C) A 63-year-old male sustained an unstable pelvic injury with spino-pelvic dissociation. (B, C) The spino-pelvic fixation was performed and showed the iliac screw, which was used with the connecting rod. (D) The radiograph after 12 months showed the maintenance of pelvic ring.

Fig. 9
(A–C) S2 alar-iliac (S2AI) screw should be toward the AIIS and passed just over the superior rim of the greater sciatic notch, above the greater sciatic notch. (D) The screw trajectory was from the dorsal cortex of the sacrum to the inner ilium by penetrating the sacro-iliac joint.

Fig. 10
(A) A 57-year-old male sustained an unstable pelvic injury with L5 body fracture. (B) First, the pedicle screw of L4 and L5 was placed percutaneously and made the entry portal for the S2 alar-iliac (S2AI) screw. (C) The postoperative radiographs showed the functional reduction of the pelvis. (D) Follow-up radiographs at eight weeks showed the maintenance of reduction adequacy.

Fig. 11
(A) A 71-year-old female sustained of an unstable pelvic injury (sacral fracture). (B–D) The PTB plate fixation was performed and the osseous corridor was used to achieve the maximal screw length. (E–H) The postoperative radiographs showed an acceptable reduction of the pelvis. (I) The follow-up radiographs at 12 months showed the maintenance of reduction.

Notes

Financial support:None.

Conflict of interests:None.

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    Fixation Options of Unstable Posterior Pelvic Ring Disruption: Ilio-Sacral Screw Fixation, S2AI Fixation, Posterior Tension Band Plate Fixation, and Spino-Pelvic Fixation
    J Korean Fract Soc. 2019;32(4):240-247.   Published online October 31, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.4.240
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