Evaluation of closed reduction and percutaneous iliosacral cannulated screw fixation for sacroiliac disruption or sacral fractures; a preliminary study

ABSTRACT

High energy pelvic ring fractures are serious injuries result from motor vehicle accidents or fall from height, unstable pelvic ring injuries usually associated with sacroiliac disruptions or sacral fractures. The ideal treatment for unstable pelvic fractures remains a matter of debate. The main purpose of the treatment is to save the patient s life and then to achieve an excellent functional outcome. Percutaneous fixation of Sacroiliac joint disruption or sacral fractures is evolved recently as a minimal invasive technique with low complication rate and morbidities. A preliminary study to evaluate prospectively the effectiveness of the percutaneous cannulated screws fixation of posterior pelvic ring injures in unstable fractures with associated injuries. Six patients have been treated in Medical City/Baghdad [during the period of Jan.2012 till July 2012] by one surgeon, four males and two females with mean age 27 years [range 20-36 years], who have unstable pelvic ring injuries associated with other skeletal, neural or visceral injuries are treated by gradual closed reduction using skeletal traction through lower femur and percutaneous sacroiliac fixations using a 7 mm Cancellous partially threaded screws following the technique described by Matta and Saucedo using C-arm fluoroscopy. A data for the duration of procedure, blood loss, intra-operative and post-operative complications and post-operative rehabilitation were collected analyzed and compared to data for open reduction and internal fixation for the same injuries from other studies. pre and post-operative radiographs and CT scans of the pelvis were studied to evaluate the procedure. A total of 13 screw where inserted percutanously to a six patients. The duration of the surgical procedure was 30 minutes to 60 minutes including the preparation time. Wound size was 5mm-10mm, Blood loss was negligible, no anesthetic complications no intra or post-operative complications, no wound complications, and a very good post-operative rehabilitation. Postoperative X-rays and CT scans show no complications and a very good reduction and fixation for the Sacroiliac joints and sacral fractures. Gradual closed reduction and Percutaneous sacroiliac fixations using cannulated screws have demonstrated a very good minimally invasive technique with no intra-operative or post-operative complications. This technique may be advantageous as it avoids using extensive approaches, bleeding, wound complications and prolonged surgeries