Anterior Plating and Ilio-sacral Screwing for Unstable Pelvic Injury

Chang-Wug Oh; Poong-Taek Kim; Byung-Chul Park; Woo-Kie Min; Sung-Man Lee; Joo-Chul Ihn; Sang-Won Lee; Soo-Hoon Oh

doi:10.4055/jkoa.2007.42.4.483

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Oh, Kim, Park, Min, Lee, Ihn, Lee, and Oh: Anterior Plating and Ilio-sacral Screwing for Unstable Pelvic Injury

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(4): 483-489.

Published online: 31 August 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.4.483

Anterior Plating and Ilio-sacral Screwing for Unstable Pelvic Injury

Chang-Wug Oh, M.D., Poong-Taek Kim, M.D., Byung-Chul Park, M.D., Woo-Kie Min, M.D.

, Sung-Man Lee, M.D., Joo-Chul Ihn, M.D.^*, Sang-Won Lee, M.D., Soo-Hoon Oh, M.D.

Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.

^*Department of Orthopedic Surgery, Daegu Veterans Hospital, Daegu, Korea.

Address reprint requests to Chang-Wug Oh, M.D. Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, 50, Samdeok 2-ga, Jung-gu, Daegu 700-721, Korea. Tel: +82.53-420-5630, Fax: +82.53-422-6605, cwoh@knu.ac.kr

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.

Keywords: Unstable pelvic ring injury, Ilio-sacral screwing, Anterior plating

Figures and Tables

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.

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.

Fig. 3

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

Table 1

Deta for Patients with an Unstable Pelvic Ring Injury

VS, vertical shear injury; LC, lateral compression injury; Type, AO-OTA classification; ISS, injury severity score.

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ORCID iDs: Woo-Kie Min
https://orcid.org/http://orcid.org/0000-0003-2079-5085
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