TOTBİD Dergisi

TOTBİD Dergisi

2012, Cilt 11, Sayı, 2     (Sayfalar: 108-119)

Surgical reduction and fixation techniques in the treatment of posterior pelvic injuries

Hüseyin Demirörs 1, Orçun Şahin 1

1 Başkent Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, Ankara

DOI: 10.5606/totbid.dergisi.2012.15
Görüntüleme: 266
İndirme : 257

Pelvic fractures are among the injuries associated with high mortality and complication rates. Open or closed reduction and fixation techniques through anterior or posterior approach have been defined in the treatment of posterior pelvic injuries. Currently, closed reduction has been adopted widely thanks to its ability to preserve fracture hematoma with better and rapid union and lower incidence of injury site problems. The basic requirements for closed reduction method are radiolucent trauma board and C-arm fluoroscopy. Early surgical intervention is also critical. The quality of the reduction should be assessed under fluoroscopy during surgery. However, open reduction through anterior approach may be performed in the presence of severe soft tissue injuries hindering posterior incision, displaced sacroiliac joint, injuries with large crescent fragment and iliac wing fractures. On the other hand, open reduction through posterior approach may be performed in the presence of displaced sacroiliac joint, sacroiliac fracture-dislocation, displaced transforaminal fracture of the sacrum and Denis zone III sacral fracture. Anterior and/or posterior internal fixation methods may be used following reduction surgery. Despite its rapid application feature, external fixation has been reported to be ineffective for the treatment of posterior injuries. Currently, open reduction through posterior approach is not widely applied, due to high incidence of injury site problems and prolonged recovery time. Accordingly, percutaneous sacroiliac screwing method designed to reduce morbidity and mortality and maintain anatomical reduction has been defined. Percutaneous sacroiliac screwing method should be performed in the treatment of polytrauma patients, thanks to its ability to early fixation with low rate of trauma. In conclusion, it is currently possible to achieve lower rate of bleeding and infection with high rate of recovery using methods leading to less trauma.

Anahtar Kelimeler : Fixation; fracture; pelvis; posterior; surgery