[Minimally invasive fixation of the pelvic ring with a transiliacal internal fixator].

PURPOSE OF THE STUDY

To evaluate the results of stabilisation of the posterior pelvic segment with a transiliacal internal fixator (TIFI) in type C fractures of the pelvis.

MATERIAL AND METHODS

Between 2008 and 2011, the TIFI method was used in 27 patients with unstable type C pelvic ring fractures (AO classification) at our department. The patient group included 15 men and 12 women with an average age of 35 years (range, 15 to 65 years). All patients suffered high-energy trauma in traffic accidents (59.3%), by falls from a height (33.3%) or due to other causes (7.4%). In 40.7% of the patients, pelvic injury was part of polytrauma. Fixation was carried out using two polyaxial screws and the rod of a spinal instrumentation Legacy® or Colorado®. The method was employed for unilateral SI joint dislocation in five cases, and for unilateral sacral fractures of Pohlemann type I in six cases, Pohlemann type II in 13 cases and Pohlemann type III in three cases. The patients were mobilised, with associated injuries taken into consideration, at 5 post-operative weeks on the average. They were followed up at 6-week intervals until healing of fracture, then at one year after surgery and every 12 months thereafter. RESULTS All 27 patients achieved bone union within 6 months. The average operative time was 29 min (21 to 45 min). The average hospital stay was 22 days (11 to 66 days). The average duration of bed rest was 36 days (14 to 71 days). Complications included bronchopneumonia in two patients, and a redislocation with displacement of the posterior segment up to 10 mm in one patient.

DISCUSSION

Transiliacal internal fixation is a minimally invasive method used to treat unstable pelvic ring fractures. Compared to other types of fixation, it carries a low risk of injury to nerve and vascular structures as well as a low risk of infectious complications, is associated with low blood loss and is easy to perform. The TIFI provides stability comparable with the use of two iliosacral screws, without the risk of excessive compression even in comminuted transforaminal fractures of the sacrum. However, the need to operate on patients lying in the prone position is a disadvantage because, in polytraumatised patients, it makes implantation at the acute phase impossible.

CONCLUSIONS

The TIFI technique is one of the options for fixation of posterior pelvic segment fractures. A short operative time and minimum complications are undeniable advantages. Indications should be carefully considered in each patient. TIFI is a minimally invasive method for anterior pelvic segment fixation that can also be used in the acute stage of injury.