“Iliosacral bridging” - A new alternative minimal invasive fixation of unstable pelvic ring fractures

Abstract

Introduction: Fractures of both the anterior and posterior pelvic ring are common injuries in polytrauma and the elderly that extend beyond those of simple low-impact trauma. While conventional X-rays predominantly show the ventral aspect of the injury, computed tomography often detect additional fractures of the sacrum. A large number of these fractures are B-injuries by AO, mainly compression fractures at an advanced age. In addition, the prevalence of pelvic insuffi ciency fractures caused by osteoporosis rather than subsequent to an obvious trauma is increasing, with such an injury often associated with pain that impairs mobilization. The standard sacroiliac screw fi xation is often characterized by loosening and thus failure of the osteosynthesis especially in osteoporotic bone of elderly patients. Method: A new alternative surgical minimal invasive technique, the "iliosacral bridging", stabilizes the fractures of the sacrum with an internal fi xation from S1 pedicle of the uninjured side to the ilium on the affected side. The combination of this internal fi xation with the standard single sacroiliac screw on the injured side allows an immediate full weight bearing and pain free mobilization. We present a case series of 8 patients. Results: The clinical and radiological analysis analogous to the pelvic-outcome-score brought forward that 2 patients showed an excellent and 2 patient a good result. The other 4 patients achieved suffi cient results. Conclusions: The "iliosacral bridging" we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries.