Minimally invasive spinopelvic “crab-shaped fixation” for unstable pelvic ring fractures: technical note and 16 case series

Abstract

Background Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes. Methods Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed. Results The average surgical time was 158 min (range, 117–230 min), with an intraoperative bleeding volume of 299 ml (range, 80–480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4–9.0 mm), to < 10 cm. Correction was retained in all cases. Conclusions Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.

A Novel Minimally Invasive Surgical Technique for Fragility Fractures of the Pelvis with Iliac Screws via Two Small Incisions

“…Toda et al reported a mean surgical time of 129 minutes with an intraoperative blood loss of 223 ml for posterior pelvic-ring stabilization in unstable pelvic ring fractures using the transiliac rod and screw xation technique 7 . Similar results were reported by Okuda et al (158 minutes and 299 ml using the crab-shaped xation technique) 8 . These surgical techniques are less invasive than conventional ORIF but are still highly invasive for frail patients.…”

Treatment of unstable pelvic ring injury with a dual internal anterior subcutaneous fixator using spinal instrumentation called “dual INFIX”: A Case Report

“…Posterior fixation of unstable pelvic ring injuries using spinal instrumentation brings good reduction and strong stability [ 7 , 8 ]. Recently, minimally invasive posterior fixations of unstable pelvic ring injuries using spinal instrumentation have been reported and show good clinical results [ 9 , 10 ]. Because these techniques require screw insertion into the ilium, cases of pelvic ring injury with iliac fracture cannot be treated using these methods.…”

Biomechanical Tests and Finite Element Analyses of Pelvic Stability using Bilateral Single Iliac Screw with Different Channels in Lumbo-iliac Fixation

“…Ebata et al [20] applied spinal-pelvic xation system in adult spinal deformity correction and achieved satisfactory results. Futamura et al [21], Koshimune et al [22], Okuda et al [23] used small incision minimally invasive lumbo-iliac xation to reduce the risk of skin and soft tissue injury and infection, and improve the healing rate of fracture. Song et al [24] compared the biomechanical characteristics between bilateral and unilateral lumbo-iliac xation in unilateral comminuted sacral fractures by nite element analysis and the results revealed that the stability of unilateral lumbo-iliac xation is insu cient to reconstruct the posterior pelvic ring.…”