Percutaneous Anterior Internal Pelvic Fixator

Percutaneous anterior stabilization of pelvic ring instability may be useful if closed reduction and stability can be achieved. The first clinical results are promising showing sufficient anterior stabilization, where the soft tissue is spared. In this report we describe the indication and technique for the percutaneous anterior internal pelvic fixator and discuss advantages and disadvantages in context of the current literature. After posterior stability is restored by the standard techniques (eg iliosacral screw placement or posterior plating), the patient is prepared in supine position with the lower limbs included to facilitate reduction. An oblique incision of 3 cm beneath the anterior superior iliac spine bilaterally is made. Blunt dissection of the soft tissue, including the fascia, is followed by the use of a Jamshidi needle to establish the corridor in the ilium. A C-arm and wire-guided implantation of the cannulated pedicle screw is followed by subcutaneous placement of a contoured connecting rod above the abdominal muscle fascia. The described technique facilitates a definitive anterior fixation of vertically and rotationally unstable pelvic ring fractures. Sufficient posterior stability or fixation has to be assumed. Implant removal is required in a second operation. To our opinion, this technique has several advantages, but as an elective surgical approach is not applicable in hemodynamically unstable patients.