Percutaneous transiliac pelvic fracture fixation: cadaver feasibility study and preliminary clinical results

Insertion of iliosacral lag screws into the S1 vertebral body has been well described in the literature. In situations in which the patient's S1 body morphology precludes the safe use of iliosacral screws, alternative implants have been suggested. The purpose of this study was to evaluate the feasibility of percutaneous transiliac pelvic fracture fixation as a treatment alternative.

First, three human cadaver torsos were examined to define the fluoroscopic anatomic parameters of the posterior iliac wing. Landmarks were identified to localize the potential initial implant insertion point for safe percutaneous placement of implants posterior to the spinal canal at the level of the posterior superior iliac spine. Next, a series of 10 clinical cases was used for an initial evaluation of a technique based on these findings, employing a cannulated, self-locking, transiliac screw. The pelvic injuries were type C in nine patients (OTA 61-C1 in seven, 61-C2 in one, and 61-C3 in one) and type B (OTA 61-B2) in one.

Anatomic dissection of the cadavers with direct measurements and fluoroscopic imaging indicated that a percutaneous technique was feasible for transiliac pelvic fixation. The initial clinical series provided support for the described technique as determined from the cadaver-derived data. In these 10 cases, there were no untoward intraoperative events. Follow-up to union (minimum, 5 months) revealed no hardware failures.

Percutaneous transiliac pelvic fixation is a feasible technique that may be considered by the pelvic surgeon pending further clinical study.