Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results

Lumbopelvic distraction stabilization with (triangular osteosynthesis) or without additional iliosacral screw allows anatomic reduction of the posterior pelvic ring after severely displaced sacral fractures, correction or resection osteotomies of malunions, respectively, septic sacroiliitis and permits early weight bearing. However, this technique is complicated by wound necrosis or infection in up to 20% to 30%. We describe our experience with a less invasive technique.

The presented technique was performed in a consecutive series (December 2006 to October 2009) of 10 patients (mean age: 47 years, 23-85 years; 5 men). Posterior pelvic ring instability was due to severely displaced vertical shear injuries of type C1/3.3 (6/10), delayed union 2 months after bilateral C 3.3 (1/10) fractures, and malunion 6 months after unilateral vertical shear injuries C 1.3 (1/10), occurred after resection of the iliosacral joint for treatment of spinal tuberculosis (1/10) or was related to a early loss of reduction of a type C 1.3 pelvic ring injury (1/10). Patients were prospectively evaluated for the occurrence of wound-healing disorders with a median follow-up of 9 months (range, 5-33).

The median duration of the hospital stay was 35 days (range, 16-57). One 85-year-old patient died 1 year after lumbopelvic stabilization for reasons unrelated to the surgical treatment. In the postoperative course, no wound-healing disorders or infections were observed, and in all cases, the soft tissues and the bone healed. Five of 10 removal of the lumbopelvic fixation was performed at a median of 8 months (range, 8-20) after stabilization to prevent sacroiliac arthrodesis or to mobilize the lumbar spine after the unilateral lumbopelvic stabilization. The indication for hardware removal was not related to wound disorders.

The presented technique respects the lumbar anatomy and provides the access required for lumbopelvic stabilization, while having the potential to decrease or even prevent postoperative wound disorders if combined with a polyaxial low-profile system. The low number of cases presented may, however, limit the relevance of the conclusions in cases of severe Morell-Lavallé lesions with skin disorders.