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[Unilateral triangular lumbopelvic stabilization: indications and techniques].

M F Hoffmann1, M Dudda, T A Schildhauer

  • 1Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland, martinfhoffmann@gmx.de.

Der Unfallchirurg
|November 16, 2013
PubMed
Summary

Triangular lumbopelvic fixation stabilizes unstable sacral fractures, reducing load on the sacrum and SI joint. This technique enables early weight-bearing, minimizing immobilization and complications associated with prominent implants.

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Area of Science:

  • Orthopedic surgery
  • Trauma surgery
  • Spinal surgery

Context:

  • Unstable sacral fractures, particularly those involving the S1 facet joint (Isler 2 and 3), can cause multidirectional instability.
  • Operative fixation is the preferred treatment, but osteosynthesis may lead to a loss of reduction in up to 15% of cases.

Purpose:

  • To describe the technique and benefits of triangular lumbopelvic fixation for stabilizing multidirectional instability of the posterior pelvic ring and lumbopelvic junction.
  • To highlight how this fixation method reduces stress on the sacrum and SI joint, allowing for early mobilization.

Summary:

  • Triangular lumbopelvic fixation integrates vertical fixation (lumbar pedicle to ilium) with horizontal fixation (iliosacral screw or transiliacal plate).
  • The iliac screw placement, from PSIS to AIIS, redirects axial loads from the lumbar spine to the ilium, bypassing the sacrum.

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  • This method facilitates early full weight-bearing, thereby reducing the need for prolonged immobilization.

    • Impact:

    • Early mobilization and reduced immobilization can lead to better patient outcomes and faster recovery.
    • Careful surgical planning and technique are crucial to minimize complications such as wound infections and implant-related irritation.
    • Recessing screw heads into the PSIS can significantly reduce hardware prominence and associated pain.