Percutaneous computed tomography-guided stabilization of posterior pelvic fractures

Nineteen patients with 21 unstable fractures of the posterior pelvic complex were treated with percutaneous computed tomography (CT)-guided posterior stabilization. CT allowed satisfactory visualization of the fracture and direction and length of the screw. It also allowed the authors to perform the procedure percutaneously, while causing only minimal blood loss. CT cuts that showed the best and safest sites for screw placement were selected. The length and direction of the screw was identified, and the skin entry site was determined. The guide pin was inserted across the fracture or disrupted sacroiliac joint; its correct position was confirmed and a cannulated screw was inserted over the pin. In the majority of patients, a pelvic external fixator was applied in the CT suite. Although assessing the deformity was possible, reduction was difficult but ultimately acceptable. All patients maintained reduction of their sacroiliac complex without loss of fixation, and all fractures healed without clinical or radiographic signs of pelvic instability. This technique was not associated with neurologic injury or deep infection. All but 2 patients returned to preinjury levels of activity and function. Two patients had associated injuries that affected their final functional outcome.