Objective: To evaluate the clinical feasibility and safety of percutaneous screw fixation in the management of vertically unstable pelvic fractures.
Methods: Forty S1 CT films of orthopedic patients aged 18 - 73, were analyzed so as to provide the best screw entrance point and angle for screw entrance. The data thus obtained were used on 14 patients with unequivocally vertical unstable pelvic fractures, 11 cases being of Tile C(1) type, 2 of C(2) type, and 1 of C type, 9 males and 5 females, aged 19 to 68. All the patients received heavy traction to reduce displacement before the surgery. Percutaneous pelvic screw fixation of the disrupted pelvic ring was performed when the patients were in the supine position, and then fixation of sacroiliac joint was performed when the patients were in the prone position.
Results: S1 CT scanning showed an average distance from the standard screw entrance point to the backbone of 10.78 cm (9.80 - 12.00 cm), and a standard screw entrance angle of 61.24 degrees (52.18 - 68.20 degrees). Anatomic reduction was achieved in all 14 patients. One patient had neurological deficit due to the screw penetrating into 1/2 of the intervertebral foramen, but the side-effect was released when the screw was removed 21 days after operation. A 6-24 months postoperative follow-up revealed that all the patients had recovered from fracture and resumed their previous work.
Conclusion: With advantages including simple procedures, better bony stability, minimal invasion of compromised soft tissue and limited blood loss, percutaneous screw fixation is a practical technique which can be widely used to treat vertical unstable pelvic fracture.