Minimally invasive screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful.

Abstract

Objective: Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding.

Indications: Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques.

Contraindications: Contraindications include infection at the surgical site, anatomical inability to place screws, or patients unfit for surgery due to health risks.

Surgical technique: The technique involves the insertion of ante- and retrograde transpubic screws and lateral compression (LC) II screws in supine position. Precise reduction of fractures is achieved using minimally invasive techniques.

Postoperative management: In younger patients, partial weight bearing for 6 weeks is recommended, with full weight bearing in older patients.

Results: Literature reports a high union rate of up to 95% for these procedures, with low rates of nonunion and infection (around 2%). Screw loosening or loss of reduction occurs in 8-18% of cases, with better outcomes using bicortical screws.