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Pelvic Ring Injury ORIF

sacral fracture xray

sacral fracture ct scan

synonyms:

ORIF Pelvic Ring CPT

ORIF Pelvic Ring Indications

  • Unstable pelvic ring injuries (SI joint dislocations, sacral fractures, etc)

ORIF Pelvic Ring Contraindications

  • Dysmorphism of the upper sacrum precludes iliosacral screws.
  • Obesity (iliosacral screw placement)
  • Soft tissue injury
  • Patients with abdominal / urologic contrast agents on board.

ORIF Pelvic Ring Alternatives

  • Nonoperative management, skeletal traction

ORIF Pelvic Ring Planning / Case Card

  • High-quality fluoro images of the entire pelvis must be varified before starting the surgery.
  • Distal femoral traction improves reduction.
  • At least 1cm must be available between the foramina on three sequential preop CT slices (cmm slices( for safe S2 sacral screw placement. (Moed BR, JOT 2006;20:378).

ORIF Pelvic Ring Technique

  • prone OSI table
  • vertical incision 1-2cm lateral to PSIS, from iliac crest to greater sciatic notch
  • reflect gluteus maximus to reveal greater sciatic notch, PIIS,inferior sacroiliac joint, piriformis(origin=lateral mass of sacrum)
  • sacrotuberous ligament, erector spinae, multifidus muscle,
  • allows visualization of ilium, sacroiliac joint, posterior sacrum
  • stronqest fixation seems to be iliosacral screws. 6.5-7mm cancellous screw into S1 body. Starting point on ilium is alonq a line running from iliac crest to greater sciatic notch @15mm anterior to and paralleling the crista glutea. 2 screws preferred. Optimal distance from crista glutea is 15-20mm. Risks=sacral nerve root, vessels, dura
  • sacroiliac joint dislocations must undergo reduction and fixation because they are a ligamentous injury and very unlikely to heal without fixation
  • Pelvic orthotic devices / binders can remain in place for up to 190 hours without causing soft tissue compromise (Krieg JC, J Trauma 2005;59(3):659-664).

ORIF Pelvic Ring Complications

  • Infection
  • Poor wound healing
  • Chronic Osteomyelitis
  • Pain
  • Painful hardware
  • Loss of reduction
  • Nonuion
  • Limb length discrepancy
  • Sitting imbalance
  • Gait disturbance
  • DVT / PE

ORIF Pelvic Ring Follow-up care

  • Post-op: 24hrs antibiotic, SCDs, Ted hose, Partial weight bearing. Review reduction on post op A/P pelvis, inlet and outletviews.
  • 7-10 Days: Wound check. Continue partial/non weight bearing
  • 6 Weeks: Advance weight bearing gradually. Review A/P pelvis, inlet and outletviews.
  • 3 Months: Review A/P pelvis, inlet and outletviews.
  • 6 Months: Return to labor. Review reduction on post op A/P pelvis, inlet and outletviews. Obtain follow-up CT scan.
  • 1Yr:Assess outcome. Review A/P pelvis, inlet and outlet views.

ORIF Pelvic Ring Outcomes

  • NO intraoperative nerve damage, 4% loss of reduction for S2 iliosacral screws(Moed BR, JOT 2006;20:378).
  • Good outcome studies are lacking. Outcomes are dependent on initial displacement, neurologic injury, urologic injury and adequacy of reduction.

ORIF Pelvic Ring Review References

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer