From the Research
The surgical procedure for a right-sided iliac fracture with SI joint involvement using plate fixation begins with patient positioning in the supine or lateral decubitus position under general anesthesia, as this approach has been shown to be effective in restoring pelvic stability and alignment, allowing for early mobilization while preventing long-term complications such as malunion, chronic pain, and post-traumatic arthritis 1.
Preoperative Planning
The procedure involves careful preoperative planning, including imaging studies to assess the extent of the fracture and SI joint disruption. The surgeon must consider the patient's overall health, medical history, and potential risks and benefits of the procedure.
Operative Technique
After sterile preparation and draping, the surgeon makes an incision along the iliac crest, extending from the anterior superior iliac spine posteriorly as needed for adequate exposure. The surgeon carefully dissects through subcutaneous tissue and splits the gluteal muscles to expose the fracture site and SI joint. Reduction of the fracture is performed using reduction clamps and temporary K-wires to restore anatomical alignment, with intraoperative fluoroscopy confirming proper reduction. For the iliac wing fracture, reconstruction plates (3.5mm) are contoured to match the pelvic anatomy and secured with screws. The SI joint disruption is addressed by placing an anterior SI plate across the joint after reduction, with screws inserted into the sacrum and ilium. In cases of posterior SI instability, percutaneous iliosacral screws may be added, as supported by studies such as 2 and 3.
Key Considerations
- The placement of anterior plates and screws requires careful consideration of the surrounding anatomy, including the lumbar nerves, to avoid iatrogenic injury, as highlighted in 4.
- The use of two anterior plates, one on the superior one third part of the joint and the other in the middle one third part of the joint, with medial exposure limited to 2.5 cm and 1.5 cm, respectively, can help minimize the risk of nerve damage.
- The screws in the sacrum should be inclined medially about 30°, directing to the true pelvis, to ensure proper fixation and avoid complications.
Postoperative Care
Postoperatively, the patient typically remains non-weight bearing or touch-down weight bearing on the affected side for 6-12 weeks, with gradual progression based on radiographic healing. This approach allows for early mobilization while preventing long-term complications such as malunion, chronic pain, and post-traumatic arthritis, as supported by studies such as 1 and 5.