Anterior plating and percutaneous iliosacral screwing in an unstable pelvic ring injury

Background. This study was carried out to evaluate the effectiveness of anterior plating with subsequent percutaneous iliosacral screwing for the management of unstable pelvic ring injuries. Methods. Nineteen patients with unstable pelvic ring injuries were included in this retrospective study. All patients were followed up for at least 1 year, and their mean age was 43 years. According to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification, there were 5 B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by means of plating, an iliosacral screw fixation was carried out percutaneously using a C-arm fluoroscope. Results. All fractures healed, except for 1 case of nonunion at the pubic ramus. Radiological results showed that there were 9 anatomic, 7 nearly anatomic, 2 moderate, and 1 poor reduction. Sixteen of the 19 patients had good or excellent results for function, and all these had satisfactory (anatomic or nearly anatomic) reductions. The two moderate and 1 poor result were from an unsatisfactory reduction in a type-C injury with residual neurological signs. A screw misplacement with a neurological compromise occurred in 1 patient, but there were no adverse sequelae after its removal. The complications encountered were 2 cases of screw loosening, 2 cases of anterior metal failure, and 1 deep infection. Conclusions. Anterior plating with subsequent percutaneous iliosacral screwing may be a useful method of treatment for unstable pelvic ring injuries, and the reduction quality and residual neurological signs were important in its functional outcome.