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Minimally Invasive Percutaneous Spinopelvic Fixation for Unstable Pelvic Ring Fracture Performed With the Patient in a Lateral Position

Tsuji, Hironori, MD*; Takigawa, Tomoyuki, MD, PhD; Misawa, Haruo, MD, PhD; Shiozaki, Yasuyuki, MD, PhD; Yamakawa, Yasuaki, MD, PhD; Noda, Tomoyuki, MD, PhD§; Ozaki, Toshifumi, MD, PhD*

doi: 10.1097/BSD.0000000000000798
SURGICAL TECHNIQUE
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Spinopelvic fixation provides a strong fixation for unstable pelvic ring fractures. However, the technique is usually performed with the patient in the prone position, with the applied weight on the anterior superior iliac crests aggravating fracture displacement. We developed a novel approach for minimally invasive percutaneous spinopelvic fixation that is performed with the patient in a lateral (side lying) position. We describe the application of our technique for the treatment of a bilateral pelvic ring and acetabulum fracture in a 79-year-old woman injured in a traffic accident. Initial posterior fixation was performed with the patient in the left-side lying position, using bilateral pedicle screws at L3 and L4 and a left sacral-alar iliac screw and 2 right iliac screws inserted under navigation. The lateral and cranial displacement of the right pelvic ring was reduced percutaneously. One week after this initial surgery, we proceeded with an open anterior reduction and internal fixation of the left pelvic ring and acetabulum fracture. The postoperative course was uneventful and clinical outcomes were satisfactory. Reduction of a pelvic ring fracture in a lateral position, with subsequent spinopelvic fixation, is a reasonable option for the treatment of an unstable pelvic ring fracture.

*Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

Department of Orthopaedic Surgery, Okayama University Hospital

Departments of Emergency Healthcare and Disaster Medicine

§Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

The authors declare no conflict of interest.

Reprints: Tomoyuki Takigawa, MD, PhD, Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan (e-mail: takigawa2004@yahoo.co.jp).

Received March 28, 2018

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.