Reduced Invasive Techniques in Pelvic Ring and Acetabular Fractures

Abstract

Summary: Although reduced invasive techniques are already used in many fields of trauma surgery, there are only a few applications presently available for pelvic and acetabular surgery. This is the result of the irregular anatomy of the pelvic bones and the enclosed organs, vascular and neural structures. During the past 20 years, standardized techniques for reduction and stabilization of pelvic and acetabular fractures have been developed, which has also led to a lower morbidity. However, the tremendous advances in visualization, mainly based on computed tomography (CT) and 3-D CT which made a far better analysis of the fracture pattern possible, could not be transferred directly into surgery. For specific indications, there are also reduced invasive techniques available. Percutaneous sacroiliac screw fixation is done with control by fluoroscope or as modality-based navigation by CT. The lower invasiveness must be weighed against the specific risks with high rates of screw malplacement, especially for beginners, or injury to the adjacent neural roots. However, also controlled by CT, the reduction of displaced fractures remains a problem. For acetabular fractures, the extended Pfannenstiel approach, which is indicated for fractures with involvement of both columns, provides an excellent exposition of the acetabulum from a medial location. This approach is indicated especially for the elderly, because of the frequently central displacement of the femoral head. Also, cerclage wiring of certain acetabular fractures can be used for indirect reduction and sometimes definite stabilization of acetabular fractures. Recent developments in the fields of computer-assisted and robotic surgery made it possible to use this promising technique also in the fields of trauma and orthopaedic surgery. The applications that are used already support certain steps of the operation. Further developments could lead to the use for the complete operation, including visualization and guiding of reduction..