Posterior Surgical Approach for Pelvic Frx

- See: Kocher Langenbock for Acetabular Frx

- Discussion:
    - position pt prone, on a radiolucent table;
    - vertical incision placed 2 cm lateral to posterosuperior spine;
    - mobilize gluteal muscles from their origins on iliac wing & sacrum;
    - mobilize piriformis from greater sciatic notch to allow palpation can be performed anteriorly along sacrum and sacroiliac joint;
         - reflect posterior portion of gluteus from posterior iliac wing;
         - maximus origin is also reflected from sacrum;
    - greater sciatic notch must be exposed for assessment of the reduction;
    - w/ sacral frx, frx is visualized on posterior sacral lamina;
    - place pointed reduction forceps from sacrum to iliac wing for reduction;
    - palpation thru greater sciatic notch as well as visualization of the most inferior portion of the SI joint give keys to reduction;
    - flouroscopy is needed used to place screws perpendicular to iliac wing across the SI joint into the sacral ala;
         - screws are directed toward the S1 vertebral body;
    - complications of posterior approach:
         - posterior incisions in acute trauma situation have resulted in unacceptably high rate of skin necrosis;
         - even w/o posterior incisions, there may be skin breakdown in many pts w/ severe unstable vertical shear injuries;
         - at surgery, gluteus maximus muscle is often torn from its insertion leaving no underlying fascia to nourish skin

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 13, 2012 1:10 pm