The pelvic bridge: a subcutaneous approach for anterior pelvic fixation
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An alternative method to external fixation for the treatment of unstable anterior pelvic ring injuries, termed the pelvic bridge technique, provides equivalent results with fewer complications and is performed using occipital cervical rods subcutaneously, with fixation into the iliac wings and parasymphyseal bone. Pelvic ring injuries represent between 0.3% and 6% of all fractures, but are much more common in patients with polytrauma (20%)1. Anterior pelvic external fixation (APEF) is a common method used to stabilize a disrupted pelvic ring, with the proven benefits of reducing morbidity and mortality associated with unstable pelvic fractures. Furthermore, it is often used in the subacute setting to augment stability after posterior reduction and fixation has been applied to the pelvis. Although fixation is technically simple, complication rates for APEF have been reported to range from 10% to 62% and include pin-site infections, fixator loosening, neurologic compromise, and fixator pin impingement on the skin. Additionally, APEF often causes discomfort and immobility for the patient and increases nursing care requirements. These problems may be particularly prevalent in obese patients with polytrauma. We developed an alternative method of stabilizing the anterior aspect of the pelvis that provides equivalent stability, while reducing the complications associated with APEF, using a subcutaneous pelvic bridge technique. As a general principle, the pelvic bridge can be used as a substitute for the APEF. In a stepwise progression, the procedure involves preoperative planning, appropriate patient positioning, making the incisions, bluntly creating a tunnel between the 2 incisions that is parallel and superficial to the inguinal ligament, contouring the plate-rod construct, inserting the construct through the subcutaneous tunnel, reducing the pelvis, and applying pedicle screw fixation into the parasymphyseal bone and screw fixation into the ilium, followed by wound closure.
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