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Review
. 2025 Feb;37(1):23-33.
doi: 10.1007/s00064-024-00887-1. Epub 2024 Dec 23.

Minimally invasive screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful

Jocelyn Corbaz  1 , Michiel Herteleer  2 , Sylvan Steinmetz  3 , Charlotte Arand  4 , Tobias Nowak  4 , Daniel Wagner  3
Affiliations
Review

Minimally invasive screw fixation of the anterior pelvic ring and the distal ilium : Tips and tricks to be successful

Jocelyn Corbaz et al. Oper Orthop Traumatol. 2025 Feb.

Abstract
in English, German

Objective: Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding.

Indications: Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques.

Contraindications: Contraindications include infection at the surgical site, anatomical inability to place screws, or patients unfit for surgery due to health risks.

Surgical technique: The technique involves the insertion of ante- and retrograde transpubic screws and lateral compression (LC) II screws in supine position. Precise reduction of fractures is achieved using minimally invasive techniques.

Postoperative management: In younger patients, partial weight bearing for 6 weeks is recommended, with full weight bearing in older patients.

Results: Literature reports a high union rate of up to 95% for these procedures, with low rates of nonunion and infection (around 2%). Screw loosening or loss of reduction occurs in 8-18% of cases, with better outcomes using bicortical screws.

Zusammenfassung: OPERATIONSZIEL: Minimal-invasive perkutane Techniken werden verwendet, um Frakturen des vorderen Beckenrings zu stabilisieren. Dies erleichtert die frühzeitige Mobilisierung und Rehabilitation, indem Komplikationen wie Infektionen und Blutungen reduziert werden.

Indikationen: Diese Techniken sind für Patienten mit nicht oder nur geringfügig dislozierten Frakturen des vorderen Beckenrings indiziert oder wenn die Frakturverschiebung durch minimal-invasive Verfahren reduziert werden kann.

Kontraindikationen: Kontraindikationen umfassen Infektionen an der Operationsstelle, anatomische Unmöglichkeiten zur Schraubenplatzierung oder Patienten, die aufgrund gesundheitlicher Risiken nicht für eine Operation geeignet sind.

Operationstechnik: In diesem Artikel werden die minimal-invasive Anwendung von ante- und retrograden transpubischen Schrauben sowie lateral compression (LC) II Schrauben dargestellt. Minimal-invasive Techniken zur Frakturreduktion werden dargestellt.

Weiterbehandlung: Bei jüngeren Patienten wird eine Teilbelastung für 6 Wochen empfohlen, während bei älteren Patienten eine volle Belastung erlaubt ist.

Ergebnisse: Hohe Konsolidierungsraten von bis zu 95 % werden bei diesen Verfahren beschreiben, mit niedrigen Raten von Pseudarthrosen und Infektionen (etwa 2 %). Schraubenlockerungen oder der Verlust der Frakturreduktion treten in 8–18 % der Fälle auf, wobei bessere Ergebnisse mit bikortikalen Schrauben erzielt werden.

Keywords: Complications; Fragility fractures of the pelvis; Minimally invasive screw osteosynthesis; Pelvic fracture; Pubic ramus.

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Conflict of interest statement

Declarations. Conflict of interest: J. Corbaz, M. Herteleer, S. Steinmetz, C. Arand, T. Nowak and D. Wagner declare that they have no competing interests. For this article, no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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References

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