3D-BV-adjustierte perkutane trianguläre Stabilisierung der geriatrischen Beckenringfraktur

Matthias Spalteholz, Jens Gulow

The 3D image enhancer-adjusted percutaneous triangular stabilization of geriatric pelvic ring fractures avoids implant-associated perioperative complications. Displaced fractures of the posterior pelvic ring require stable instrumentation to enable solid bony fusion in a balanced alignment and to control the risk of neurological and vascular damage. This is mandatory in high-energy injuries in young patients and especially in low-energy injuries of geriatric patients. Various surgical techniques have been established. The triangular stabilization technique shows the best biomechanical results. The percutaneous instrumentation reduces access-related morbidity and provides all the benefits of minimally invasive surgery. In order to avoid implant-associated complications, such as vascular and nerve injuries, anatomical and radiological principles are indispensable. The use of 3D image enhancement ensures a safe instrumentation. Nevertheless, pitfalls have to be considered. This article presents the technique of percutaneous triangular stabilization using the 3D scan. After percutaneous insertion of the guide wires into the L4 vertebral body, the iliac bone and transiliosacrally under 2D X‑ray control, the correct wire position is verified by the 3D scan. Then, screws are inserted and the instrumentation is completed in a standard fashion. Using this technique implant-associated perioperative complications, such as nerve and vascular damage due to screw misplacement can be reduced.