Percutaneous fixation of unstable pelvic ring disruption under CT guidance

CT-guided percutaneous osteosynthesis of posterior disruption of an unstable pelvic ring is an alternative to the fluoroscopically guided procedure or to open reduction and internal fixation (ORIF), which is the technique of choice for unstable pelvic fracture with disruption of the sacroiliac joint or fracture of the sacral wing. However, ORIF has a high rate of morbidity and mortality, and the CT-guided procedure involves less blood loss and has a lower rate of infectious and postoperative complications. CT guidance of the percutaneous technique also has significant advantages over fluoroscopic guidance. The critical point is the placement of the guidewire inside the sacral body through the external surface of the iliac wing and of the fracture line or sacroiliac diastasis. We describe and illustrate the procedure through three cases, two sacroiliac articular disruptions and a fracture of the sacral wing.