External Fixation for SI-Joint Fractures: A Step-by-Step Guide

Pelvic ring fractures can be a serious injury that can affect an individual's mobility and quality of life. The Sacroiliac (SI) joint, which is located at the back of the pelvis, can be particularly vulnerable to injury due to its crucial role in supporting the weight of the upper body. A common treatment for SI-joint fractures is through external fixation. In this blog, we will provide a detailed step-by-step guide on external fixation for SI-joint fractures.

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Step 1: Preoperative Planning

Before the surgery, the physician should conduct a thorough physical examination and obtain imaging studies such as X-rays, CT scans, or MRI. CT scans and MRI are particularly helpful in the identification of the extent of the fracture and the displacement of the bone fragments. Based on the findings, the physician will determine the ideal size and position of the external fixator.

Step 2: Anesthesia and Positioning

The patient is placed under general anesthesia or regional anesthesia depending on the preference of the surgeon. The patient is placed in a lateral position with the fractured side facing upwards. The leg on the side of the injury is placed in a foam pad or a traction boot. The opposite leg is placed over the other leg.

Step 3: Marking the Incisions

The surgeon makes two small incisions on either side of the sacrum. One incision is made at the level of the posterior superior iliac spine (PSIS), and the other is made just below the iliac crest. The surgeon marks the sites where the pins will be inserted.

Step 4: Placement of the Pins

The surgeon drills a hole into the bone using a special drill and then inserts a pin into the hole. The pins are inserted into the ilium bone (the upper part of the pelvis) and the sacrum (the triangular bone at the base of the spine). The pins are held together by a connecting rod that is adjusted to the ideal length and curvature.

Step 5: Application of the Frame

Once the pins and connecting rod are in place, the surgeon applies the frame. The frame consists of two metal rings connected by four struts. The rings encircle the pelvis, while the struts bridge the gap between the two rings. The struts are then tightened to compress the fracture and stabilize the SI-joint.

Step 6: Closure of the Incisions

After the frame is applied, the surgeon closes the incisions using sutures or staples.