- See: Kocher Langenbock for Acetabular Frx
- Discussion:
- position pt prone, on a radiolucent table;
- vertical incision placed 2 cm lateral to posterosuperior spine;
- mobilize gluteal muscles from their origins on iliac wing & sacrum;
- mobilize piriformis from greater sciatic notch to allow palpation can be performed anteriorly along sacrum and sacroiliac joint;
- reflect posterior portion of gluteus from posterior iliac wing;
- maximus origin is also reflected from sacrum;
- greater sciatic notch must be exposed for assessment of the reduction;
- w/ sacral frx, frx is visualized on posterior sacral lamina;
- place pointed reduction forceps from sacrum to iliac wing for reduction;
- palpation thru greater sciatic notch as well as visualization of the most inferior portion of the SI joint give keys to reduction;
- flouroscopy is needed used to place screws perpendicular to iliac wing across the SI joint into the sacral ala;
- screws are directed toward the S1 vertebral body;
- complications of posterior approach:
- posterior incisions in acute trauma situation have resulted in unacceptably high rate of skin necrosis;
- even w/o posterior incisions, there may be skin breakdown in many pts w/ severe unstable vertical shear injuries;
- at surgery, gluteus maximus muscle is often torn from its insertion leaving no underlying fascia to nourish skin