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Re: APC III pelvis advice
послал Jeff Richmond 27 Сентябрь 2006, 08:31
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One piece of advice-
I wouldn't "fix" the symphysis first- sometimes if the rotation is off you may have trouble anatomically reducing the remaineder. In this extra-articular fracture, it may not be so critical but don't make things harder than they are. I'd expose and clamp the symphysis as temporary fixation, leaving you the easy freedom to release the symphysis to move the anterior segment if need be.
Also- Adam's perc results are gorgeous (I've seen the pictures) but are very difficult to achieve and you need an awesome fluoro tech. You may be able to expose just the iliac fossa and anatomically reduce the wing and fix with
lag screws/plates at the level of the crest, and then what Adam would call the "LC-II screw"- a screw from the region of the AIIS into the posterior crest where you would put a supra-acetabular ex-fix....not a particularly
hard screw to shoot percutaneously-alternate between an obturator oblique to get the starting point and an iliac oblique to stay just above the
acetabulum.
Good Luck
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