Emergency pelvic stabilization in critically unstable patients

Immediate posterior pelvic ring stabilization is the prerequisite for pelvic packing. In patients "in extremis", often no adequate positioning or imaging is available. Percutaneous application of a stabilizing K-wire or even a screw at the posterior pelvic ring can give adequate stability without an increased risk damage to surrounding structures, when respecting classical landmarks. In 10 human adult whole-body cadavers, a percutaneous application of a 2.8 mm K-wire was performed without image intensification. Only after insertion, standard a.p., inlet, and outlet imaging was performed to confirm wire positioning. The classical entry point for iliosacral screw fixation was used. An Arcadis© Orbic 3D C-arm (SIEMENS, Solothurn, Switzerland) was used for final control. In 16 of 20 hemipelves (80%), in all three standard radiographic planes, the K-wire was in the expected anatomic position. Malposition was observed as usually too anterior positioning of the wire in relation to the sacrum. Using standard landmarks, percutaneous application of K-wires into the posterior pelvic ring without intraoperative imaging was found to be feasible and resulted in few mal-placements as confirmed by post-insertion radiographs. The complication rate is comparable to mal-placement of pelvic C-clamp pins. This technique is feasible in patients in extremis.