Prone percutaneous Jungbluth for reduction of irreducible posterior pelvic ring injuries: a technical trick.

Unstable pelvic ring injuries represent a challenge due to the complex anatomy. Further, surgical access to the pelvic ring is altered by patient positioning in the supine versus prone position. Certain injury patterns present with the posterior pelvis in a fixed displaced position. These injuries can be exceedingly challenging to reduce from a supine position. In the prone position, these injuries can be reduced more directly with an open approach, but this is associated with wound healing complications. The technical trick herein demonstrated a successful technique utilizing a large Jungbluth clamp percutaneously applied to the posterior superior iliac spines with 4.5-mm cortical screws. This allowed for more direct manipulation of the posterior pelvic ring than supine techniques, while minimizing biologic cost. Described in this report it is particularly efficacious for reducing associated fixed dislocation of the L5/S1 facet when associated with pelvic ring injury. Care must be taken to appreciate the limitations of this technique in reducing certain vectors of displacement, particularly flexion and extension deformities.