the instant invention is a novel method for posterior pelvic stabilization . the method uses internal hardware placed in a minimally invasive fashion . stabilization of pelvic ring injuries is most often indicated when the volume of the pelvis is increased and / or an unstable pattern of injury is present . this stabilization method must be applied in the operating room under sterile conditions with adequate fluoroscopic guidance . it can be utilized in an emergent setting following provisional stabilization in the emergency room with a pelvic binder , sheet or clamp . to aid in the determination of utilizing internal fixation methods , we prefer the tile classification since it is based on the concept of pelvic stability . in the tile classification , type a fractures involve a stable pelvic ring . the partially stable type b lesions , such as “ open - book ” and “ bucket - handle ” fractures , are caused by external and internal rotation forces , respectively . in type c injuries , there is complete disruption of the posterior sacroiliac complex . these unstable fractures are almost always caused by high - energy severe trauma associated with motor vehicle accidents , falls from a height , or crushing injuries . type a and type b fractures make up 70 % to 80 % of all pelvic injuries . internal fixation methods are typically considered for tile b and c type injuries . in many patients with partially stable injury patterns , the presence of significant pain with upright posture can be alleviated with the addition of internal fixation . if adequate reduction cannot be obtained in a closed manner , then more traditional open reduction techniques need to be employed . the patient may be positioned in the supine position on a radiolucent table . the skin may be prepped and draped from above the umbilicus to the proximal thigh . the lower extremity may be prepped into the field as well to facilitate reduction techniques . the posterior instability may be addressed first . the inventive procedure for placement of iliosacral screws and bone plate ( s ) for posterior pelvic instability will be described herein below , but first we need to describe the sacrum and sacroiliac joint in more detail . the sacroiliac joint is a diarthrodial joint that joins the sacrum to the ilium bones of the pelvis . in the sacroiliac joint , the sacral surface has hyaline cartilage that moves against fibrocartilage of the iliac surface . fig2 a depicts the medial aspect of a left ilium . the surface of the ilium and sacrum that form the sacroiliac joint is also known as the auricular surface 4 . the iliosacral screws of the present invention pass from the ilium into the sacrum through this auricular surface 4 . fig2 b depicts the anterior view of a sacrum . the auricular surface 4 is on either side of the sacrum 2 . among other things , the sacerum contains five vertebral bodies , s1 - 55 . the iliosacral screws pass through the ilium , through the auricular surface 4 , and into the s1 vertebral body for the upper screw and the s2 vertebral body for the lower screw . the method and apparatus for the minimally invasive treatment of unstable pelvic ring injuries with internal posterior iliosacral screw ( s ) and bone plate ( s ) will now be described with respect to the figures . fig3 a is a depiction of the posterior of a pelvis having a pelvic ring fracture in which the left ilium 1 has separated from the sacrum 2 and right ilium 1 ′. fig3 b is a depiction of the posterior of a pelvis , wherein the first step of the inventive method has been performed . in the first step , the separated ilium 1 and the remainder of the pelvis are manipulated to bring the auricular surfaces of the separated ilium 1 and the sacrum 2 into alignment . then a cannulation guide wire 5 is inserted into the posterior of the ilium 1 adjacent to the s1 vertebral body and is then passed through the auricular surface and into the s1 vertebral body . the guide wire 5 should be advanced to near the medial area of the s1 vertebral body . fig3 b ′ depicts an anterior view of a horizontal cross section of the pelvis at the end of the first step , where the guide wire 5 has been advanced through the ilium 1 , through the auricular surface 4 ( also known as the sacroiliac joint 3 ), and into the sacrum . fig3 c is a depiction of the posterior of a pelvis , wherein the second step of the inventive method has been performed . in the second step , another cannulation guide wire 5 ′ is inserted into the posterior of the ilium 1 adjacent to the s2 vertebral body and is then passed through the sacroiliac joint , into and through the s2 vertebral body and into the opposite ilium 1 ′. the second guide wire 5 ′ should be advanced through the s2 vertebral body , and if a second plate is to be placed on the opposite ilium 1 ′, the guide wire should be advanced completely through the opposite auricular surface and through the opposite ilium 1 ′. it should be noted that the order of the first and second steps is interchangeable . in practice , in some instances , there may be some advantage to the order in which the cannulation guide wires 5 , 5 ′ are inserted . fig3 d is a depiction of the posterior of a pelvis , wherein the third step of the inventive method has been performed . in the third step a two holed bone plate 6 is slid over the guide wires 5 , 5 ′ and advanced to the surface of the ilium 1 . fig3 d ′ depicts an anterior view of a horizontal cross section of the pelvis at the end of the third step of the inventive method , where the bone plate 6 has been slid over guide wires 5 , 5 ′ and advanced to the surface of the ilium 1 . fig3 e is a depiction of the posterior of a pelvis , wherein the fourth step of the inventive method has been performed . in the fourth step a cannulated screw 7 ( either cancellous or cortical and either fully or partially threaded ) is inserted onto the superior cannulation guide wire 5 , and screwed through the superior opening in the bone plate 6 , through the ilium 1 , the auricular surface and into the s1 vertebral body . preferably , the cannulated screw 7 is long enough to extend from the bone plate 6 , to a medial location within the s1 vertebral body . fig3 e ′ depicts an anterior view of a horizontal cross section of the pelvis at the end of the fourth step of the inventive method , where the cannulated screw 7 has been screwed through the bone plate 6 and into the s1 vertebral body . fig3 f is a depiction of the posterior of a pelvis , wherein the fifth step of the inventive method has been performed . in the fifth step another cannulated screw 8 is inserted onto the inferior cannulation guide wire 5 ′, and screwed through the inferior opening in the bone plate 6 , through the ilium 1 , the auricular surface and the s2 vertebral body . preferably , the cannulated screw 8 is long enough to extend from the bone plate 6 to a position all of the way through the s2 vertebral body and into the opposite ilium 1 ′. again , if a second plate is to be placed on the opposite ilium 1 ′, the cannulated screw 8 should be advanced completely through the opposite ilium 1 ′ and protrude far enough that it may be affixed to the second plate . it should be noted that the order of the fourth and fifth steps is interchangeable . in practice , in some instances , there may be some advantage to the order in which the cannulated screws 7 , 8 are inserted . fig3 g is a depiction of the posterior of a pelvis , wherein the sixth step of the inventive method has been performed . in the sixth step , the cannulation guide wires 5 , 5 ′ are removed leaving the cannulated iliosacral screws 7 , 8 and the bone plate 6 in place to fixate the unstable pelvic ring fracture . fig3 g ′ depicts an anterior view of a horizontal cross section of the pelvis at the end of the sixth step of the inventive method , where the cannulation guide wires 5 , 5 ′ have been removed leaving the iliosacral screws 7 , 8 and the bone plate 6 in place . fig3 h is a depiction of the posterior of a pelvis , wherein optional additional steps have been performed to create a bilateral fixation by adding an additional iliosacral screw 7 ′ and bone plate 6 ′ to the opposite iliosacral joint of the pelvis . that is , a cannulation guide wire is inserted through the other ilium 1 ′, the other auricular surface and into the s1 vertebral body . another bone plate 6 ′ is placed over the cannulation guide wire and then an additional cannulated screw 7 ′ is placed onto the additional cannulation guide wire , and screwed through the superior opening in the bone plate 6 ′, through the ilium 1 ′, the auricular surface and into the s1 vertebral body . preferably , the cannulated screw 7 ′ is long enough to extend from the bone plate 6 ′, to a medial location within into the s1 vertebral body . the inferior opening in the bone plate 6 ′ is affixed to the end of the cannulated screw 8 that protrudes from the opposite ilium 1 ′. this may be accomplished by either : 1 ) threading the protruding end of the cannulated screw 8 into the threads of the second bone plate 6 ′; or , 2 ) by passing the protruding end of the cannulated screw 8 through the inferior opening in the bone plate 6 ′ and threading a nut ( not shown ) onto the protruding end the cannulated screw 8 and tightening the nut against the bone plate 6 ′. fig3 h ′ depicts an anterior view of a horizontal cross section of the pelvis at the end of the optional additional steps of the inventive method . as described above an additional cannulated screw 7 ′ is inserted through the superior opening in an additional bone plate 6 ′, through the opposite ilium 1 ′, the opposite auricular surface 4 ′, and into the s1 vertebral body . fig4 a depicts a cross section of a cannulated screw 7 and specifically shows how a cannulated screw 7 may be inserted onto the cannulation guide wire 5 . fig4 b show a cannulated screw 7 inserted onto a cannulation guide wire 5 . also shown in both figures is the locking head 9 of the screw , because the preferred embodiment is used in a variable - angle locked plating system . fig5 is a depiction of a lateral view of a pelvis ( ilium 1 , sacrum 2 ) having been fixated using the inventive method and apparatus . the cannulated screws 7 , 8 pass through the auricular surface 4 , holding ilium 1 and sacrum 2 together . the bone plate 6 gives the fixation construct additional strength by resisting the possibility of pulling the cannulated screws 7 , 8 through the ilium 1 , 1 ′ when the pelvis is weight bearing . further , one can see the cannulation openings 7 ″, 8 ″ in the cannulated screws 7 , 8 . fig6 a and 6b are depictions of different views of a type bone plating system , a variable - angle locked plating system , useful in the present invention . while other bone plating systems may be used , the variable - angle locked plating system is preferred in that this type of system allows for conformity of the bone plate 6 , 6 ′ with the ilium 1 , 1 ′, while allowing the cannulated screws 7 , 7 ′, and 8 to be inserted into the ilium / sacrum at the needed proper angle . the screws and plates of the present invention are formed from sturdy bio - compatible materials , preferably titanium . the screws may be between 7 . 0 - 8 . 5 mm in outer diameter ( o . d . ), inclusive , and the cannulation guide wires may be 3 mm o . d . after stabilizing the posterior elements via the iliosacral screws and bone plate ( s ) method / construct of the present invention , the anterior pelvis may be addressed . preferably the anterior fixation methods / apparatuses are those disclosed in u . s . pat . nos . 8 , 900 , 278 ; 8 , 814 , 866 ; 8 , 398 , 635 ; and 8 , 177 , 785 , the disclosures of which are herein incorporated by reference . it is to be expected that considerable variations may be made in the embodiments disclosed herein without departing from the spirit and scope of this invention . accordingly , the significant improvements offered by this invention are to be limited only by the scope of the following claims .
the instant invention is a novel method for stabilization of the posterior pelvis when treating an unstable pelvic ring fracture . cannulated screws are inserted through the posterior of the ilium through the sacroiliac joint and into the sacrum . the screws are used to affix the iliosacral joint while it heals . the screws are used in conjunction with a bone plate to provide the construct / fixation with added strength and stability compared to iliosacral fixation using screws alone .