Authors: Dr. Muhammad Nirman Shehzad, Dr. Shahzad Ahmed Mengal, Dr. Nazir Ahmed, Dr. Saoud Javed
ABSTRACT: Percutaneous fixation has become an increasingly important part of modern pelvic and acetabular trauma surgery. The technique offers the potential for stable fixation with less soft-tissue disruption, lower blood loss, and reduced surgical morbidity compared with extensive open approaches. However, percutaneous fixation around the pelvis remains technically demanding. The challenge is not simply to identify safe osseous corridors on CT scan and three-dimensional reconstruction view but translating it into a reliable intraoperative fluoroscopic image.
This narrative review describes the major percutaneous corridors used for pelvic ring and acetabular fixation and focuses on the practical skills required to use them safely. Particular attention is given to preoperative CT planning, reduction, patient positioning, fluoroscopic views, C-arm manipulation, and the often-underappreciated role of the radiographer.
The learning curve for these procedures is partly a learning curve in radiographic anatomy. Surgeons must learn not only about the correct placement of the screws, but also how to recognize the trajectory on fluoroscopy. Equally, radiographers need familiarity with pelvic imaging and the specific views required by the surgeon. This review proposes a practical framework in which pelvic percutaneous fixation is understood as a combination of anatomy, reduction, imaging, and team-based technical execution.
Keywords: pelvic fracture; acetabular fracture; percutaneous fixation; pelvic ring; iliosacral screw; acetabular screw; fluoroscopy; C-arm; radiographer; minimally invasive surgery