SI joint anterior plating surgical Technique and scopeNOA PAS.pptx

Pelvi-acetabulum Trauma and SI joint anterior plating

1. Anterior Plating In Sacroiliac Joint Injury: Scope and Technique Suresh Pandey Professor and Head, Orthopedics College of Medical Sciences, Bharatpur Orthocon 2025 NOA-PAS ICL

2. SI joint injury with floating Iliac wing Orthocon 2025 NOA-PAS ICL

3. 2 yr F/U Orthocon 2025 NOA-PAS ICL

4. Problem Magnitude Unstable Pelvis Fracture on rise Missed SI injury Associated Injury Mortality Morbidity Orthocon 2025 NOA-PAS ICL

5. Pelvis Ring anatomy and Function Orthocon 2025 NOA-PAS ICL

6. SI joint Anatomy … Orthocon 2025 NOA-PAS ICL

7. SI Joint Dislocation Orthocon 2025 NOA-PAS ICL Often with anterior ring injury: Pubic symphysis or rami MOI: APC Lateral compression Vertical translation

8. Why diagnosis and treatment important? Chronic pain Limping Disability LLD Sexual dysfunction Orthocon 2025 NOA-PAS ICL

9. Options Conservative Operative Posterior fixation Anterior fixation Combination Orthocon 2025 NOA-PAS ICL

10. Structures at Risk Orthocon 2025 NOA-PAS ICL

11. Options and guide to decision Orthocon 2025 NOA-PAS ICL

12. Anterior plating vs SI screw: What guides you? Major Concern Adequacy of reduction Stability of fixation Safety corridor and NV bundle Need for anterior approach Operative time and blood loss Radiation exposure Expertise and setup Orthocon 2025 NOA-PAS ICL

13. SI screw Pros Common Minimally invasive Good strength Good outcome Cons Technically demanding Needs experience and proper setup Image interpretation and safe corridor Indirect reduction Excess Radiation exposure Sacral Dysmorphism Orthocon 2025 NOA-PAS ICL

14. What matters more? Reduction quality Adequacy of fixation Avoidance of NV bundle Minimal complications Higher good to excellent results Orthocon 2025 NOA-PAS ICL

15. Anterior Plating Indications Dislocation Fracture dislocation Associated anterior ring injury Crescent Fracture Failed Closed Reduction Lack of setup/experience Orthocon 2025 NOA-PAS ICL

16. Advantage of anterior plating Technically easy Ensure adequate reduction Can address anterior injury of ilium/acetabulum with the same incision Complications and Outcomes comparable Orthocon 2025 NOA-PAS ICL

17. Contraindication Poor soft tissue status Contaminated wound anteriorly Colostomy Surgeon’s preference Orthocon 2025 NOA-PAS ICL

18. Approach Lateral window of IIA Modified Iliofemoral Orthocon 2025 NOA-PAS ICL Lateral window of IIA Modified Iliofemoral

19. Advantages of Modified Iliofemoral over lateral window only Orthocon 2025 NOA-PAS ICL

20. Position, Incision and Exposure Orthocon 2025 NOA-PAS ICL

21. Dissection Orthocon 2025 NOA-PAS ICL

22. Expose joint and Debride Orthocon 2025 NOA-PAS ICL

23. Reduction Techniques Manual Schanz pin Farabeuf clamp Jungbluth clamp Ext fixator Orthocon 2025 NOA-PAS ICL

24. Reduction… APC: Internal rotation LC injury: Distract and Appose the margins Vertical Shear: Traction and rotation Orthocon 2025 NOA-PAS ICL

25. Reduction and Fixation Anterior Reduction followed by posterior reduction and fixation Orthocon 2025 NOA-PAS ICL

26. Bone density and optimum plate position Orthocon 2025 NOA-PAS ICL

27. What types of Plate and length? Recon 3-4 holes Contouring Option of DCP, square locking plates Orthocon 2025 NOA-PAS ICL

28. Tips Plate number 1 followed by 2 Drill holes in the sacrum Put plate and Screw Complete the Ilium Side screws Orthocon 2025 NOA-PAS ICL

29. How medial on sacral ala is safe? Orthocon 2025 NOA-PAS ICL

30. Trajectory 30 deg medial parallel to SI joint Orthocon 2025 NOA-PAS ICL

31. Post operative Protocol Mobilization and sitting early 6 wks toe touch crutch walking Full wt bearing 3 mths Orthocon 2025 NOA-PAS ICL

32. Experience of anterior plating SI joint 32 cases between 2018-2024 No neurological or vascular sequelae No infection No Implant Failure Orthocon 2025 NOA-PAS ICL

33. 24 yr male RTA: APC injury Orthocon 2025 NOA-PAS ICL

34. 29 yr M with Lt SI joint injury: APC Orthocon 2025 NOA-PAS ICL

35. 22 yr M RTA with Lt SI joint injury: LC Orthocon 2025 NOA-PAS ICL

36. Evidence: SI screw vs Plating 202 pt. plating 258 pt. SI screw Orthocon 2025 NOA-PAS ICL

37. Literature: Meta-analysis 1567 patients 7 fixation methods Orthocon 2025 NOA-PAS ICL

38. Biomechanics Comparison SI screw vs Plating Variable results on the superiority of the strength 80% of SI screw but sufficient to hold SI joint and heal it Reduction Quality most important determinant Orthocon 2025 NOA-PAS ICL Orthop . 2016 Jul;40(7):1537-43. doi : 10.1007/s00264-015-3007-0. Epub 2015 Oct 5.

39. Conclusion: Anterior Locking plate showed the highest load to displacement. Orthocon 2025 NOA-PAS ICL

40. Key Takeaways Remember anatomy, and injury characteristics Realize your constraints Ant plating is relatively simple and ensures good reduction Attention to avoid injury to nerve and vascular trunk AP of SI joint is a good choice with comparable results, safety margin, and complications Orthocon 2025 NOA-PAS ICL

41. Orthocon 2025 NOA-PAS ICL