The Pelvic Bridge: A Subcutaneous Approach for Anterior Pelvic Fixation.

Introduction: An alternative method to external fixation for the treatment of unstable anterior pelvic ring injuries, termed the pelvic bridge technique, provides equivalent results with fewer complications and is performed using occipital cervical rods subcutaneously, with fixation into the iliac wings and parasymphyseal bone.

Step 1 Preoperative Planning: For preoperative planning, review the appropriate imaging, including radiographs and computed tomography (CT) scans, to mesh the findings on imaging to the clinical picture of the patient and ensure that the patient meets operative criteria and that none of the contraindications are present.

Step 2 Patient Positioning: Position the patient to facilitate anterior and posterior fixation.

Step 3 Approach: Make the incisions necessary to expose the osseous contour where fixation will be utilized.

Step 4 Contouring The Plate-rod Construct: Carefully contour the plate-rod construct, which is necessary to minimize postoperative complications.

Step 5 Passing The Plate-rod Construct: Use care when inserting the rod as doing so will help to avoid neurovascular complications.

Step 6 Achieving Adequate Reduction: To recreate pelvic stability, the pelvic ring needs to heal in as close to anatomic position as possible and there are multiple methods that help to obtain an adequate reduction.

Step 7 Fracture Fixation: Multiple constructs may be used to stabilize the anterior pelvic ring, but the fundamental principle is to attach the 2 hemipelves to achieve stability, and the location where fixation can be achieved depends on the fracture pattern.

Step 8 Wound Closure: Ensure meticulous closure to reduce the chance of infection and achieve appropriate soft-tissue coverage over hardware.

Step 9 Rehabilitation: Early mobilization is a fundamental goal of this procedure, but the time to full weight-bearing is dependent on fracture characteristics and healing.

Results: Anterior pelvic internal fixation (APIF) using the pelvic bridge technique has been demonstrated to have significantly fewer complications than APEF.