Posterior Approach to Sacroiliac Joint
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The posterior approach to sacroiliac joint is a simple, safe approach that does not endanger any vital structures.
- Posterior Approach to Sacroiliac Joint uses include:
- Open reduction and internal fixation of disruptions of the sacroiliac joint.
- Open reduction and internal fixation of fractures of the ilium near the joint.
- Treatment of infections of the sacroiliac joint or surrounding bones.
- Open reduction and internal fixation of disruptions of the sacroiliac joint.
- The popularity of this approach has decreased with the increasing use of percutaneous screw fixation techniques.
- Place the patient prone on the operating table.
- Landmarks:
- Posterior iliac crest.
- Posterior superior iliac spine.
- Incision:
- Make a curved incision overlying the posterior iliac crest, beginning 3 cm distal and lateral to the posterior superior iliac spine.
- Extend the incision from this spot to the posterior superior iliac spine and then continue along the crest to its highest point.
- There is No internervous plane for Posterior Approach to Sacroiliac Joint.
- Divide the subcutaneous tissues in line with the skin incision.
- Cut down into the outer border of the subcutaneous surface of the iliac crest to reveal the layer of fascia that covers the gluteus maximus muscle.
- Detach the origin of the gluteus maximus from the crest and carefully reflect the muscle downward and laterally.
- As the gluteus maximus muscle is reflected, the gluteus medius and piriformis muscles will be uncovered as they emerge through the greater sciatic notch.
- Gently elevate the gluteus medius muscle from the outer wing of the ilium.
- The muscle cannot be elevated much anteriorly because its deep surface is tethered by its neurovascular bundle , the superior gluteal nerves and vessels.
- In cases of trauma, the ruptured sacroiliac joint or fracture is easily visible, but reduction is extremely difficult.
- To evaluate any reduction, detach part of the origin of the piriformis muscle from around the greater sciatic notch and insert a finger through the notch to palpate the joint from its anterior surface.
- The surface of the joint will feel smooth if it has been reduced.
- The Posterior Approach to Sacroiliac Joint can be extended anteriorly and the gluteus medius and gluteus minimus muscles elevated from the outer side of the iliac wing.
- This will enable more extensive fractures of the wing and the ilium to be dealt with.
- The structures at risk during Posterior Approach to Sacroiliac Joint includes:
- Nerves:
- The inferior gluteal nerve.
- superior gluteal nerve.
- sacral nerve roots.
- Vessels:
- Branches of the superior and inferior gluteal arteries run with their respective nerves and also are in danger.
- Nerves:
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th