Surg Radiol Anat (1999) 21: 305-307 Surgical o: Radiolog,c Anatomy Journal of Clinical Anatomy © Springer-Verlag 1999 A posterior approach for inspection of reduction of sacroiliac joint disruption N.A. Ebraheim, J. Lu, B.E. Heck and R.A. Yeasting Department of Orthopaedic Surgery, Medical College of Ohio, Toledo, Ohio, USA Summary: This anatomic study was undertaken to describe a new posterior approach enabling direct inspection of reduction of sacroiliac joint disruption (SIJD), and guidance of iliosacral screw placement. The reduction of SIJD is usually monitored by inspection of the opposing sacrum and ilium at the poste- rior margin of the greater sciatic notch and there is a relative lack of information concerning inspection of reduction of SIJD from the postemsuperior aspect of the sacroiliac joint surface. Ten cadavers were dissected to determine the possibili- ty of inspecting reduction of SIJD from the posterosuperior aspect of the sacroi- liac joint by means of a posterior approa- ch which passed immediately lateral to the deep back muscles and the fifth lum- bar transverse process. The results indi- cated that the posterosuperior aspect of the sacroiliac joint surface and sacral ala can be directly palpated or visualised. This approach facilitates improved access for inspection of reduction of SIJD and guidance of iliosacral screw placement. Correspondence to: N.A, Ebraheim Contr61e de la r~duction des luxations sacro-iliaques par une voie d'abord post6rieure R~sum~ : Le but de cette 6rude anato- mique est de drcrire une voie d'abord originale permettant de contr61er directe- ment la rrduction d'une luxation de l'articulation sacro-ilaque (LSI), et de guider la raise en place de vis sacro- ilaques. La rrduction d'une LSI est habi- tuellement controlre par rapport l'aspect du sacrum et de l'ilium du cot6 oppos6 au niveau du bord postrrieur de la grande 6chancrure sciatique, mais il exis- te un manque de donnres sur le controle de la rrduction d'une LSI au niveau de la pattie postrm-supdrieure de l'articulation sacro-iliaque. Dix cadavres ont 6t6 dissr- qurs afin de drfinir la possibilit6 de contrrler la rrduction d'une LSI au niveau du bord postrro-supdrieur de 1'articulation sacro-iliaque par une voie d'abord postrrieure passant immrdiate- ment en dehors de la masse musculaire sacro-lombaire et du cinqui~me proces- sus transverse lombaire. Les rdsuttats montrent que la pattie postrro-suprrieure de l'articulation sacro-iliaque et l'aile du sacrum peuvent ~tre directement palprs ou visualisrs. Cet abord permet un meilleur contrrle de la rrduction d'une LSI et facilite la raise en place de vis sacro-iliaques. Key words: Sacroiliac joint - Disruption - Reduction - Anatomy With the increasing incidence of sacroiliac joint disruption or disloca- tion (SIJD) secondary to high-energy trauma, the need for reduction and sta- bitisation of this disruption to facilita- te repair of other injuries and minimi- se potential late complications has become more important. Slatis et al reported on the late follow-up of 65 Malgaigne fracture-dislocations, trea- ted with pelvic sling and traction [8, 9]. They noted that 33 (51%) had late complications. Many of these compli- cations were attributable to inadequate reduction and inability to maintain reduction of the hemipelvis [7]. Through the posterior approach for iliosacral screw fixation of SIJD has been achieved, maintaining a satisfac- tory reduction, inspection and confir- mation of the reduction of SIJD, and guidance of drill and screw positions still remain major intraoperative concerns. The present study aims to define an approach for inspection of reduction of SIJD and guidance of placement screw from the posterosu- perior aspect of the sacroiliac joint surface and sacral ala.