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Three-dimensional computed tomography reconstruction two years after the trauma. (A) Anterior view; (B) posterior view; (C) left wing view; (D) right wing view.
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New imaging tests revealed deformity in lateral rotation and high right hemipelvis (Fig. 1A-D), which led to shortening of the ipsilateral lower limb.
Posterior sacroiliac osteotomy. (A) Demonstration of the area of safety and angle of attack of the osteotome for the sequential bone cuts; (B and C) sequential bone resection, with groove creation and maintenance of the thin anterior cortical layer; (D) completion of osteotomy using a Kerrison punch.
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Careful osteotomies were made in the SIJ from its cephalic to caudal ends; thin osteotomes were used from the posterior sacral aspect toward the inside of the joint, creating a progressively wider groove in the joint space (Fig. 2A-C). The thin bony layer remaining in the anterior portion of the joint was then removed with Kerrison punches (Fig. 2D).
Posterior reduction of deformity. (A) Drawing of the technique and (B) grafting of the osteotomy groove.
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The deformity was reduced with pliers that allowed distraction of the heads of the L5 and iliac screws (Fig. 3A). A spongy graft from the iliac crest was then placed in the osteotomy bed and the SIJ (Fig. 3B).
Radiographs of the first postoperative year. (A) Inlet view and (B) outlet view.
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Lesion consolidation was observed sixth month after surgery (Fig. 4A and B).