Closed reduction percutaneous screw fixation offers significant biological and biomechanical advantages and can be employed independently for the surgical treatment of pelvic acetabular fractures,as well as serving as a complementary method to open reduction internal fixation.The osseous fixation pathway(OFP)constitutes the anatomical foundation for the minimally invasive approach to pelvic and acetabular fracture management.The pelvis's OFP can be categorized into anterior,middle,and posterior parts.The anterior OFP encompasses both the superior pubic/anterior column and inferior pubic OFPs.The former is primarily uti-lized for addressing transverse and T-shaped acetabular fractures,as well as anterior column and superior pubic fractures.The latter is predominantly applied to inferior pubic fractures.The middle OFP includes the anterior inferior iliac spine to the posterior iliac crest(LC-Ⅱ)OFP,the gluteus medius column OFP,and the iliac crest OFP.The LC-Ⅱ OFP is primarily designated for pelvic cres-cent,iliac wing,and select high anterior column acetabular fractures.The gluteus medius column OFP is used for the treatment of some iliac fractures or acetabular fractures.And the iliac crest OFP is used for the treatment of simple iliac wing fractures or acetabu-lar fractures involving the iliac crest.The posterior OFP includes the posterior column of the acetabulum OFP,sacroiliac OFP,and sacral OFP.The posterior column of the acetabulum OFP is used for the treatment of acetabular fractures involving the posterior col-umn;the sacroiliac OFP is mainly utilized for a range of pelvic injuries,including pelvic rotational or vertical unstable pelvic injury,sacroiliac dislocation or fracture dislocation;open injury of the posterior ring of the pelvis with relatively mild contamination;elderly sacral(incomplete)fractures;residual gap at the end of sacral fracture after pubic symphysis and plate internal fixation;certain trau-matic spinopelvic dissociation;in combination with lumbopelvic fixation for the treatment of pelvic fractures with lumbosacral junc-tion injury.Sacral OFP is advised for treating bilateral sacroiliac dislocation and certain crescent-like pelvic fractures;bilateral sacral fractures;sacral fractures involving Denis Ⅲ zone,osteoporotic sacral incomplete fractures.The pursuit of minimally invasive treat-ment modalities for pelvic and acetabular fractures comes with challenges.A comprehensive understanding of OFP morphology and intraoperative imaging,coupled with a commitment to enhancing fracture reduction quality and surgical proficiency,is imperative for the precise management of such injuries.
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