Table 4.

Surgical approaches to the posterior pelvic ring.

Approach	Indications	Possible complications	Avoid complications
Dorsal approach	Fractures of the sacrum with stenosis of neuroforamina, Spino-pelvic dissociation	Nerve root injuries	Careful dissection and decompression before reduction
		Injury of Truncus lumbosacralis	1st window preparation: stop dissection at the anterior sacrum 15 mm medial of the sacroiliac joint
		Injury of bladder	Place urinary catheter preoperatively, Blunt dissection of retrosymphyseal space
		Injury of Corona mortis	2nd window preparation: identification in the middle of the upper pubic bone and ligation
		Injury of spermatic cord	2nd window preparation: dissect abdominal muscles from inguinal ligament
		Injury of vasa obturatoria	Subperiosteal dissection underneath the obturator internus muscle
		Injury of obturator nerve	Subperiosteal dissection underneath the obturator internus muscle
		Injury of sciatic nerve	Avoid deep dissection along quadrilateral plate
		Incisional hernia	Refixation of oblique abdominal muscles to iliac crest and inguinal ligament
1st window of ilioinguinal approach	Fracture of pelvic wing, Sacroiliac dislocation	Injury of the lateral cutaneous femoral nerve	Skin incision and dissection to iliac crest lateral of anterior superior iliac spine
		Injury of Truncus lumbosacralis	Stop dissection at the anterior sacrum 15 mm medial of the sacroiliac joint
		Incisional hernia	Refixation of oblique abdominal muscles to iliac crest
Percutaneous lateral approach	Fractures of the sacrum, Sacroiliac dissociations	Injury of S1 or S2 nerve roots or vessels because of malpositioning of sacroiliac screw	Application of laxatives starting two days before surgery to reduce enteral air and to improve intraoperative x-ray imaging of all important bony landmarks