Dr. Adam Starr

This book’s purpose is to present a system of percutaneous management of pelvic and acetabular fractures. The techniques discussed are currently in use at Parkland Memorial Hospital in Dallas, Texas. Other authors initially described many of these surgical  methods; some we developed ourselves. The community of surgeons who treat pelvic and acetabular fractures is small, and word about new techniques travels fast. Different centers and different surgeons inevitably make incremental changes in the way fractures are repaired. In our view, this is a good thing; there’s more than one way to skin a cat, and good ideas—no matter their source—always seem to bubble up to the surface. This little textbook aims to put forward what works for us and our hope is that it will be useful to surgeons who are tasked with managing similar patients.

The title uses the word “percutaneous,” but the phrase “minimally invasive” is probably more accurate. Our goal in fixing these fractures is to achieve adequate stability while limiting surgical trauma. The forthcoming chapters cover the equipment we use, the imaging and the screw pathways we commonly employ. There’s a tendency for young pelvic surgeons to focus on imaging and screw placement. This is understandable; you have to be able to see, and you have to know where your screws can go. However, the most important step in each case is the reduction. It is also the hardest step to teach, and the hardest to illustrate. We show techniques of reduction for many of the case examples included here. This is likely the most valuable information we can convey and we hope  our descriptions of reduction maneuvers are understandable.

It’s also important to note that this is not meant to be an exhaustive review of pelvic and acetabular fracture management. Discussion of early management and resuscitation are brief and we’ve not delved into the outcomes of fracture management. Those topics are well covered elsewhere. The focus here is on the surgical treatment of pelvic and acetabular fractures. Our goal is to present to the reader some information and techniques that have proven useful at our center. Our sincere hope is that readers will absorb the information shown, improve upon it, and move past it. Management of patients with pelvic or acetabular fractures can be rewarding, but there is plenty of room for improvement.

Adam Starr, MD