The W-Plate: A Novel Technique for Fixation of Unstable Pelvic Ring Injuries

Summary: Anterior pelvic fixation is increasingly cited as a potentially important component of stable fixation for unstable anterior posterior compression (APC) and lateral compression (LC) pelvic ring injuries. Although anterior fixation constructs are frequently supplemented with the addition of percutaneous posterior fixation, this is not always possible given the degree of injury and/or coexisting sacral dysmorphism. Therefore, efforts should be made to maximize the strength of anterior fixation for these injuries. Superior pubic symphyseal plating has long been the gold standard for APC injuries because of ease of access and ability for long screws. Anterior-based plates additionally have been proposed for use in dual plating but only allow for short-caliber anterior to posterior screws in the pubic rami and ultimately have not been widely adopted. This article proposes and describes a novel technique of an anteriorly based “W-plate” with multiplanar screw trajectories that can be advanced through longer bony corridors in the pelvis as compared with existing strategies. Using a contoured, 5-hole reconstruction plate, the W-plate allows for anterior column (retrograde superior rami) screws to stabilize the anterior plating construct. This article details the W-plate technique and an associated case series of its use at multiple institutions.