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Liu S, Liu S, Xiao K, Wei X, Liang Y. Fragility fracture of the pelvis treated with robot-assisted surgery under local anesthesia: a case report. Trauma Surg Acute Care Open 2024; 9:e001254. [PMID: 38476763 PMCID: PMC10928790 DOI: 10.1136/tsaco-2023-001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Songyang Liu
- Orthopaedic department, Aerospace Center Hospital, Beijing, China
| | - Shen Liu
- Orthopaedic department, Aerospace Center Hospital, Beijing, China
| | - Kai Xiao
- Orthopaedic department, Aerospace Center Hospital, Beijing, China
| | - Xing Wei
- Orthopaedic department, Aerospace Center Hospital, Beijing, China
| | - Yonghui Liang
- Orthopaedic department, Aerospace Center Hospital, Beijing, China
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2
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Xing B, Shen X, Ma L, Qi X. TiRobot-Assisted Percutaneous Cannulated Screw Fixation for Elderly Patients with Fragility Fractures of the Pelvis: A Retrospective Study. Orthop Surg 2024; 16:662-674. [PMID: 38384135 PMCID: PMC10925510 DOI: 10.1111/os.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The incidence of fragility fractures of the pelvis (FFPs) is increasing in the elderly population, and FFPs that require fixation are a challenge for orthopedic surgeons. The insertion of implants is not risk free due to the complex anatomical and osteoporotic bones and requires a steep learning curve. This study aimed to investigate the clinical efficacy of TiRobot-assisted percutaneous cannulated screw fixation in the treatment of elderly FFP patients. METHOD The clinical data of 46 elderly FFP patients who had been treated with percutaneous cannulated screw fixation from May 2020 to September 2022 were retrospectively analyzed. Twenty-four patients were treated with percutaneous cannulated screw fixation assisted by the TiRobot (TiRobot-assisted group) and 22 patients were treated with conventional freehand surgery (freehand group). Postoperative outcomes, including Matta value, excellent and good rate (EGR) of fracture reduction, and accuracy of screw placement (ASP), were compared. Changes in the Visual analog scale (VAS) pain score and the Majeed score were recorded and compared between groups before and after surgery and during the 24-week follow-up. Repeated-measures analysis of variance (ANOVA) and effect sizes were used as analysis methods. RESULTS A total of 90 screws were implanted, 51 screws in the TiRobot-assisted group and 39 screws in the freehand group. The operation time of the two groups was 34.1 ± 2.67 min versus 64.5 ± 4.19 min (p < 0.001). There were no screw-related complications or revision surgeries in any group. The Matta value of the TiRobot-assisted group was 5.13 ± 3.52, which was significantly lower than that of the freehand group (9.00 ± 3.68, p < 0.001), while the EGR was 91.67% versus 72.73%, with statistical significance (p < 0.001). The ASP was 100% in the TiRobot-assisted group, better than that in the freehand group, where it was 85.7% (p = 0.043). At each timepoint in the early postoperative period, the VAS score of the TiRobot-assisted group was significantly lower than that of the freehand group and was close to consistent by the last follow-up; the Majeed score of the former was significantly higher than that of the latter at each timepoint of follow-up, with statistical significance (p < 0.001). CONCLUSION TiRobot-assisted percutaneous cannulated screw fixation of elderly FFP patients is advantageous over conventional freehand surgery, with less invasion, more accurate screw placement, better fracture reduction, early pain relief, and rapid recovery, suggesting that Freehand method to stabilize FFP in the elderly population.
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Affiliation(s)
- Baorui Xing
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Department of Orthopaedic SurgeryHebei Cangzhou Hospital of Integrated Traditional Chinese and Western MedicineCangzhouChina
| | - Xiaoyu Shen
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lijie Ma
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiangbei Qi
- Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Oda T, Kitada S, Hirase H, Takada Y, Iwasa K, Niikura T. Evaluation of a treatment protocol based on conservative therapy for fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02469-z. [PMID: 38393362 DOI: 10.1007/s00068-024-02469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE In an aging society, fragility fractures of the pelvis (FFP) have increased significantly. However, there is no clear consensus on the timing and criteria for transitioning from conservative treatment to surgery for these fractures. Thus, we aimed to investigate the effects of our treatment protocol for FFP based on conservative treatment. METHODS We conducted a retrospective study including 74 patients with FFP at our institution between 2015 and 2021. All patients were treated conservatively for the first two weeks. During this period, only wheelchair transfer was allowed. If the patient could not walk after this period, surgery was performed. Fracture type (Rommens classification), walking ability, presence of complications after admission, presence of fracture union, and surgical treatment was investigated. Patients were divided into two groups: a stable group (type I/II) and an unstable group (type III/IV). RESULTS Fracture union was achieved in all patients. Thirteen patients developed complications after being admitted to our hospital; seven showed decreased walking ability, and six required surgeries. The stable and unstable groups comprised 47 and 27 patients, respectively. There were no statistically significant differences between the groups regarding the percentage of patients who developed complications or experienced decrease in walking ability. The percentage of patients who required surgery was significantly higher in the unstable group (p < 0.05). CONCLUSION Our FFP management protocol was effective regardless of fracture type. It is important to provide a period for careful assessment of instability, and to try to prevent fracture progression.
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Affiliation(s)
- Takahiro Oda
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
| | - Shimpei Kitada
- Orthopaedic Reconstruction Center, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan.
| | - Hitoshi Hirase
- Orthopaedic Reconstruction Center, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
| | - Yuma Takada
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
| | - Kenjiro Iwasa
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
- Orthopaedic Reconstruction Center, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji, Nishinomiya, 662-0918, Japan
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Grüneweller N, Leunig J, Zderic I, Gueorguiev B, Wähnert D, Vordemvenne T. Stabilization of Traumatic Iliosacral Instability Using Innovative Implants: A Biomechanical Comparison. J Clin Med 2023; 13:194. [PMID: 38202203 PMCID: PMC10779522 DOI: 10.3390/jcm13010194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Demographic changes over the past decade have had a significant impact on pelvic ring fractures. They have increased dramatically in the orthogeriatric population. Surgeons are faced with implant fixation issues in the treatment of these fragility fractures. This study compares two innovative implants for stabilizing the iliosacral joint in a biomechanical setting. (2) Methods: An iliosacral screw with a preassembled plate allowing the placement of an additional short, angular stable screw in the ilium and a triangular fixation system consisting of a fenestrated ilium screw and an iliosacral screw quasi-statically inserted through the "fenestra" were instrumented in osteoporotic artificial bone models with a simulated Denis zone 1 fracture. Biomechanical testing was performed on a servo-hydraulic testing machine using increasing, synchronous axial and torsional sinusoidal cyclic loading to failure. (3) Results: The SI-Plate and TriFix showed comparable stiffness values. The values for fracture gap angle and screw tip cutout were significantly lower for the TriFix compared to the SI-Plate. In addition, the number of cycles to failure was significantly higher for the TriFix. (4) Conclusions: Implant anchorage and primary stability can be improved in iliosacral instability using the triangular stabilization system.
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Affiliation(s)
- Niklas Grüneweller
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Julia Leunig
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (J.L.); (I.Z.)
| | - Dirk Wähnert
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
| | - Thomas Vordemvenne
- Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany (D.W.)
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Kleeblad LJ, Loggers SA, Zuidema WP, van Embden D, Miclau T, Ponsen KJ. Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion. OTA Int 2023; 6:e293. [PMID: 38152437 PMCID: PMC10750456 DOI: 10.1097/oi9.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 12/29/2023]
Abstract
Introduction Fragility fractures of the pelvis (FFP) in elderly patients are an underappreciated injury with a significant impact on mobility, independency, and mortality of affected patients and is a growing burden for society/health care. Given the lack of clinical practice guidelines for these injuries, the authors postulate there is heterogeneity in the current use of diagnostic modalities, treatment strategies (both operative and nonoperative), and follow-up of patients with FFP. The goal of this study was to assess international variation in the management of FFP. Methods All International Orthopaedic Trauma Association (IOTA) steering committee members were asked to select 15 to 20 experts in the field of pelvic surgery to complete a case-driven international survey. The survey addresses the definition of FFP, use of diagnostic modalities, timing of imaging, mobilization protocols, and indications for surgical management. Results In total, 143 experts within 16 IOTA societies responded to the survey. Among the experts, 86% have >10 years of experience and 80% works in a referral center for pelvic fractures. However, only 44% of experts reported having an institutional protocol for the management of FFP. More than 89% of experts feel the need for a (inter)national evidence-based guideline. Of all experts, 73% use both radiographs and computed tomography (CT) to diagnose FFP, of which 63% routinely use CT and 35% used CT imaging selectively. Treatment strategies of anterior ring fractures were compared with combined (anterior and posterior ring) fractures. Thirty-seven percent of patients with anterior ring fractures get admitted to the hospital compared with 75% of patients with combined fractures. Experts allow pain-guided mobilization in 72% after anterior ring fracture but propose restricted weight-bearing in case of a combined fracture in 44% of patients. Surgical indications are primarily based on the inability to mobilize during hospital admission (33%) or persistent pain after 2 weeks (25%). Over 92% plan outpatient follow-up independent of the type of fracture or treatment. Conclusion This study shows that there is a great worldwide heterogeneity in the current use of diagnostic modalities and both nonoperative and surgical management of FFP, emphasizing the need for a consensus meeting or guideline.
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Affiliation(s)
| | | | - Wietse P. Zuidema
- Department of Trauma Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Daphne van Embden
- Department of Trauma Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Theodore Miclau
- Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Kees-Jan Ponsen
- Department of Trauma Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Marintschev I, Hofmann GO. Minimally invasive bilateral fixed angle locking fixation of the dorsal pelvic ring: clinical proof of concept and preliminary treatment results. Eur J Trauma Emerg Surg 2023; 49:1873-1882. [PMID: 37041259 PMCID: PMC10449978 DOI: 10.1007/s00068-023-02259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/07/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Dorsal pelvic ring fractures may result from high energy trauma in younger patients or from osteoporosis as fragility fractures in elderly patients. To date, no strong consensus exists on the best surgical technique to treat posterior pelvic ring injuries. The aim of this study was to evaluate the surgical performance of a new implant for angle-stable fixation of the posterior pelvic ring and patient outcome. METHODS In a prospective pilot study, 27 patients (age: 39-87 years) with posterior pelvic ring fractures classified according to the AO classification (n = 5) or to the fragility fractures of the pelvis (FFP) classification (n = 22) were treated using the new implant. During a follow-up period of 1 year, surgical parameters of the implantation technique, complication rate, morbidity, mortality, preservation of patient mobility, and social independence were evaluated. RESULTS No implant misplacement or failure was observed. Two patients developed symptomatic spinal canal stenosis at L4/L5 following mobilization. MRI diagnosis proved the implant was not responsible for the symptoms. In one case, an additional plate stabilization of a pubic ramus fracture was necessary 6 months later. There was no inpatient mortality. One patient died due to her underlying oncological disease within the first 3 months. The main outcome parameters were pain, mobility, preservation of independent living and employment. CONCLUSION Operative instrumentation of dorsal pelvic ring fractures should be stable enough to allow for immediate weight bearing. The new locking nail implant offers percutaneous reduction and fixation options and may decrease the generally observed rate of complications. TRAIL REGISTRATION German Clinical Trials Register ID: DRKS00023797, date of registration: 07.12.2020.
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Affiliation(s)
- Ivan Marintschev
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Gunther O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Department of Trauma and Reconstructive Surgery, Workers Compensation Hospital Bergmannstrost, Merseburger Str. 165, 06112, Halle/Saale, Germany
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Timmer RA, Krijnen P, van der Zwaal P, Schipper IB, Meylaerts SAG. Clinical implications of additional posterior fractures in combined anterior-posterior pelvic ring fractures in elderly patients. Injury 2023:S0020-1383(23)00391-1. [PMID: 37137736 DOI: 10.1016/j.injury.2023.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Historically, pelvic ring fractures (PRF) are considered to occur predominantly in the anterior ring and therfore to be mechanically stable. Combined anterior and posterior (A + P) PRF are expected to be less mechanically stable and therefore to be associated with higher levels of pain and reduced mobility compared to isolated anterior fractures. The current study investigates the clinical relevance of combined A + P PRF in elderly patients. METHODS A prospective multicentre cohort study was conducted in patients >70 years of age with anterior PRF after low-energy trauma diagnosed on conventional radiographs. All patients underwent an additional CT-scan. Patients were divided into two groups; isolated anterior or combined A + P fractures. Patients were treated conservatively with adequate analgesia for at least one week. If patients could not be mobilised after conservative treatment, surgical fixation was performed. Numerical Rating Scale (NRS) pain scores, dependence on walking aids and Activities of Daily Living scores (ADL) were measured at 2-4 weeks, and 3, 6 and 12 months after fracture. RESULTS 102 patients (age 81.1 ± 7.6 years) were included. Isolated anterior fractures were diagnosed in 25 (24.5%) and A + P fractures in 77 (75.5%) patients. Baseline characteristics did not differ between the two groups. Most patients were successfully treated conservatively and 5 (4.9%) underwent percutaneous trans-iliac, trans-sacral screw fixation after failure of conservative treatment. At 2-4 weeks post trauma, patients with A + P fractures had similar median pain scores (3 (range 0-8) vs. 5 (0-10), p = 0.19) and ADL scores (85 (25-100) vs. 78.6 (5-100), p = 0.67), but were more dependent on walking aids (92.8% vs. 72.2%; p = 0.02) compared to patients with isolated anterior fractures. There were no significant differences at 3 months. At one year follow-up the median NRS pain and ADL scores for both fracture groups were 0 and 100, respectively. Mortality was 10.8%, and additional loss to follow-up was 17.6%. CONCLUSIONS The vast majority of elderly patients with PRF have combined A + P fractures. The clinical implications of additional posterior pelvic ring fractures in elderly patients appears to be limited.
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Affiliation(s)
- R A Timmer
- Department of Trauma Surgery, Haaglanden Medical Center, The Hague, the Netherlands; Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands; Network Acute Care West, Leiden, the Netherlands
| | - P van der Zwaal
- Department of Trauma Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - S A G Meylaerts
- Department of Trauma Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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8
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Kobayashi T, Akiyama T, Morimoto T, Hotta K, Mawatari M. A systematic review regarding clinical characteristics, complications, and outcomes of surgical and non-surgical patients with fragility fracture of the pelvis. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:35-49. [PMID: 36923634 PMCID: PMC10009624 DOI: 10.18999/nagjms.85.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 03/18/2023]
Abstract
We conducted this systematic review to clarify the clinical characteristics, complications, and outcomes of surgical and non-surgical patients with fragility fracture of the pelvis (FFP). We searched PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE for English language articles on FFP. We calculated pooled odds ratios (ORs) or mean differences (MDs) of surgical patients in comparison to non-surgical patients for clinical characteristics (Rommens FFP classification, age, sex, dementia, osteoporosis, diabetes mellitus, pulmonary disease, cardiovascular disease, and malignancy), complications (pneumonia, urinary tract infection, cardiac event, thrombosis, pulmonary embolism, pressure ulcer, multiple organ failure, anemia caused by surgical bleeding, and surgical site infection), and outcomes (hospital mortality and one-year mortality). Five studies involving 1,090 patients with FFP (surgical patients, n = 432; non-surgical patients, n = 658) were included. FFP type III and IV (OR = 8.44; 95% confidence interval [CI] 5.99 to 11.88; p<0.00001), a younger age (MD = -3.29; 95% CI -3.83 to -2.75; p<0.00001), the absence of dementia (OR = 0.36; 95% CI 0.23 to 0.57; p<0.0001), and the presence of osteoporosis (OR = 1.74; 95% CI 1.29 to 2.35; p = 0.0003) were significantly associated with the surgical patients. Urinary tract infection (OR = 2.06; 95% CI 1.37 to 3.10; p = 0.0005), anemia caused by surgical bleeding (OR = 4.55; 95% CI 1.95 to 10.62; p = 0.0005), and surgical site infection (OR = 16.74; 95% CI 3.05 to 91.87; p = 0.001) were significantly associated with the surgical patients. There were no significant differences in the outcomes between the surgical and non-surgical patients. Our findings may help to further understand the treatment strategy for FFP and improve clinical outcomes.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takayuki Akiyama
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Amagi Chuo Hospital, Asakura, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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9
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Curvafix: A novel implant for pelvic fragility fractures. Trauma Case Rep 2022; 43:100749. [PMID: 36654764 PMCID: PMC9841228 DOI: 10.1016/j.tcr.2022.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Fragility fractures of the pelvis are a frequently encountered injury in orthopedic practice. These injuries occur in patients with diminished bone density secondary to low energy mechanisms. This injury is associated with increased mortality and decreased quality of life. These fractures have been treated conservatively and with open or percutaneous surgical fixation. This case report illustrates the use of the Curvafix, a novel intramedullary implant used to treat a patient with a pelvic fragility fracture.
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10
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Haveman RA, Bäumlein M, van Veelen N, Oberkircher L, Beeres FJP, Babst R, Ruchholtz S, Link BC. Percutaneous sacroiliac screw fixation in fragility fractures of the pelvis: Comparison of two different augmentation techniques. Injury 2022; 53:4062-4066. [PMID: 36220693 DOI: 10.1016/j.injury.2022.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Fragility fractures of the pelvis (FFP) are becoming increasingly common. Percutaneous sacroiliac screw fixation is an accepted and safe treatment method for FFP. Augmentation is an option to optimize fixation strength of the screws. This study aims to compare patient mobility and the occurrence of complications after operative treatment of FFP utilizing two different augmentation techniques. METHODS All patients who received augmented sacroiliac screws for the treatment of FFPs between 01.01.2017 and 31.12.2018 at one of the two participating hospitals were included. The operative techniques only differed with regards to the augmentation method used. At the one hospital cannulated screws were used. Definitive screw placement followed augmentation. At the other hospital cannulated and fenestrated screws were used, permitting definitive screw placement prior to augmentation. RESULTS In total, 59 patients were included. The NRS score for pain was significantly lower after surgery. Preoperative mobility levels could be maintained or improved in 2/3 of the patients. There were no fatal complications. Two revision surgeries were performed because of screw misplacement. There were no significant differences between the two augmentation techniques in terms of complications. CONCLUSION Both augmentation techniques have a low complication rate and are safe methods to maintain patients' mobility level. The authors advocate early consideration of surgical treatment for patients with FFP. Augmentation can be considered a safe addition when performing percutaneous sacroiliac screw fixation.
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Affiliation(s)
- R A Haveman
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne.
| | - M Bäumlein
- Center for Orthopedics and Trauma Surgery, Philipps University Marburg
| | - N van Veelen
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne
| | - L Oberkircher
- Center for Orthopedics and Trauma Surgery, Philipps University Marburg
| | - F J P Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne
| | - R Babst
- Department of Health Science and Medicine, University of Lucerne
| | - S Ruchholtz
- Center for Orthopedics and Trauma Surgery, Philipps University Marburg
| | - B-C Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne
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11
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Kress H, Klein R, Pohlemann T, Wölfl CG. Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060809. [PMID: 35744073 PMCID: PMC9227275 DOI: 10.3390/medicina58060809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3-7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0-60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved.
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Affiliation(s)
- Hannah Kress
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
| | - Roman Klein
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
| | - Tim Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Saarland University Medical Center, 66421 Homburg, Germany;
| | - Christoph Georg Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
- Correspondence:
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Filip A, Veliceasa B, Puha B, Filip N, Cojocaru E, Pertea M, Carp CA, Huzum B, Alexa O, Rommens PM. Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040477. [PMID: 35454313 PMCID: PMC9024514 DOI: 10.3390/medicina58040477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022]
Abstract
Background and objectives: Fragility fractures of the pelvis (FFP) are of increasing interest lately, being associated with a loss of mobility and affecting the quality of life. The aim of our study was to investigate the effect of FFP on disability and pain in patients, after one year since injury. Materials and Methods: In the study, we included 76 patients diagnosed with FFP, who were admitted to our trauma department between January 2016 and January 2019, and were above 65 years of age. The Von Korff pain intensity and disability scores were calculated in the hospital at 6 months and after 1 year. Results: Fifty-four patients were female (71%), with an average age of 75.9 ± 7.19 years. Twenty-two patients were male (29%) and had a mean age of 77.22 ± 7.33 years. We did not record significant differences regarding age between the men and women (p > 0.05). Significant improvements appeared between the baseline and the 6 month follow-up; the average pain intensity score at 6 months was 44.94 (SD 21.20) (p < 0.001), and the disability score was 54.30 (SD 21.62). The following average pain intensity and disability scores after 12 months were similar to the values at6 months: 44.48 (SD 21.74) for pain intensity and 52.36 (SD 24.53) for disability. The Von Korff pain score at 6 months and after 1 year depends on gender and on the initial Von Korff pain score (p = 0.02). The Von Korff disability score at 6 months depends on gender, the baseline pain score and the baseline disability score (p = 0.001). Conclusions: our patients reported long-lasting pain that had a severe effect on their daily routines, and they could not return to their normal status prior to injury.
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Affiliation(s)
- Alexandru Filip
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
- Correspondence: (B.V.); (N.F.)
| | - Bogdan Puha
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Nina Filip
- Department of Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania
- Correspondence: (B.V.); (N.F.)
| | - Elena Cojocaru
- Department of Morpho-Functional Sciences (I), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania;
| | - Mihaela Pertea
- Department Plastic Surgery and Reconstructive, Surgical Sciences (I), Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700020 Iasi, Romania;
| | - Claudiu Adrian Carp
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Bogdan Huzum
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Ovidiu Alexa
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
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The grade of instability in fragility fractures of the pelvis correlates with impaired early mobilization. Eur J Trauma Emerg Surg 2022; 48:4053-4060. [PMID: 35279755 PMCID: PMC9532290 DOI: 10.1007/s00068-022-01933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to investigate whether gait patterns of patients with fragility fractures of the pelvis (FFP) comply with the grade of fracture instability, defined by radiological patterns. PATIENTS AND METHODS This prospective, single-center, observational study included 39 patients with an FFP. Gait analysis was performed with a wearable insole force sensor (Loadsol® by Novel, Munich, Germany) 4-7 days after admission. Patients were divided in two groups: Group A included FFP type 1 fractures, which affect the anterior pelvic ring only, Group B contained FFP type 2-4 fractures with an involvement of the posterior pelvic ring. Primary outcome parameter was the FTI ratio (force-time integral (N*s)). RESULTS The mean age was 85.08 years (SD ± 6.45), 94.9% (37/39) of the patients were female. The most common fracture type was an FFP 2b (64.1%, 25/39). Group A showed a significantly higher FTI ratio (45.12%, SD ± 4.19%) than Group B (38.45%, SD ± 5.97%, p = 0.002). Further, a significant correlation of the FTI ratio and the average (r = 0.570, p < 0.001) and maximum (r = 0.394, p = 0.013) peak force was observed. CONCLUSION The gait pattern of patients with an FFP type 2-4 was more imbalanced than of patients with an FFP type 1 fracture. These findings match with the radiological classification of FFP, which indicates higher instability, when the posterior pelvis is affected. Gait analysis might offer earlier functional diagnostics and may accelerate the treatment decision with shorter periods of immobility in future. Especially in cross-border cases, early gait analysis could be beneficial to clarify the indication for or against surgery.
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Rommens PM, Hopf JC, Arand C, Handrich K, Boudissa M, Wagner D. Prospective assessment of key factors influencing treatment strategy and outcome of fragility fractures of the pelvis (FFP). Eur J Trauma Emerg Surg 2022; 48:3243-3256. [PMID: 35122506 PMCID: PMC9360063 DOI: 10.1007/s00068-022-01887-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fragility fractures of the pelvis (FFP) are a clinical entity with an increasing significance in clinical practice. Little is known about the conditions, which influence decision making and outcome. SETTING Level I trauma center. MATERIAL AND METHODS Prospective assessment of selected parameters of patients, who were admitted with a FFP in a 2-year period. Fractures were classified in accordance with the Rommens and Hofmann classification. Living environment, level of autonomy (independent walking), type of treatment (conservative versus operative), type of surgical technique, European Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L), Short Form-8 Physical Component Score (SF-8 PCS) and Short Form-8 Mental Component Score (SF-8 MCS), Barthel Index, Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were collected at primary presentation (t1), at discharge (t2) and after 3 (t3) and 12 months (t4). Length of hospital stay, in-hospital complications, surgery-related complications, new osteoporotic fractures and mortality rate within the first year were also registered. The key factors influencing the choice of therapy and outcome were looked for. RESULTS 110 patients, 99 women (90%) and 11 men (10%), were included in the study. Their mean age was 79.2 years (SD 10 years). Fourteen patients had FFP type I (12.7%), 59 FFP type II (53.6%), 11 FFP type III (10%) and 26 FFP type IV fractures (23.6%). All patients with FFP type I were treated conservatively. 48 patients with FFP types II-IV were treated conservatively and 48 operatively. Patients, who got a conservative outpatient treatment first and were hospitalized later, had higher FFP fracture types at admission. Operatively treated patients were hospitalized at a median of 33.5 days after the beginning of complaints, whereas the median day of admission of the conservative group was the day of trauma (p < 0.001). The operatively treated patients were hospitalized in a worse clinical condition (SF-8 PCS, EQ-5D-5L, autonomy). Length of stay (LoS) of operatively treated patients was significantly longer than of conservatively treated (p < 0.001). There was a tendency to more in-hospital complications in the operative group (p = 0.059). The rate of surgery-related complications (8.3%) was low with only one revision needed. Selected outcome parameters improved during the observation period nearly reaching the level before FFP after 1 year. SF-8 PCS, Barthel index and rate of patients living home were higher in the operative group at t4. The improvement of autonomy (independent walking) between t1 and t4 was significant in the operated group (p = 0.04) but not in the conservative group (p = 0.96). One-year mortality rate was 11.7% with no difference between the fracture types. One-year mortality rate of conservatively treated patients with FFP type II-IV was 13.5% versus 6.9% in the operative group (p = 0.38). CONCLUSION Conservative treatment is appropriate in patients with FFP type I as well as in patients with FFP type II, provided that the last ones are hospitalized immediately after the traumatic event. Surgical treatment is recommended in patients with higher fracture types, with delayed presentation or after unsuccessful conservative treatment. In the conservative and operative group, all selected parameters considerably improved between t1 and t4 with a steeper increase in the operative group. The rate of postoperative complications is low. The 1-year mortality rate is the lowest in the operative group. Surgical stabilization of FFP is safe and reliable provided it is performed with care and in the appropriate target group.
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Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Johannes Christoph Hopf
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Kristin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
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