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Jia Z, Qin H, Lin J, Wang X, Bai R, Zou S, Huang W, Hu X. Minimally Invasive Treatment of Pelvic Fractures with Titanium Elastic Nailing: An Innovative Technology. Surg Innov 2024:15533506241249260. [PMID: 38654530 DOI: 10.1177/15533506241249260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Minimally invasive treatment has become the most popular and effective treatment for pelvic fractures. This study aimed to evaluate the safety and efficacy of a new technique, titanium elastic nailing (TEN), for the minimally invasive treatment of pelvic fractures. METHOD Twenty-four patients with pelvic fractures were referred to us between January 2020 to January 2022, including sixteen males and 8 females. Pelvic fractures were temporarily fixed by pelvic fixation belt accompanied by traction from the lower limb bone. Anterior pelvic ring injuries (superior ramus of pubis) and ilium fractures were treated with closed reduction and intramedullary fixation with minimally invasive TEN. Intraoperative C-arm, including pelvic anteroposterior, pelvic outlet, inlet and ilium oblique views, and O-arm fluoroscopy (intraoperative CT) were employed to assess fractures reduction and determine the location of the elastic titanium nail within the bone channel. RESULTS By adopting closed reduction and minimally invasive incision techniques, pelvic fractures could be safely fixed by placing an elastic titanium nail in the osseous medullary cavity channels of the pelvis. Postoperative investigation indicated that the wounds of all patients were healed in the first stage without any occurrence of complications, such as injuries to the nerves, blood vessels, and important tissue structures. Patients are essential quickly after the operation and could perform the functional exercise in the early stages of the recovery. CONCLUSION TEN can be used for minimally invasive treatment of pelvic fractures. This novel technique has no obvious complications and is worthwhile in clinical practice.
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Affiliation(s)
- Zhaofeng Jia
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hanjun Qin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jiandong Lin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xin Wang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ruochen Bai
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Suying Zou
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Wenjun Huang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xinjia Hu
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Liu W, Zhao J, Cheng J, Huang L, Ning C, Hu F. A Countertraction Closed Reduction Technique in Minimally Invasive Fixation of Recent Type C Pelvic Ring Injuries. Orthop Surg 2024; 16:989-997. [PMID: 38389215 PMCID: PMC10984815 DOI: 10.1111/os.14005] [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: 10/09/2023] [Revised: 01/01/2024] [Accepted: 01/05/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Closed reduction of pelvic injuries is a prerequisite and critical step in minimally invasive treatment. Achieving non-invasive closed reduction of pelvic injuries is a challenging clinical problem. This study demonstrated a non-invasive traction technique for closed reduction called countertraction closed reduction technique (CCRT) and evaluated its effectiveness for type C pelvic ring injuries. METHOD The data of patients with unstable pelvic fractures treated with CCRT and minimally invasive fixation were retrospectively reviewed from January 2017 to February 2022. Sacroiliac screws were placed to fix the posterior pelvic ring, and internal or external fixation was used to fix the anterior pelvic ring. Operation time, intraoperative blood loss, duration of hospital stay, fracture union and postoperative complications were recorded. Fracture reduction quality was evaluated using the Matta scoring criteria. Functional recovery and general quality of life were evaluated using the Majeed functional scoring criteria. RESULTS Thirteen patients (nine males and four females), with an average age of 49.6 years were treated with CCRT and followed up for a mean of 18.5 months. The average operation time was 137.2 minutes (range 92-195 minutes), the average intraoperative blood loss was 31.2 mL (range 10-120 mL) and the average duration of hospital stay was 14.3 days (range 4-32 days). All patients achieved bony union with an average union time of 11.9 weeks (range 10-16 weeks). According to the Matta radiographic criteria, the quality of fracture reduction was excellent in eight patients, good in four, and fair in one. The average Majeed functional score was 89.7 (range 78-100). The functional evaluation revealed that the outcomes were excellent in nine patients, and good in four patients. Complications included incision fat liquefaction in one patient, and heterotopic ossification in another patient. There were no surgical complications as a result of CCRT. CONCLUSION CCRT is a non-invasive closed reduction method for minimally invasive fixation of fresh Tile C1 and C2 pelvic fractures. The advantages of CCRT combined with minimally invasive treatment include a small surgical incision, reduced intraoperative bleeding, satisfactory fracture reduction, bone healing and functional recovery.
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Affiliation(s)
- Wei Liu
- Department of Orthopedic Trauma & Hand and Foot Surgerythe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
- Department of Trauma Surgerythe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Jinmin Zhao
- Department of Orthopedics Trauma and Hand SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Jianwen Cheng
- Department of Orthopedics Trauma and Hand SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Linke Huang
- Department of Bone and Joint Surgery & Sports Medicinethe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Chao Ning
- Department of Bone and Joint Surgery & Sports Medicinethe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Feng Hu
- Department of Orthopedic Trauma & Hand and Foot Surgerythe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
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Li J, Qi L, Liu N, Yi C, Liu H, Chen H, Tang P. A New Technology Using Mixed Reality Surgical Navigation with the Unlocking Closed Reduction Technique Frame to Assist Pelvic Fracture Reduction and Fixation: Technical Note. Orthop Surg 2023; 15:3317-3325. [PMID: 37749773 PMCID: PMC10693998 DOI: 10.1111/os.13874] [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: 12/06/2022] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Pelvic ring disruption (PRD) is a serious trauma associated with high mortality and disability rates. Poor reduction can lead to complications such as pelvic deformity and delayed fracture healing. Here, we introduce a new technology using mixed reality surgical navigation (MRSN) with an unlocking closed reduction technique (UCRT) frame to assist pelvic fracture reduction and fixation. METHODS Thirty patients with PRD were enrolled in this study. All of the patients underwent preoperative CT scans, with the pelvis and tracker segmented into three-dimensional models. Under MRSN guidance, auxiliary reduction screws were inserted to grasp the pelvic bone. An ideal trajectory for closed reduction was planned, and suitable CS screws were used for stable fixation after good reduction. Operation time, fluoroscopy frequency, and both Matta and Majeed scores were analyzed. RESULTS The mean follow-up period was 10.8 months (7.5, 12.25 months) (range 6-24 months). The average duration of operation was 212.5 min (187.5, 272.8 min) (range 133-562 min), and the average reduction time was 23.0 min (15.0, 42.5 min) (range 10-70). The average fluoroscopy frequency was 34.0 times (31.5, 52.5 times) (range 23-68 times). One hundred and fifty screws were successfully inserted on the first attempt. All the fractures healed well with no complications. Excellent reduction quality (Matta score ≤4 mm) was achieved in 29/30 cases, and good reduction quality (Matta score between 4 and 10 mm) was achieved in 1/30 cases. All patients achieved bone healing after an average of 4.0 months (3.5, 5.9 months) (range 3-6), as well as good function recovery with an average Majeed score of 91.0 (87.8, 95.0) (range 71-100). CONCLUSION The MRSN technique described improved reduction accuracy and radiation exposure without considerable extension of operation time.
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Affiliation(s)
- Jiaqi Li
- Chinese PLA General Medical SchoolBeijingChina
- Department of Orthopaedic TraumaFourth medical center of Chinese PLA General hospitalBeijingChina
| | - Lin Qi
- Chinese PLA General Medical SchoolBeijingChina
- Department of Orthopaedic TraumaFourth medical center of Chinese PLA General hospitalBeijingChina
| | - Ning Liu
- Department of Orthopaedic TraumaFourth medical center of Chinese PLA General hospitalBeijingChina
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Haoyang Liu
- AI Sports Engineering Lab, School of Sports EngineeringBeijing Sport UniversityBeijingChina
| | - Hua Chen
- Chinese PLA General Medical SchoolBeijingChina
- Department of Orthopaedic TraumaFourth medical center of Chinese PLA General hospitalBeijingChina
| | - Peifu Tang
- Chinese PLA General Medical SchoolBeijingChina
- Department of Orthopaedic TraumaFourth medical center of Chinese PLA General hospitalBeijingChina
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Aprato A, Branca Vergano L, Casiraghi A, Liuzza F, Mezzadri U, Balagna A, Prandoni L, Rohayem M, Sacchi L, Smakaj A, Arduini M, Are A, Battiato C, Berlusconi M, Bove F, Cattaneo S, Cavanna M, Chiodini F, Commessatti M, Addevico F, Erasmo R, Ferreli A, Galante C, Giorgi PD, Lamponi F, Moghnie A, Oransky M, Panella A, Pascarella R, Santolini F, Schiro GR, Stella M, Zoccola K, Massé A. Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures. J Orthop Traumatol 2023; 24:46. [PMID: 37665518 PMCID: PMC10477162 DOI: 10.1186/s10195-023-00726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND There is no evidence in the current literature about the best treatment option in sacral fracture with or without neurological impairment. MATERIALS AND METHODS The Italian Pelvic Trauma Association (A.I.P.) decided to organize a consensus to define the best treatment for traumatic and insufficiency fractures according to neurological impairment. RESULTS Consensus has been reached for the following statements: When complete neurological examination cannot be performed, pelvic X-rays, CT scan, hip and pelvis MRI, lumbosacral MRI, and lower extremities evoked potentials are useful. Lower extremities EMG should not be used in an acute setting; a patient with cauda equina syndrome associated with a sacral fracture represents an absolute indication for sacral reduction and the correct timing for reduction is "as early as possible". An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an indication for laminectomy after reduction in the case of a displaced sacral fracture in a high-energy trauma, while a worsening and progressive radicular neurological deficit represents an indication. In the case of a displaced sacral fracture and neurological deficit with imaging showing no evidence of nerve root compression, a laminectomy after reduction is not indicated. In a patient who was not initially investigated from a neurological point of view, if a clinical investigation conducted after 72 h identifies a neurological deficit in the presence of a displaced sacral fracture with nerve compression on MRI, a laminectomy after reduction may be indicated. In the case of an indication to perform a sacral decompression, a first attempt with closed reduction through external manoeuvres is not mandatory. Transcondylar traction does not represent a valid method for performing a closed decompression. Following a sacral decompression, a sacral fixation (e.g. sacroiliac screw, triangular osteosynthesis, lumbopelvic fixation) should be performed. An isolated and complete radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an absolute indication. A worsening and progressive radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. In the case of a displaced sacral fracture and neurological deficit in a low-energy trauma, sacral decompression followed by surgical fixation is indicated. CONCLUSIONS This consensus collects expert opinion about this topic and may guide the surgeon in choosing the best treatment for these patients. LEVEL OF EVIDENCE IV. TRIAL REGISTRATION not applicable (consensus paper).
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Affiliation(s)
- Alessandro Aprato
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy.
| | | | | | | | - Umberto Mezzadri
- ASST Grande Ospedale Metropolitano Niguarda di Milano, Milan, Italy
| | - Alberto Balagna
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy
| | | | | | | | | | | | | | | | | | - Federico Bove
- ASST Grande Ospedale Metropolitano Niguarda di Milano, Milan, Italy
| | | | | | | | | | | | - Rocco Erasmo
- Ospedale Civile Santo Spirito di Pescara, Pescara, Italy
| | | | | | | | | | | | - Michel Oransky
- Università degli studi di Roma, ASST degli spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | | | | | - Alessandro Massé
- Università degli studi di Torino, Viale 25 Aprile 137 Int 6, 10133, Turin, Italy
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[A multicenter retrospective study assessing pelvic unlocking closed reduction device for reducing unstable pelvic posterior ring disruption]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1327-1334. [PMID: 36382448 PMCID: PMC9681597 DOI: 10.7507/1002-1892.202206060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To explore the application value and effectiveness of pelvic unlocking closed reduction device for the treatment of unstable pelvic posterior ring disruption. METHODS A retrospective analysis of clinical data of 243 cases of unstable pelvic posterior ring disruption treated with pelvic unlocking closed reduction device in 13 orthopaedic trauma centers across the country between December 2018 and June 2020 was performed. There were 139 males and 104 females; the age ranged from 18 to 92 years, with an average age of 48.5 years. The cause of injury included 132 cases of traffic accident injuries, 102 cases of falling from height, and 9 cases of crushing injuries. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 5 cases of type 61-B1, 13 cases of type 61-B2, 32 cases of type 61-C1.1, 47 cases of type 61-C1.2, 89 cases of type 61-C1.3, 35 cases of type 61-C2, and 22 cases of type 61-C3. The time from injury to operation was 2-121 days, with a median of 10 days. Preoperative preparation time, installation time of unlocking closed reduction device, fracture reduction time, intraoperative fluoroscopy times, intraoperative blood loss, and surgical complications were recorded, and Matta scoring standard was used to evaluate the quality of fracture reduction. According to Matta evaluation results, the patients were divided into two subgroups: excellent-good group and fair-poor group. The differences in gender, age, time from injury to operation, AO/OTA classification, and perioperative clinical indicators were compared between the two groups, and the effects of baseline data and perioperative indicators on the quality of fracture reduction were studied. RESULTS Pelvic unlocking closed reduction device did not interfere with the display of the pelvic structure and fracture displacement direction during the intraoperative fluoroscopy, effectively correcting the displacement of the pelvic ring. The preoperative preparation time was 17-60 minutes, with an average of 30 minutes; installation time of unlocking closed reduction device was 10-32 minutes, with an average of 21 minutes; intraoperative fracture reduction time was 15-205 minutes, with an average of 49.2 minutes; intraoperative fluoroscopy times were 41-420 times, with an average of 132 times; intraoperative blood loss was 40-1 500 mL, with an average of 71.5 mL. The reduction quality of pelvic fracture was evaluated according to Matta score immediately after operation. The results were excellent in 153 cases, good in 61 cases, fair in 24 cases, and poor in 5 cases. The excellent and good rate was 88.1%. Further subgroup analysis showed that there was no significant difference in other indexes ( P>0.05) between the excellent-good group and the fair-poor group except for the time from injury to operation and AO/OTA classification ( P<0.05). Among them, the excellent-good reduction rate was 92.2% (119/129) in patients with injury-to-operation time less than 10 days, and the fair-poor reduction rate was 25.7% (9/35) and 40.9% (9/22) in patients with AO/OTA 61-C2 and 61-C3 types, respectively. There was no surgery-related complication due to the application of the pelvic unlocked reduction device, no secondary iliac fractures, vascular, or nerve injuries, and postoperative CT showed that all channel screws were located in the osseous channel. CONCLUSION The pelvic unlocking reduction device can effectively help to reduce the unstable pelvic posterior ring and maintain reduction, meet the needs of different projection angles of pelvic fracture with intraoperative C-arm fluoroscopy. The system facilitate the operation of pelvic reduction and precise fixation.
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Zhang S, Mo H, Liu Y, Zhu G, Yu B. Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute. J Orthop Surg Res 2021; 16:577. [PMID: 34587970 PMCID: PMC8482592 DOI: 10.1186/s13018-021-02735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials From January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The exclusion criteria included: (1) pathological fracture, or combined with pelvic bone tumor or severe osteoporosis; (2) femoral fracture and thoracolumbar fracture; (3) open pelvic fracture; (4) Morel-Lavallée injury; (5) complicated acetabular fracture. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system. Results According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5 to 28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate. Five patients undergoing revision surgery were followed up for 6–36 months with an average of 18 months. According to Majeed’s score at the last follow-up in the 5 patients undergoing revision surgery, there were 2 cases of excellent, 2 cases of good, 1 case of fair. The excellent and good rate reached 80%. Conclusion The treatment of complicated unstable pelvic fractures requires performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.
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Affiliation(s)
- Sheng Zhang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China. .,Department of Orthopedics, People's Hospital of Hua Zhou, Huazhou, Guangdong Province, China.
| | - Huagui Mo
- Department of Orthopedics, Jiangmen Central Hospital, Jiangmen, Guangdong Province, China
| | - Yucheng Liu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China
| | - Guohua Zhu
- Department of Orthopedics, People's Hospital of Hua Zhou, Huazhou, Guangdong Province, China
| | - Bin Yu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China
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Chen H, Zhang Q, Wu Y, Chang Z, Zhu Z, Zhang W, Tang P. Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique. Orthop Surg 2021; 13:942-948. [PMID: 33817995 PMCID: PMC8126934 DOI: 10.1111/os.12958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS). METHODS A retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post-surgical reduction quality was evaluated using Matta scoring criteria and patient lower-extremity functional outcome was evaluated using Majeed functional scoring criteria. RESULTS When used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post-surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra-acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients' lower-extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow-up at an average of 41.6 months postoperatively. CONCLUSION With excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS-assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.
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Affiliation(s)
- Hua Chen
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Qun Zhang
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Yan Wu
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Zuhao Chang
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Zhengguo Zhu
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Wei Zhang
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Peifu Tang
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing, China
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Yanagisawa Y, Watanabe Y, Matsumoto Y, Makihara T, Inoue Y, Yamazaki M. Closed reduction and minimally invasive surgical treatment of type IIIa fragility fractures of the pelvis associated with ipsilateral periprosthetic femur fracture: A case report. Trauma Case Rep 2020; 30:100374. [PMID: 33204804 PMCID: PMC7653280 DOI: 10.1016/j.tcr.2020.100374] [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] [Accepted: 11/01/2020] [Indexed: 12/01/2022] Open
Abstract
Patients with fragility fractures of the pelvic ring (FFP) are elderly and, from the perspective of surgical invasion, percutaneous and stable fixation may be a superior surgical method than open reduction and internal fixation (ORIF). While in the case of FFP type IIIa, ORIF, as a rule, typically requires open reduction of the displaced ilium via an anterior intrapelvic approach and/or lateral window of the ilioinguinal approach. We have reported here the case of an 89-year-old woman who suffered from FFP type IIIa with ipsilateral periprosthetic femur fracture that was surgically treated. The iliac fracture was approached in a minimally invasive manner using the traction operation while preparing for femoral shaft fracture surgery, which did not require open reduction, and showed favorable outcomes.
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Affiliation(s)
- Yohei Yanagisawa
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.,Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yu Watanabe
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.,Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukei Matsumoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.,Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takeshi Makihara
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Chen H, Jiang B, Zhang Q, Chang Z, Yang Z, Zhang J, Liu H, Tang P. [Intelligent monitoring system assisted pelvic fracture closed reduction for treating one case with complex pelvic fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:874-877. [PMID: 32666731 DOI: 10.7507/1002-1892.202001035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To introduce the experience of intelligent monitoring system assisted pelvic fracture closed reduction to treat complex pelvic fracture in a minimally invasive method. Methods A 30-year-old male patient with complex pelvic fracture caused by a falling injury was treated in December 2019. The pelvic fracture was diagnosed by X-ray film and CT three-dimensional reconstruction. The AO/Orthopaedic Trauma Association (AO/OTA) classification was 61-C3.3 type (H-shaped sacrum fracture with pubic symphysis separation). At 48 hours after injury, the vital signs were stable, and the operation was performed. The pelvic fracture was reduced with the help of pelvic reduction frame and skeletal traction, the intelligent monitoring system, and fixed with the channel screws. Results The intraoperative blood loss was 50 mL, the operation time was 180 minutes, and the fluoroscopy time was 45 seconds. The incision healed well after operation. The X-ray film of pelvis was taken on the next day after operation, and the fracture reduction was evaluated as anatomical reduction according to Matta standard; CT three-dimensional reconstruction showed that the fixation screws were all located in the cortex of bone, without penetrating the cortex of bone. Conclusion The intelligent monitoring system assisted pelvic fracture closed reduction is reliable in the minimally invasive treatment of complex pelvic fractures, which can achieve good results and reduce intraoperative fluoroscopy.
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Affiliation(s)
- Hua Chen
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Bin Jiang
- Noitom Technology Ltd., Beijing, 100088, P.R.China
| | - Qun Zhang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Zuhao Chang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Zifeng Yang
- Department of Orthopaedics, Mudanjiang Linye Zhongxin Yiyuan, Mudanjinag Heilongjiang, 157011, P.R.China
| | - Jian Zhang
- Department of Orthopaedics, Mudanjiang Linye Zhongxin Yiyuan, Mudanjinag Heilongjiang, 157011, P.R.China
| | - Haoyang Liu
- Noitom Technology Ltd., Beijing, 100088, P.R.China
| | - Peifu Tang
- Department of Orthopaedics, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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10
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Boudissa M, Roudet A, Fumat V, Ruatti S, Kerschbaumer G, Milaire M, Merloz P, Tonetti J. Part 1: Outcome of Posterior Pelvic Ring Injuries and Associated Prognostic Factors - A Five-Year Retrospective Study of One Hundred and Sixty Five Operated Cases with Closed Reduction and Percutaneous Fixation. INTERNATIONAL ORTHOPAEDICS 2020; 44:1209-1215. [PMID: 32328739 DOI: 10.1007/s00264-020-04574-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
PURPOSES The aim of this study was to evaluate: 1. the outcome of pelvic ring fractures treated by closed reduction and percutaneous fixation, 2. the prognostic factors associated with a poor quality reduction, 3. the prognostic factors associated with ilio-sacral screws misplacement and 4. the prognostic factors associated with nonunion. METHODS Data from medical charts for all patients admitted with unstable posterior pelvic ring injuries from 2009 to 2013 were extracted. A total of 165 patients with a mean age of 40 years were included. One hundred and five patients were reviewed at a mean of 32 months of follow-up. The prognostic factors analyzed were clinical and radiological factors. Tile B and Tile C pelvic ring fractures were compared and analyzed separately. Then specific statistical analysis was performed using a logistic regression model to eliminate confusion factors. RESULTS An excellent or good clinical result was achieved for 94 patients (90%). An excellent or good reduction was achieved for 141 patients (85%). Nonunion rate, smoking patients, bad reductions, age of patients and ISS score were significantly higher in Tile C group. To eliminate confusion factors we used a multivariate analysis logistic regression model. Only unstable vertical bilateral posterior injuries (Tile C2 and C3) were independent prognostic factors for unsatisfactory reduction (p = 0.001; OR = 4.72; CI 95% [2.08-16.72]). Screw misplacement was recorded for 30 patients (16%) and sacral dysmorphia was an associated prognostic factor (p = 0.0001; OR = 15.6; CI95% [3.41-98.11]). Nonunion was recorded for ten patients (6%) and smoking was an associated prognostic factor (p = 0.01, OR = 5.12; CI95% [1.1-24.1]). CONCLUSIONS Posterior pelvic ring fractures treated by closed reduction and percutaneous fixation are associated with excellent/good clinical results if excellent/good reduction and bone healing are achieved without screw misplacement. Bilateral unstable vertical posterior pelvic ring injuries, and sacral dysmorphia are risk factors for bad quality reduction and screw misplacement respectively.
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Affiliation(s)
- Mehdi Boudissa
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France. .,Grenoble Alpes University, Grenoble, France. .,TIMC-IMAG lab, Univ. Grenoble Alpes, CNRS UMR, 5525, Saint-Martin-d'Hères, France.
| | - A Roudet
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - V Fumat
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - S Ruatti
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - G Kerschbaumer
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - M Milaire
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - P Merloz
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - J Tonetti
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France.,TIMC-IMAG lab, Univ. Grenoble Alpes, CNRS UMR, 5525, Saint-Martin-d'Hères, France
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11
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Yarboro SR, Hadeed MM, Vess EM, Weiss DB. A Locked Sacroiliac Joint Dislocation Requiring Open Reduction: A Case Report. JBJS Case Connect 2019; 9:e0384. [PMID: 31584908 DOI: 10.2106/jbjs.cc.18.00384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Vertically unstable pelvic ring injuries are often associated with sacroiliac (SI) joint subluxations or dislocations. The following report describes an irreducible SI joint dislocation where the ilium was locked in a position superior to the sacrum. This injury was refractory to initial closed reduction techniques and ultimately required an open reduction. CONCLUSIONS This report demonstrates the limitations of closed manipulation for some vertically unstable pelvic ring injuries. It is critical to have a strong understanding of the anatomy and typical manipulations to succeed in both closed and open SI joint reduction attempts.
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Affiliation(s)
- Seth R Yarboro
- Department of Orthopedics, University of Virginia, Charlottesville, Virginia
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12
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Kokubo Y, Oki H, Sugita D, Takeno K, Miyazaki T, Negoro K, Nakajima H. Functional outcome of patients with unstable pelvic ring fracture. J Orthop Surg (Hong Kong) 2017; 25:2309499016684322. [PMID: 28142352 DOI: 10.1177/2309499016684322] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate factors that correlated with unsatisfactory short- and long-term outcome in patients who sustained unstable pelvic ring fracture. The study subjects of this study were those of type B and C pelvic ring fractures (82 patients; mean age 54 years). Age, gender, associated injuries, fracture type, Injury Severity Score rating and treatment methods were assessed, and Majeed score for functional outcome and radiographic studies at 1 year after injury (short-term) and at final follow-up (long-term), with mean follow-up of 98 months were analyzed. Significant univariate factors ( p < 0.05) were entered in a multivariate logistic regression model to determine the independent predictors of unsatisfactory functional outcome. Univariate analysis showed that fractures of the lower extremity, nerve damage, conservative treatment, and radiological outcome correlated with unsatisfactory short-term functional outcome, while female gender, brain injury, nerve damage, conservative treatment, fracture location at the posterior portion of pelvic ring, radiological outcome, and pure sacroiliac dislocation only for type C fracture correlated with unsatisfactory long-term outcome. Multiple logistic regression analysis identified fractures of the lower extremity (odds ratio (OR): 5.364), conservative treatment (OR: 13.690), and nerve damage (OR: 21.392) as determinants of unsatisfactory short-term functional outcome and nerve damage (OR: 66.926) and poor radiological results (OR: 33.944) as determinant of long-term functional outcome. In patients with unstable pelvic ring injury, fractures of the lower extremity, conservative therapy, and nerve damage influenced short-term functional outcome, while that nerve damage and the pelvic ring displacement over 20 mm negatively affected long-term outcome.
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Affiliation(s)
- Yasuo Kokubo
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Hisashi Oki
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Daisuke Sugita
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Kenichi Takeno
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Kohei Negoro
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui, Faculty of Medical Sciences, Eiheiji, Fukui, Japan
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13
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Park SE, Lee SW, Kim WY, Park Y. Atypical Pelvic Crescent Fracture Caused by Vertical Shear Force. Hip Pelvis 2014; 26:194-7. [PMID: 27536580 PMCID: PMC4971147 DOI: 10.5371/hp.2014.26.3.194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022] Open
Abstract
The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by vertical shear injury and is characterized by posterior fracture-dislocations of the sacroiliac joint. In this case report, we review the literature on classification and treatment of atypical type of crescent fracture.
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Affiliation(s)
- Sang-Eun Park
- Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Se-Won Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Weon-Yoo Kim
- Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Yong Park
- Department of Orthopedic Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
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14
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Zong Z, Chen S, Jia M, Shen Y, Hua X, Liu D. Posterior iliac crescent fracture-dislocation: is it only rotationally unstable? Orthopedics 2014; 37:e435-40. [PMID: 24810819 DOI: 10.3928/01477447-20140430-53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
Posterior iliac crescent fracture-dislocation is generally considered rotationally unstable and vertically stable. The current study (1) investigated whether vertical instability may occur in posterior iliac crescent fracture-dislocation and (2) analyzed the clinical features of vertically unstable iliac crescent fracture-dislocation as well as treatment strategies. Patients with pelvic fracture who were treated in the authors' department from June 2009 to June 2012 were retrospectively reviewed. This study analyzed the clinical features, including incidence, hemodynamic state, associated injuries, injury severity score, and treatment methods for vertically unstable iliac crescent fracture-dislocation. Four patients had vertically unstable fracture-dislocation, accounting for 12.9% of all iliac crescent fracture-dislocations. All 4 patients were hemodynamically unstable on admission and had complications of associated injuries with a higher injury severity score. In 3 of the 4 patients, iliac crescent fracture-dislocations were reduced via the posterior approach at the initial stage and these patients underwent fixation with a plate. The remaining patient was initially given transcondylar traction because of severe complications and underwent open reduction and internal fixation (ORIF) via a posterior approach at a later stage. The outcomes of all 4 patients were rated as good or excellent by the Kobbe rating system at the last follow-up. Vertical instability may occur in iliac crescent fracture-dislocation. The authors propose ORIF of the fracture-dislocation via a posterior approach. When initial surgery is not possible because of severe associated organ injuries, the authors propose transcondylar traction to allow reduction of the sacroiliac joint and ORIF at a later stage.
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15
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Abstract
Pelvic ring disruption after trauma is uncommon, occurring in 20–37/100,000 people in the general population. However, in high velocity poly trauma up to 20% of cases have this injury contributing significantly to morbidity and mortality. The management of pelvic and acetabular trauma has become a subspecialty within the orthopaedic trauma care. The injury patterns are now better understood, there is agreement on a classification system and operative stabilisation has become a viable treatment option.
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Affiliation(s)
| | - Neil Ashwood
- Department of Orthopaedics, Queen’s Hospital, Burton upon Trent, UK
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16
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Ilharreborde B, Breitel D, Lenoir T, Mosnier T, Skalli W, Guigui P, Hoffmann E. Pelvic ring fractures internal fixation: iliosacral screws versus sacroiliac hinge fixation. Orthop Traumatol Surg Res 2009; 95:563-7. [PMID: 19910275 DOI: 10.1016/j.otsr.2009.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 07/21/2009] [Accepted: 08/28/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pelvic ring fractures are severe injuries whose functional results depend on the quality of reduction. Numerous internal fixation alternatives have been described, but the biomechanical studies comparing them remain rare. HYPOTHESIS This study compared the biomechanical behavior of iliosacral screws (ISS) with sacroiliac hinge type fixation (SIF) following unstable pelvic ring fractures fixation. MATERIALS AND METHODS A lesion simulating sacroiliac disruption and pubic disruption was created on 14 cadaver pelves. After randomization, the fractures were internally fixed using an anterior plate associated with either an ISS or an SIF. The specimens were then submitted to forces applied vertically at the coxofemoral joints. Relative movements in vertical translation and in rotation between the iliac wing and the sacrum, as well as the stiffness and the forces at failure of the assemblies were measured and compared. RESULTS The mean age of the bodies was 66 years (+/-8). No significant difference was demonstrated between the groups in terms of residual motion and stiffness in both vertical and rotational displacement. The results showed a slight residual mobility in rotation of the hemipelvis. The SIFs presented greater, although non significant resistance to failure. No fixation, however, restituted stiffness comparable to a healthy pelvis. DISCUSSION The results of this study show that a Tile C.1.2-type injury to the pelvic ring can be treated as effectively with ISS or SIF when combined anterior and posterior fixations are performed. SIF therefore seems reliable and its continued use is justified. The long-term clinical outcomes should nevertheless be evaluated, notably on the younger population, more often affected by this type of injury.
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Affiliation(s)
- B Ilharreborde
- Department of Orthopaedic Surgery and Traumatology, Beaujon Hospital, AP-HP, Paris 7 University, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France.
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