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Sevillano-Perez E, Prado-Novoa M, Postigo-Pozo S, Peña-Trabalon A, Guerado E. L4 fixation is not necessary in L5-Iliac spinopelvic fixation after trauma, but coadjutant transilio-transsacral fixation is. Injury 2024; 55:111378. [PMID: 38309085 DOI: 10.1016/j.injury.2024.111378] [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: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Spinopelvic dissociation (SPD) is a severe injury characterized by a discontinuity between the spine and the bony pelvis consisting of a bilateral longitudinal sacral fracture, most of the times through sacral neuroforamen, and a horizontal fracture, usually through the S1 or S2 body. The introduction of the concept of triangular osteosynthesis has shown to be an advance in the stability of spinopelvic fixation (SPF). However, a controversy exists as to whether the spinal fixation should reach up to L4 and, if so, it should be combined with transiliac-transsacral screws (TTS). OBJECTIVE The purpose of this study is to compare the biomechanical behavior in the laboratory of four different osteosynthesis constructs for SPD, including spinopelvic fixation of L5 versus L4 and L5; along with or without TTS in both cases. MATERIAL AND METHODS By means of a formerly described method by the authors, an unstable standardized H-type sacral fracture in twenty synthetic replicas of a male pelvis articulated to the lumbar spine, L1 to sacrum, (Model: 1300, SawbonesTM; Pacific Research Laboratories, Vashon, WA, USA), instrumented with four different techniques, were mechanically tested. We made 4 different constructs in 5 specimen samples for each construct. Groups: Group 1. Instrumentation of the L5-Iliac bones with TTS. Group 2. Instrumentation of the L4-L5-Iliac bones with TTS. Group 3. Instrumentation of L5-Iliac bones without TTS. Group 4: Instrumentation of L4-L5-Iliac bones without TTS. RESULTS AND CONCLUSIONS According to our results, it can be concluded that in SPD, better stability is obtained when proximal fixation is only up to L5, without including L4 (alternative hypothesis), the addition of transiliac-transsacral fixations is essential.
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Affiliation(s)
| | - Maria Prado-Novoa
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Sergio Postigo-Pozo
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Alejandro Peña-Trabalon
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Enrique Guerado
- School of Medicine, University of Malaga, Malaga, Spain; Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, Marbella Malaga, Spain.
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Yu YH, Tsai PJ, Liu CH, Chen IJ, Hsu YH, Chou YC, Tseng IC. Causes of Increased Use of Closed Reduction and Internal Fixation for High-Energy-Related Traumatic Sacral Fractures. World J Surg 2023; 47:903-911. [PMID: 36567348 PMCID: PMC9971072 DOI: 10.1007/s00268-022-06876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Reasons for the increased use of closed reduction and internal fixation (CRIF) for traumatic sacral fractures (SFs) are unclear in the literature. Therefore, we aimed to report the annual changes in the number of patients, mechanisms of injury, fracture patterns, and fixation methods. METHODS In this retrospective study, we extracted data of 271 patients (mean age, 37.5 years) from the trauma register over an 8-year period. Annual records regarding the number of patients, injury mechanisms, fracture types, and treatment options were statistically analyzed to examine the interactions among these factors. RESULTS The number of patients with SFs increased significantly each year. The rate of admission to the intensive care unit after resuscitation was high (64.9%). Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C pelvic ring injury (PRI), Dennis zone II injury, Roy-Camille type 2 injury, and U/H-type injury were the most common fracture types. Trans-iliac trans-sacral screws were mainly used in AO type B PRI, and their use significantly increased each year. For AO type C PRI, open reduction and internal fixation (ORIF) with rigid fixation was the main treatment, and the use of CRIF with iliosacral screws decreased each year. Stepwise statistical analysis revealed that the increase in AO type B PRI and ORIF for anterior PRI were the factors contributing to the increased use of CRIF for SFs. CONCLUSIONS While the use of osteosynthesis for SFs is increasing, an increased use of CRIF for traumatic SFs has also been observed in clinical practice. This increase can be attributed to the increase in AO type B PRIs and ORIF for anterior PRIs.
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Affiliation(s)
- Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302, Taiwan.
| | - Ping-Jui Tsai
- grid.145695.a0000 0004 1798 0922Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302 Taiwan
| | - Chang-Heng Liu
- grid.145695.a0000 0004 1798 0922Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302 Taiwan
| | - I.-Jung Chen
- grid.145695.a0000 0004 1798 0922Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302 Taiwan
| | - Yung-Heng Hsu
- grid.145695.a0000 0004 1798 0922Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302 Taiwan
| | - Ying-Chao Chou
- grid.145695.a0000 0004 1798 0922Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, 33302 Taiwan
| | - I.-Chuan Tseng
- grid.413801.f0000 0001 0711 0593Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan, Taiwan
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He L, Gong S, Li T, Gu M, Xu Z, Chen H, Yi C. Pelvic incidence-guided reduction in transverse parts of U-shaped sacral fractures: Technical recommendations. J Orthop Surg (Hong Kong) 2022; 30:10225536221143551. [PMID: 36450299 DOI: 10.1177/10225536221143551] [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] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The purpose of this study is to present a surgical technique that simultaneously reduces and fixates the transverse parts of U-shaped sacral fractures. METHODS The sacral fracture was exposed through a posterior median approach. In a flexion injury, the rotation of the lower sacral segment is reduced by distraction along a pre-curved rod. Then, lordotic restoration is performed with a Weber clamp placed at the lower sacral segment through dragging. In an extension injury, longitudinal distraction is performed along the spinopelvic rod to reduce the vertical displacement. Next, the transverse displacement is reduced by a dissector placed between the upper and lower sacral segments through levering. The sagittal reduction on the lateral pelvic view was judged by PI. A regression analysis of Oswestry disability index (ODI) with Z-scores of PI, lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) was performed. RESULTS At the 1-year follow-up, the average PI, LL, SS, and PT values were 51.6 (range: 43.1-76.0), 44.8 (34.6 - 60.1), 35.4 (18.1 - 48.0), and 16.7 (2.2-35.4) degrees, respectively. All patients were able to maintain an upright stance. The average ODI was 27.6% (2-72%). Surprisingly, the regression analysis demonstrated a significant linear relationship between ODI and LL (R2 = 0.367, p = .048) but not between ODI and PI (R2 = 0.227, p = .138). CONCLUSIONS Using PI as guidance, the surgical procedures were helpful to reduce the PI of transverse sacral fractures into the normal range. However, the relationship between PI and the prognosis remains to be evaluated by future researches.
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Affiliation(s)
- Li He
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Song Gong
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
| | - Hua Chen
- The Department of Orthopaedic Trauma, Chinese PLA General Hospital, Beijing, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Medical College, Tongji Hospital, Ringgold: 66375Huazhong University of Science and Technology, Wuhan, China
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Luo Y, Li Y, He L, Yin E, Gu M, Xu Z, Chen H, Hou Z, Yi C. Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures. Injury 2022; 54 Suppl 2:S8-S14. [PMID: 35180997 DOI: 10.1016/j.injury.2022.02.022] [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: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures. METHODS From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up. RESULTS Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort. CONCLUSION LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Chen
- Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Linhart C, Befrui N, Etzel L, Böcker W, Kammerlander C, Ehrnthaller C. Jumper's fracture of the sacrum: a novel and reproducible way for successful reduction and fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:18-27. [PMID: 34609616 DOI: 10.1007/s00586-021-07010-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgical treatment of jumper's fractures is a highly demanding situation for the surgeon due to its rareness and frequent association with severe concomitant injuries. There is no current consensus regarding a standard treatment approach, thus reducing quality of care. Our objectives were to describe, apply and assess a novel surgical technic. METHODS The presented research is an observational retrospective study of patients who underwent the described novel surgical intervention in a level 1 trauma center. We conducted analyses of the patient cohort using patient-related outcome measures at least 1 year after surgery, as well as investigating pain, quality of life and the clinical effectiveness of the procedure. RESULTS A total of 24 patients (17 male and 7 female) with an average age 47 ± 16.3 years were included. ISS scores ranged from 9 to 66 with a mean ISS of 40 ± 15. Clinical scores exist of 15 out of 24 patients (62.5%). The mean VAS score was 53.7 ± 12.9. The mean EQ-5D index was 0.68 ± 0.22. Significant negative correlation existed between the ISS value and the EQ-5D index (r = - 0.704; p < 0.005) and EQ-5D VAS (r = - 0.809; p < 0.001). Anatomical reduction was achieved in all patients (n = 24). Radiological follow-up was performed in 58%. CONCLUSION We present one of the largest studies with operatively treated jumper's fractures of the sacrum. The technique is capable of reproducibly restoring the physiological anatomy of the patient and allows pain-adapted mobilization.
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Affiliation(s)
- Christoph Linhart
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nima Befrui
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Lucas Etzel
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Ehrnthaller
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
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Liu Z, Gu Y, Jin X, Tian W, Qi H, Sun Y, Li G, Wang H, Xiao X, Li P, Hu Y, Jia J. Comparison of Outcomes Following TiRobot-Assisted Sacroiliac Screw Fixation with Bone Grafting and Traditional Screw Fixation without Bone Grafting for Unstable Osteoporotic Sacral Fracture: A Single-Center Retrospective Study of 33 Patients. Med Sci Monit 2021; 27:e932724. [PMID: 34556623 PMCID: PMC8480221 DOI: 10.12659/msm.932724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This retrospective study from a single center aimed to compare patient outcomes following TiRobot-assisted sacroiliac screw fixation and bone grafting with traditional screw fixation without bone grafting in 33 patients with unstable osteoporotic sacral fracture (UOSF). MATERIAL AND METHODS Patients with UOSF were included and divided into 2 groups: a TiRobot-assisted surgical group with 18 patients (robot-aided sacroiliac screw fixation and bone grafting) and a standard surgical group with 15 patients (free-hand screw fixation without bone grafting). T values of bone mineral density (BMD) £-2.5 standard deviation (SD) were diagnosed as osteoporosis. Screw positioning and fracture healing time were evaluated. Functional outcomes were investigated at the final follow-up. RESULTS There were no statistically significant differences in screw positioning; however, there were satisfactory positioning rates in 94.4% (17/18) of patients in the TiRobot-assisted surgical group and 73.3% (11/15) in the standard surgical group. The advantages with TiRobot on surgical time of screw placement, fluoroscopy frequency, and total drilling times were noted (P=0.000). The nonunion rates were 5.6% (1/18) in the TiRobot-assisted surgical group and 33.3% (5/15) in the standard group (P=0.039). Healing time in the union cases had a significant difference (P=0.031). Functional outcome scores in the TiRobot-assisted surgical group were superior to that in the standard group (P=0.014). CONCLUSIONS The findings showed that TiRobot-assisted sacroiliac screw fixation and bone grafting was a safe and effective surgical treatment option that had a reduced radiation dose and improved fracture healing, when compared with standard screw fixation without bone grafting.
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Affiliation(s)
- Zhaojie Liu
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Ya Gu
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Xin Jin
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Wei Tian
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Haotian Qi
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Yuxi Sun
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Gang Li
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Hongchuan Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Xiang Xiao
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Pengfei Li
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Yongcheng Hu
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
| | - Jian Jia
- Department of Orthopedics, Tianjin Hospital, Tianjin, China (mainland)
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Campbell ST, Firoozabadi R. Delayed Displacement of a Subtle Sacral Insufficiency Fracture Unmasking Lumbopelvic Instability: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00063. [PMID: 33764910 DOI: 10.2106/jbjs.cc.20.00329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE There is limited literature reporting on sacral insufficiency fractures as a cause of lumbopelvic instability. We describe the presentation, treatment, and clinical outcome with a 2-year follow-up of a woman who sustained a low-energy spinopelvic dissociation diagnosed with magnetic resonance imaging. There was significant delayed displacement, and the patient was treated surgically with percutaneous iliosacral and trans-sacral screws. CONCLUSION U-type sacral insufficiency fractures may be subtle on advanced imaging and must be followed closely if nonoperative treatment is chosen. These patients may require surgical intervention. Iliosacral screws and lumbopelvic fixation are treatment options, each with advantages and disadvantages.
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Affiliation(s)
- Sean T Campbell
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY
| | - Reza Firoozabadi
- Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, Washington
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Liu ZJ, Hu YC, Tian W, Jin X, Qi HT, Sun YX, Jia J. Robot-Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation. Orthop Surg 2021; 13:563-572. [PMID: 33665983 PMCID: PMC7957401 DOI: 10.1111/os.12908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023] Open
Abstract
Objective To investigate the surgical strategy, safety, and efficacy of close reduction and robot‐aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. Methods Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot‐aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow‐up. Results There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow‐up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015). Conclusions Robot‐aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.
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Affiliation(s)
- Zhao-Jie Liu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Wei Tian
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xin Jin
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Hao-Tian Qi
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Yu-Xi Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Jian Jia
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation. Sci Rep 2020; 10:14878. [PMID: 32913181 PMCID: PMC7483410 DOI: 10.1038/s41598-020-71498-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/11/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.
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Schubert I, Höch A, Pöppelmeier O, Josten C, Strohm PC. U-Frakturen des Os sacrum – Wie therapiert man richtig? Unfallchirurg 2020; 123:896-903. [DOI: 10.1007/s00113-020-00842-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mohd Asihin MA, Bajuri MY, Ahmad AR, Ganaisan PK, Fazir M, Salim AA. Spinopelvic Fixation Supplemented With Gullwing Plate for Multiplanar Sacral Fracture With Spinopelvic Dissociation: A Case Series With Short Term Follow Up. Front Surg 2019; 6:42. [PMID: 31380389 PMCID: PMC6659408 DOI: 10.3389/fsurg.2019.00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/01/2019] [Indexed: 12/03/2022] Open
Abstract
We describe a series of three patients who sustained multiplanar sacral fracture with spinopelvic dissociation treated with bilateral triangle osteosynthesis supplemented with a gullwing plate. Multiplanar sacral fracture causes the sacrum to divide into two parts which in severe cases, fracture displacement results in neurological injury. Spinopelvic fixation supplemented with a gullwing plate surgical treatment is still a viable option with an acceptable outcome. The average waiting time prior to surgery is 3 weeks.
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Affiliation(s)
| | - Mohd Yazid Bajuri
- Department of Orthopedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Hospital Canselor, Kuala Lumpur, Malaysia
| | - Abdul Rauf Ahmad
- Department of Orthopedic, Hospital Tuanku Ja'afar, Seremban, Malaysia
| | | | - Mohamad Fazir
- Department of Orthopedic, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Azizul Akram Salim
- Department of Orthopedic, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
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Zhang R, Yin Y, Li S, Li A, Hou Z, Zhang Y. Lumbopelvic Fixation Versus Novel Adjustable Plate for Sacral Fractures: A Retrospective Comparative Study. J INVEST SURG 2019; 33:784-792. [PMID: 30885021 DOI: 10.1080/08941939.2019.1569737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this study is to compare the therapeutic effects of the lumbopelvic technique and a novel adjustable plate for sacral fractures. Materials and Methods: Patients with unilateral sacral fractures fixed via the lumbopelvic technique or using a novel adjustable plate from June 2011 to June 2017 were recruited into this study and were divided into two groups: group A (lumbopelvic fixation) and group B (novel adjustable plate). Surgical time, intraoperative blood loss, frequency of intraoperative fluoroscopy, reduction quality, and related complications were reviewed. Fracture healing was assessed by the radiographs conducted at follow-up. Functional outcome was evaluated according to the Majeed score at the final follow-up. Results: The mean blood loss and frequency of intraoperative fluoroscopy in group B were reduced compared with group A (both P < 0.001). The mean surgical time was 122.22 ± 13.09 minutes in group A and 103.96 ± 24.80 minutes in group B (P = 0.007). All patients healed well in this study, and no difference in the fracture healing time was noted between the two groups (P = 0.685). Satisfactory rates of reduction quality and functional outcome did not differ (both P > 0.05) in this study. The complication rate was 22.22% (4/18) in group A and 4.16% (1/24) in group B (P = 0.191). Conclusion: For patients with unilateral sacral fractures, satisfactory radiographic appearance and functional outcome could be obtained by both the lumbopelvic technique and a novel adjustable plate. However, the novel adjustable plate represents a less invasive technique with lower radiograph exposure.
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Affiliation(s)
- Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Shilun Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Ao Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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