Surgical technique of percutaneous iliosacral screw fixation in S3 level in unstable pelvic fracture with closed degloving injury and morrell lavallee lesion: Two case reports

Iliosacral screw corridors in Japanese subjects: a study using reconstruction CT scans

Objectives:

To investigate the characteristics of iliosacral (IS) screw corridors of Japanese pelves.

Methods:

Computer tomography images of 42 adult Japanese subjects without any pelvic injury were analyzed at a workstation. Using the manual reconstruction function, the width of a simulated horizontal corridor for an IS screw on the true coronal and true axial planes in the upper (S1), second (S2), and the third (S3) sacral segments was measured. For pelves without an adequate S1 corridor, a cranially tilted corridor was sought. A corridor was defined as “adequate” if its width on both planes was 10 mm or more.

Results:

An adequate horizontal corridor was found in S1 in 17 (40.5%) subjects, in S2 in 29 (69.0%) subjects, and in S3 in no subject. An independent factor affecting the adequacy of the S1 corridor was the adequacy of the S2 corridor (OR: 0.09). Similarly, an independent factor affecting S2 adequacy was S1 adequacy (OR: 0.10). A tilted, 10 mm diameter corridor was found in all 25 subjects who did not have an adequate horizontal corridor in the S1 segment. The angle required to obtain a 10 mm diameter corridor inversely correlated with the diameter of a horizontal corridor on the true coronal plane (R = −0.713, P = .000).

Conclusions:

The characteristics of IS screw corridors in the 42 Japanese subjects were similar to those reported in previous studies conducted in the West. The importance of preoperative planning using reliable techniques, such as three-dimensional reconstruction, should be emphasized.

Level of evidence: Diagnostic Level III. See Instructions for Authors for a complete description of level of evidence.

A screw view model of navigation guided minimal invasive percutaneous pelvic screws insertion for lateral compression pelvic ring injuries: A case report

RATIONALE

The objective of the present study was to evaluate the accuracy, effectiveness, and safety of screw view model of navigation (SVMN) guided minimal invasive percutaneous pelvic screws (PPSs) insertion for lateral compression pelvic ring injuries (PRI).

PATIENT CONCERNS

A female patient experienced a high falling injury, and presented with pain, swelling, deformity, and movement limitation of the left hip for 3 hours.

DIAGNOSES

She was diagnosed with pelvic fractures, left iliac fracture, left pubic branch fracture, left ischial branch fracture, and lumbar transverse process fracture.

INTERVENTIONS

We used a SVMN technique to guide PPSs insertion, including a percutaneous anterior inferior iliac spine screw, a percutaneous iliac screw (PIS), and a percutaneous sacroiliac screw (PSIS).

OUTCOMES

In total, 3 PPSs were inserted and all were presented with excellent position postoperatively. The designing time of all screws was 11.7 minutes, the time of all guide needles insertion was 18.1 minutes, the time of all screws insertion was 32.8 minutes, blood loss was 21 mL, and the time of radiation exposure lasted 7.2 minutes. Moreover, surgical complications, including neurovascular compromise, wound infection, fracture nonunion, and screw loosening, were not observed during the 12 months follow up visit.

LESSONS

SVMN technique guided PPSs insertion is an effective and safety approach for the treatment of PRI in selected patients. Besides, it is necessary for surgeons to master the rationale of computer navigation, to familiar with the anatomy of pelvis and to select suitable patients.

Inaccuracies in the Use of the Majeed Pelvic Outcome Score: A Systematic Literature Review

OBJECTIVES

To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature.

DATA SOURCES

Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018.

STUDY SELECTION

Search words used were: Majeed, pelvis, and outcome.

DATA EXTRACTION

Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score.

DATA SYNTHESIS

Descriptive statistics were used to report the outcome of our findings.

CONCLUSIONS

Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.

A screw-view model of navigation aid retrograde transpubic screw fixation for anterior pelvic ring fracture: A case report with 28 months follow-up and technical note

RATIONALE

The purpose of this study was to evaluate the accuracy of a retrograde transpubic screw fixation assisted by a screw-view model of navigation in treating a pelvic fracture.

PATIENT CONCERNS

A 30-year-old female patient injured in a motor vehicle accident, displayed symptoms characterized by swelling and pain of the pudendum.

DIAGNOSES

The patient was diagnosed with a fracture of the pubic ramus.

INTERVENTIONS

We used a screw-view model of navigation to assist our retrograde transpubic screw fixation in this patient.

OUTCOMES

In total, 2 screws were inserted into the bilateral pubic ramus and both were excellently positioned. It took 7.4 minutes to design the screws, 8.1 minutes to implant the guidewire, and 39.3 minutes to place the screws. Intraoperative blood loss amounted to 21 mL and the total fluoroscopic time was 3.8 minutes. No clinical complications, such as neurologic, vascular, or urologic injury, infection, screw loosening, or loss of reduction, were found after the operation. Follow-up lasted 28 months.

LESSONS

The outcome of our study suggests that the screw-view model of navigation maximizes the retrograde transpubic screw insertion accuracy in the treatment of a pubic ramus fracture, which is made efficient by pain relief and early out-of-bed mobilization. Our suggestion is, therefore, that the relative position between the pubic ramus and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.