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Chien RS, Chen IJ, Lai CY, Chen JP, Yu YH. Critical distance of the sacroiliac joint for open reduction using screw fixation for traumatic sacroiliac joint diastasis: a retrospective study. J Orthop Surg Res 2024; 19:268. [PMID: 38678298 PMCID: PMC11055354 DOI: 10.1186/s13018-024-04759-z] [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: 12/28/2023] [Accepted: 04/21/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Osteosynthesis for sacroiliac joint (SIJ) diastasis using an iliosacral screw (ISS) and a trans-iliac-trans-sacral screw (TITSS) can be performed using a closed or an open method. However, no clear indication for open reduction has been established. METHODS Data on patients with unilateral traumatic SIJ diastasis who underwent ISS and TITSS fixation were retrospectively collected and separated into groups according to the reduction method: closed reduction group (C group) and open reduction group (O group). Demographic data and perioperative image assessments were compared between the groups. The critical distance of the SIJ was identified to elucidate the indication for open reduction of the diastatic SIJ. RESULTS Fifty-six patients met the inclusion criteria over a 3-year period. There was no significant difference in the reduction quality of pelvic ring injuries between the groups, according to Matta's and Lefaivre's criteria. The improvement in the SIJ distance was significantly greater in the O group than in the C group in the axial plane on multiplanar computed tomography (p = 0.021). This model predicted that a difference of > 3.71 mm between the injured and healthy SIJ was a recommended indication for open reduction, with an area under the curve of 0.791 (95% confidence interval 0.627-0.955, p = 0.004). CONCLUSIONS Open reduction for SIJ diastasis might achieve better reduction quality than does closed reduction in the axial plane in selected cases. When the difference between the injured and healthy SIJ was wider than 3.71 mm, open reduction was recommended for satisfactory radiological outcomes.
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Affiliation(s)
- Ruei-Shyuan Chien
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, 5, Fu-Hsin St. Kweishan, Taoyüan, 33302, Taiwan
| | - I-Jung Chen
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, 5, Fu-Hsin St. Kweishan, Taoyüan, 33302, Taiwan
| | - Chih-Yang Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, 5, Fu-Hsin St. Kweishan, Taoyüan, 33302, Taiwan
| | - Jui-Ping Chen
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, 5, Fu-Hsin St. Kweishan, Taoyüan, 33302, Taiwan
| | - Yi-Hsun Yu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, 5, Fu-Hsin St. Kweishan, Taoyüan, 33302, Taiwan.
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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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Hirschfeld M, Pascual-Lopez FJ, Guerado E. [Translated article] Spinopelvic dissociation: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00052-3. [PMID: 38336155 DOI: 10.1016/j.recot.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE To analyze the treatment indications based in classifications and surgery techniques. METHOD A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.
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Affiliation(s)
- M Hirschfeld
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain.
| | - F J Pascual-Lopez
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain
| | - E Guerado
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, Spain
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Lee Y, Lambrechts M, Narayanan R, Bransford R, Benneker L, Schnake K, Öner C, Canseco JA, Kepler CK, Schroeder GD, Vaccaro AR. The Surgical Algorithm for the AO Spine Sacral Injury Classification System. Spine (Phila Pa 1976) 2024; 49:165-173. [PMID: 37970681 DOI: 10.1097/brs.0000000000004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023]
Abstract
STUDY DESIGN Global cross-sectional survey. OBJECTIVE To establish a surgical algorithm for sacral fractures based on the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine Sacral Injury Classification System. SUMMARY OF BACKGROUND DATA Although the AO Spine Sacral Injury Classification has been validated across an international audience of surgeons, a consensus on a surgical algorithm for sacral fractures using the Sacral AO Spine Injury Score (Sacral AOSIS) has yet to be developed. METHODS A survey was sent to general orthopedic surgeons, orthopedic spine surgeons, and neurosurgeons across the five AO spine regions of the world. Descriptions of controversial sacral injuries based on different fracture subtypes were given, and surgeons were asked whether the patient should undergo operative or nonoperative management. The results of the survey were used to create a surgical algorithm based on each subtype's sacral AOSIS. RESULTS An international agreement of 70% was decided on by the AO Spine Knowledge Forum Trauma experts to indicate a recommendation of initial operative intervention. Using this, sacral fracture subtypes of AOSIS 5 or greater were considered operative, while those with AOSIS 4 or less were generally nonoperative. For subtypes with an AOSIS of 3 or 4, if the sacral fracture was associated with an anterior pelvic ring injury (M3 case-specific modifier), intervention should be left to the surgeons' discretion. CONCLUSION The AO Spine Sacral Injury Classification System offers a validated hierarchical system to approach sacral injuries. Through multispecialty and global surgeon input, a surgical algorithm was developed to determine appropriate operative indications for sacral trauma. Further validation is required, but this algorithm provides surgeons across the world with the basis for discussion and the development of standards of care and treatment.
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Affiliation(s)
- Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Richard Bransford
- Department of Orthopaedic and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Lorin Benneker
- Spine Unit, Sonnenhof Spital Bern, University of Bern, Bern, Switzerland
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Cumhur Öner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Beucler N. Spino-pelvic triangular fixation for unstable U-shaped sacral fractures and Tile C pelvic ring disruptions: The relentless pursuit of vertical, lateral, and anteflexion rotational stability. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100264. [PMID: 37711283 PMCID: PMC10497840 DOI: 10.1016/j.xnsj.2023.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, 83800 Toulon Cedex 9, France
- Ecole du Val-de-Grâce, French Military Health Service Academy, 1 place Alphonse Laveran, 75230 Paris Cedex 5, France
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Beucler N, Tannyeres P, Dagain A. Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review. Asian Spine J 2023; 17:1155-1167. [PMID: 38050362 PMCID: PMC10764139 DOI: 10.31616/asj.2023.0024] [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: 02/07/2023] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 12/06/2023] Open
Abstract
Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure.
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Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
- Ecole du Val-de-Grâce, French Military Health Service Academy, Paris,
France
| | - Paul Tannyeres
- Ecole du Val-de-Grâce, French Military Health Service Academy, Paris,
France
- Orthopaedic Surgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
| | - Arnaud Dagain
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, Toulon,
France
- Val-de-Grâce Military Academy, Paris,
France
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Migliorini F, Cocconi F, Schipper I, Ten Duis K, Marzi I, Komadina R, Hildebrand F, Wendt K. Arterial angioembolisation versus pre-peritoneal pelvic packing in haemodynamically unstable patients with complex pelvic fractures: a meta-analysis. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02389-4. [PMID: 37962595 DOI: 10.1007/s00068-023-02389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Angioembolisation (AE) and/or pre-peritoneal pelvic packing (PPP) may be necessary for patients with complex pelvic fractures who are haemodynamically unstable. However, it remains unclear whether AE or PPP should be performed as an initial intervention and ongoing debates exist. This meta-analysis aimed to compare AE versus PPP in haemodynamically unstable patients with acute pelvic fractures. The primary outcomes of interest were to compare in-hospital mortality rate and number of blood units transfused. Secondary outcomes included evaluating differences in the time from diagnosis to treatment, as well as the length of stay in the intensive care unit (ICU) and hospital. METHODS All clinically relevant studies comparing AE versus PPP in patients with complex pelvic fractures and haemodynamic instability were accessed. The 2020 PRISMA guidelines were followed. In September 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase, without constraint. RESULTS Data from 320 patients were collected (AE: 174; PPP: 146). The mean age on admission was 47.4 ± 7.2 years. The mean Injury Severity Score (ISS) on admission was 43.5 + 5.4 points. Baseline comparability was observed in ISS (P = 0.5, Table 3) and mean age (P = 0.7, Table 3). No difference was reported in mortality rate (P = 0.2) or rate of blood units transfused (P = 0.3). AE had a longer mean time to the procedure of 44.6 min compared to PPP (P = 0.04). The mean length of ICU and hospital stay were similar in both groups. CONCLUSION Despite the longer mean time from admission to the procedure, no significant differences were found between AE and PPP in terms of in-hospital mortality, blood units transfused, or length of ICU, and hospital stay. These findings should be interpreted considering the limitations of the present study. High-quality comparative research is strongly warranted. LEVEL OF EVIDENCE Level IV, meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Inger Schipper
- Department of Orthopaedic and Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kaj Ten Duis
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Ingo Marzi
- Department of Orthopaedic and Trauma Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Radko Komadina
- Department of Orthopaedic and Trauma Surgery, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Klaus Wendt
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Morita T, Takigawa T, Ishihara T, Taoka T, Ishimaru T, Kanazawa T, Tada K, Omori T, Yagata Y, Toda K, Nakago K, Ito Y. Minimally invasive surgery technique for unstable pelvic ring fractures with severe vertical shear displacement: A retrospective study. Orthop Traumatol Surg Res 2023; 109:103528. [PMID: 36565742 DOI: 10.1016/j.otsr.2022.103528] [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: 05/23/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unstable pelvic fractures, especially vertical shear fractures, require surgery for correct reduction, rigid fixation, and improved postoperative outcomes. Herein, we assess the effectiveness of our minimally invasive procedure for the management of unstable pelvic fractures. HYPOTHESIS We hypothesized that this procedure would be useful for the management of unstable pelvic fractures. PATIENTS AND METHODS This study included 28 patients with unstable pelvic fractures (vertical shear injuries; AO types C1-3) treated using minimally invasive surgery for spinopelvic fixation (MIS-SP) between 2014 and 2020 (mean follow-up time, 15 months). The MIS-SP requires four percutaneous pedicle screws and four iliac screw insertions. Subsequently, reduction and fixation are performed. RESULTS The mean preoperative displacement of the posterior pelvic elements in craniocaudal correction was 17.6 (range, 9.0-32.2) mm. The mean length of the craniocaudal reduction was 16.5 (8.1-30.1) mm, with a mean reduction rate of 93.5% (78%-100%). The mean length of the mediolateral reduction was 11.3 (3.9-19.6) mm, with a mean reduction rate of 87.3% (76%-100%). DISCUSSION Our novel reduction and fixation procedure is a powerful, minimally invasive option for the treatment of unstable pelvic ring fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takuya Morita
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan.
| | - Tomoyuki Takigawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takeshi Ishihara
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takuya Taoka
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takahiko Ishimaru
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Tomoko Kanazawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Keitaro Tada
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takao Omori
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yukihisa Yagata
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kazukiyo Toda
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kie Nakago
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yasuo Ito
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
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Hirschfeld M, Pascual-López FJ, Guerado E. Spinopelvic dissociation: Current concepts. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00193-5. [PMID: 37689352 DOI: 10.1016/j.recot.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION Spinopelvic dissociation is an uncommon injury, but, at the same time, very serious, since it can associate important complications with high morbidity and mortality. Its low frequency means that the experience of the specialists who have to deal with it is often very limited. OBJECTIVE To analyze the treatment indications based in classifications and surgery techniques. METHOD A search for scientific articles from high-impact journals was performed through international databases, such as Pubmed, Cochrane Library, Scopus, Science Direct and OVID. CONCLUSIONS The management of the injury we are analyzing represents a challenge. The diagnosis is carried out through a meticulous anamnesis and physical examination, supported by imaging tests, where tomography acquires special relevance. The treatment is fundamentally surgical, reserved the conservative option for a few cases. Triangular fixation is nowadays considered the treatment of choice.
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Affiliation(s)
- M Hirschfeld
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España.
| | - F J Pascual-López
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España
| | - E Guerado
- Hospital Universitario Costa del Sol, Facultad de Medicina, Universidad de Málaga, España
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10
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Baksh N, Yeung C, Vaynrub M. Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23205. [PMID: 37581594 PMCID: PMC10555589 DOI: 10.3171/case23205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Because patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instability is uncommon and often underdiagnosed. Although most sacral fractures are stable, patients with unstable U- or H-type fractures have spinopelvic dissociation and can experience progressive pain, sacral kyphosis, and neurological injury. Open lumbopelvic fusion carries a high perioperative risk for this patient population, which has often been previously radiated and is medically frail. The authors investigated the utility and safety of percutaneous lumbopelvic fixation, as previously described for traumatic spinopelvic dissociation, in the oncological setting. The authors retrospectively reviewed five consecutive patients with unstable pathologic sacral fractures who had undergone percutaneous lumbopelvic fixation after conservative management failed. OBSERVATIONS Patients experienced significant improvement between pre- and postoperative visual analog scale scores (9.2 and 1.6, respectively) and Eastern Cooperative Oncology Group grades (median 3 and 1, respectively). All patients were independently ambulatory at the final follow-up. Sagittal alignment remained stable in four patients and worsened in one. There were no major medical or surgical complications. LESSONS Percutaneous lumbopelvic fixation shows promising results for palliation, durability, and safety for pathologic sacropelvic instability.
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Altwaijri NA, Abdulaziz M, Bhat R, Ellafi A, Alhabdan KA. Spinopelvic Dissociation Case Report and Literature Review. Cureus 2023; 15:e39750. [PMID: 37398760 PMCID: PMC10310894 DOI: 10.7759/cureus.39750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
A 32-year-old male was brought to our emergency department following trauma due to fall of heavy object (tree) on his back. After Advanced Trauma Life Support (ATLS) protocol implementation, the patient was noted to have a complete perianal tear and loss of power in L3-S1 measuring 1/5 complete loss of sensation below the level of L2. Imaging showed spinopelvic dissociation with cauda equina syndrome. Spinopelvic fixation and fusion with rigid fixation done. The patient regained normal function following extensive physiotherapy. This paper concludes that good and prompt surgical intervention facilitated neurological recovery following decompression.
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Affiliation(s)
| | | | - Rafiq Bhat
- Orthopedic Surgery, King Saud Medical City, Riyadh, SAU
| | - Ahmad Ellafi
- Orthopedic Surgery, King Saud Medical City, Riyadh, SAU
| | - Khaled A Alhabdan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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El-Hamalawy AG, Abdel Karim M, Khaled SA, Abdel-Kader KFM, Kassem E. Minimally invasive stabilization of posterior pelvic ring injuries through transiliac internal fixator versus Iliosacral screw: A prospective comparative cohort study. Injury 2023; 54:S0020-1383(23)00175-4. [PMID: 36878734 DOI: 10.1016/j.injury.2023.02.042] [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: 09/03/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Longitudinal sacral fractures are usually a matter of controversy regarding decision-making for reduction, fixation, and approach. Percutaneous and minimally invasive techniques present perioperative difficulties, but with fewer postoperative complications compared to open techniques. The objective of this study was to compare the functional as well as radiological outcomes of the Transiliac Internal fixator (TIFI) versus Iliosacral screw (ISS) fixation of sacral fractures applied percutaneously in a minimally invasive technique. METHODS A Prospective comparative cohort study was conducted in a level 1 trauma center in a university hospital. The study included 42 patients with complete sacral fractures, 21 patients have been allocated to each group (TIFI group & ISS group). The clinical, functional, as well as radiological data, were collected and analyzed for the 2 groups. RESULTS The mean age was 32 (18 -54 years), and the mean follow-up was 14 (12 -20 months). There was a statistically significant difference in favor of the TIFI group regarding a shorter operative time (P = 0.04) as well as less fluoroscopy time (P = 0.01) whereas there was less blood loss in the ISS group (P = 0.01). Both the mean Matta's radiological score, the mean Majeed score as well as the pelvic outcome score were comparable between the 2 groups with no statistically significant difference. CONCLUSION This study suggests that both TIFI and ISS through a minimally invasive technique represent valid methods for sacral fracture fixation with a shorter operative time, less radiation exposure in TIFI and less blood loss in the ISS. However, the functional, as well as radiological outcomes, were comparable between the 2 groups.
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Affiliation(s)
| | | | - Sherif A Khaled
- Professor of Trauma and Orthopaedic Surgery, Cairo University, Egypt
| | | | - Elsayed Kassem
- Associate Professor of Trauma and Orthopaedic Surgery, Cairo University
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Kassem E, Khaled SA, Karim MA, El-Hamalawy AG, Fahmy M. Does minimally invasive percutaneous transilial internal fixator became an effective option for sacral fractures? A prospective study with novel implantation technique. Eur J Trauma Emerg Surg 2023; 49:1535-1544. [PMID: 36693947 DOI: 10.1007/s00068-022-02212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
AIM To assess radiological and functional outcomes of transilial internal fixator (TIFI) for treatment of sacral complete transforaminal fractures with a novel implantation technique that decrease wound irritation problems in addition to facilitating easy application of reduction methods beside showing the best entry points, screw trajectories and angles. METHODS A Prospective case series from 2019 to 2021 was conducted at university hospital including 72 patients with Denis type 2 sacral fractures. The operative and fluoroscopy time, reduction, implantation techniques, postoperative radiological and functional data were collected and evaluated with minimum follow-up of 12 months. RESULTS The mean initial fracture displacement was 4.42 mm while mean postoperative maximum residual fracture displacement was 2.8 mm, Radiological outcome assessed using Matta's grading at the final follow-up visit with 63 cases scored as Excellent,7 cases as Good, 2 cases as fair. Functional outcome using Majeed scoring shows 64 cases of Excellent grading and 8 cases were Good. Short operative and fluoroscopy time, easy reduction techniques, few skin problems were recorded. CONCLUSION TIFI through a minimally invasive technique represents a valid method for dealing with transforaminal sacral fractures. TIFI provides a rigid fixation for posterior ring injuries with few risks regarding iatrogenic nerve injury, avoiding different variations of upper sacral osseous anatomy or sacral dysmorphism. In addition, there is no necessity for high quality fluoroscopy for visualization of sacral foramina intraoperatively, decreasing risk of radiation exposure, unlike other methods of fixation as iliosacral screws. Our novel modification for implantation technique provides few risks for postoperative and wound complications.
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Affiliation(s)
- Elsayed Kassem
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt
| | - Sherif A Khaled
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud Fahmy
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt.
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Xu D, Lou W, Li M, Xiao J, Wu H, Chen J. Current status of robot‐assisted surgery in the clinical application of trauma orthopedics in China: A systematic review. Health Sci Rep 2022; 5:e930. [DOI: 10.1002/hsr2.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Ming Li
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jingwei Xiao
- Department of Surgery Ningbo University Medical College Ningbo China
| | - Hongbao Wu
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery Ningbo No. 6 Hospital Ningbo China
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Yanagisawa Y, Kotaki T, Nakajima S, Uesugi M, Yamazaki M. Set-screw loosening of spinopelvic crab-shaped fixation for a patient with vertically unstable pelvic ring fracture. Trauma Case Rep 2022; 42:100725. [PMID: 36311280 PMCID: PMC9597112 DOI: 10.1016/j.tcr.2022.100725] [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: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Spinopelvic fixation (SPF) is an effective treatment method for vertically unstable pelvic ring fractures with spinopelvic dissociations (Patel et al., 2022). A heavy container fell on a 35-year-old man who was trapped and sustained injuries. His pelvic ring fracture dislocation was identified as AO Classification 61-C2.3 with rotational and vertical unstable pelvic ring; thus, crab-shaped fixation (SPF modification) was performed (Okuda et al., 2019). The pelvic fracture was fused, and the clinical outcome was good with modified Majeed score of 96. However, set-screw loosening was observed during the postoperative course. Reports of implant failures in SPF for unstable pelvic ring fractures commonly occur. However, only a few reports have demonstrated implant failure of crab-shaped fixation. Written informed consent was obtained from the patient for publication of this case report and accompanying images.
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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,Corresponding author at: Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Tomomi Kotaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Shun Nakajima
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masafumi Uesugi
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190 Sakai, Ibaraki 306-0433, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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