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Rovere G, De Mauro D, Smakaj A, Sassara G, De Vitis R, Farsetti P, Camarda L, Maccauro G, Liuzza F. Triangular osteosynthesis and lumbopelvic fixation as a valid surgical treatment in posterior pelvic ring lesions: a systematic review. Front Surg 2024; 11:1266393. [PMID: 38456170 PMCID: PMC10917920 DOI: 10.3389/fsurg.2024.1266393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
Objective Unstable fractures of the sacrum often occur in patients with pelvic fractures and represent a real challenge for the orthopedic surgeon. Triangular osteosynthesis (TOS) and lumbopelvic fixation (LP) may represent a valid management option for the treatment of this condition. We present a systematic literature review about lumbopelvic fixation and triangular fixation as treatment option for unstable sacral fractures, to assess clinical and radiological outcomes after surgery and to evaluate appropriate indications and impact on the natural history of sacral fractures. Methods The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 50 articles out of 108 titles, were considered eligible for the full-text analysis. Finally, 16 studies that met inclusion criteria were included in this review. Results Overall, 212 patients (87 males, 58 females) with sacral fractures treated with TOS triangular fixation or LP lumbopelvic fixation were collected. The mean age was 37.6 years. Mean follow-up reported in all studies was 24.14 months. Conclusion The results presented by the different authors, highlight the effectiveness of TOS triangular fixation and LP lumbopelvic fixation for the treatment of unstable sacral fractures associated with other pelvic fractures, in terms of function, stability, cost-effectiveness, and quality of life postoperatively.
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Affiliation(s)
- Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico De Mauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Sassara
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco De Vitis
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Rome, Italy
| | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, Palermo, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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Salášek M, Český R, Whitley A, Šídlo K, Klézl P, Džupa V. Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies. Int Orthop 2023; 47:1331-1344. [PMID: 36867255 PMCID: PMC10079748 DOI: 10.1007/s00264-023-05719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic ring fractures requiring surgical stabilization are severe injuries. Surgical site infections occurring after stabilization of the pelvis are serious complications, requiring complex and multidisciplinary treatment. METHODS This is a retrospective observational study from a level I trauma centre. One hundred and ninety-two patients who underwent stabilization of closed pelvic ring injuries without signs of pathological fracture were selected for inclusion into the study. After excluding seven patients for having incomplete data, the final study group consisted of 185 patients (117 men and 68 women). Basic epidemiologic data and potential risk factors were recorded and analyzed by Cox regression, Kaplan-Meier curves, and risk ratios in 2 × 2 tables. Categorical variables were compared by Fisher exact tests and chi squared tests. Parametric variables were analyzed with Kruskal-Wallis tests with post hoc Wilcoxon tests. RESULTS Surgical site infections occurred in 13% of the study group (24 from 185). Eighteen infections occurred in men (15.4%) and six in women (8.8%). There were two significant risk factors in women: age over 50 years (p = 0.0232) and concomitant urogenital trauma (p = 0.0104). The common risk ratio for both these factors was 212.59 (8.78-5148.68), p = 0.0010. No significant risk factors were identified in men despite younger men having a higher incidence of infection (p = 0.1428). CONCLUSION Overall rate of infectious complications was higher than in the literature, but this might be caused by inclusion of all patients regardless of surgical strategy. Higher age in women and lower age in men were associated with higher infection rates. Concomitant urogenital trauma was a significant risk factor in women.
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Affiliation(s)
- Martin Salášek
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic. .,New Technologies for the Information Society, Faculty of Applied Sciences of University of West Bohemia, Alej Svobody 80, 304 60, Plzeň, Czech Republic.
| | - Richard Český
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Kryštof Šídlo
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Klézl
- Department of Urology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Valér Džupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine of Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Shi B, Peng Y, Zhang G, Zhang S, Luo Y, Lv F, Hu Y, Zhang L. Spinopelvic dissociation: extended definition, physical examination, classification, and therapy. J Orthop Surg Res 2023; 18:56. [PMID: 36658546 PMCID: PMC9854108 DOI: 10.1186/s13018-023-03523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. METHODS Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. RESULTS The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. CONCLUSION The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.
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Affiliation(s)
- Bin Shi
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Ye Peng
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Gongzi Zhang
- grid.414252.40000 0004 1761 8894Department of Rehabilitation Medicine, Chinese PLA General Hospital, Beijing, 100853 People’s Republic of China
| | - Shuwei Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Yang Luo
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Faqin Lv
- grid.414252.40000 0004 1761 8894Department of Ultrasonography, The No. 3 Medical Center of Chinese PLA General Hospital, Beijing, 100039 People’s Republic of China
| | - Ying Hu
- grid.9227.e0000000119573309Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055 People’s Republic of China
| | - Lihai Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
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Liu ZJ, Gu Y, Jia J. Robotic guidance for percutaneous placement of triangular osteosynthesis in vertically unstable sacrum fractures: a single-center retrospective study. J Orthop Surg Res 2023; 18:8. [PMID: 36597117 PMCID: PMC9811800 DOI: 10.1186/s13018-022-03489-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of robot-aided percutaneous triangular osteosynthesis combined with close reduction for vertically unstable sacrum fractures (VUSFs). METHODS The data on 21 patients of the VUSF were retrospectively analyzed from November 2016 to January 2021. According to Denis classification, there were 3 cases in zone I, 11 cases in zone II, and 7 case in zone III. The main perioperative indicators were recorded. The maximal angulation and displacement deviations of the screws were analyzed by comparing the planned trajectory with the actual position. Postoperative X-ray radiographs and CT scans were obtained for evaluating the reduction quality. Functional outcome was scored with Majeed criterion. RESULTS Fourteen patients of the unilateral VUSF and 7 patients of the bilateral VUSF underwent unilateral and bilateral triangular osteosynthesis with robotic assistance, respectively. No intraoperative neurovascular injuries and postoperative infection occurred. All patients were followed up for at least 12 months. The average operation time of posterior pelvic ring was 111.4 min, with the mean intraoperative bleeding of 110.5 ml. A total of 58 pedicle and iliosacral screws were implanted with robotic assistance. Of those, 52 screws were in the cancellous bone except 4 pedicle and 2 iliosacral screws cutting the cortical bone. The angulation and displacement deviations of the screws were 4.2° ± 2.5° and 1.7 ± 0.9 mm, respectively. The average displacement of the sacral fracture was reduced from 19.7 mm preoperatively to 3.1 mm postoperatively. According to Matta's criterion, the reduction quality was graded as "excellent" in 13 patients and "good" in 8. All sacral fractures healed within 6 months except one fracture with nonunion. The mean Majeed score at the last follow-up was 89.6. CONCLUSIONS Robot-aided triangular osteosynthesis combined with close reduction provide a safe and reliable option for percutaneous treatment of the fresh VUSF, with a high accuracy of iliosacral and pedicle screw implantation except insertion of iliac screws. Meanwhile, the technique may help to reduce incision-related complications.
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Affiliation(s)
- Zhao-Jie Liu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Ya Gu
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
| | - Jian Jia
- grid.417028.80000 0004 1799 2608Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211 China
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Tsai YT, Chou YC, Wu CC, Yeh TT. Traditional versus Minimally Invasive Spinopelvic Fixation for Sacral Fracture Treatment in Vertically Unstable Pelvic Fractures. J Pers Med 2022; 12:jpm12020262. [PMID: 35207750 PMCID: PMC8876864 DOI: 10.3390/jpm12020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Numerous different fixation techniques are used to treat vertical shear sacral fractures. We report our experience with spinopelvic fixation using a minimally invasive technique. Methods: Thirty-eight patients with vertical pelvic and sacral fractures were treated with spinopelvic fixation (traditional open method, n = 21; minimally invasive technique, n = 17). Intergroup comparisons and statistical analysis were performed for intraoperative blood loss, operative time, post-operative radiographic grading, post-operative functional score, and complication rates. Results: Patients treated with the minimally invasive technique had a significantly shorter operative time (−52 min, p = 0.022), reduced blood loss volume (−287 mL, p < 0.001), and better cosmetic appearance (p < 0.05) than those in the traditional open group. There were no significant intergroup differences in post-operative radiographic grading (p = 0.489) or post-operative functional scores (p = 0.072). The complication rate was lower in the minimally invasive group (1/17 patients) than in the traditional open group (2/21 patients). Conclusions: Minimally invasive spinopelvic fixation is a viable treatment for sacral fractures and can reduce blood loss and operative time.
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Affiliation(s)
- Yao-Tung Tsai
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-T.T.); (C.-C.W.)
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 11490, Taiwan;
| | - Chia-Chun Wu
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-T.T.); (C.-C.W.)
| | - Tsu-Te Yeh
- Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-T.T.); (C.-C.W.)
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
- Correspondence: ; Tel.: +886-2-8792-7185; Fax: +886-2-8792-7186
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Patel S, Ghosh A, Jindal K, Kumar V, Aggarwal S, Kumar P. Spinopelvic fixation for vertically unstable AO type C pelvic fractures and sacral fractures with spinopelvic dissociation- A systematic review and pooled analysis involving 479 patients. J Orthop 2022; 29:75-85. [PMID: 35241881 PMCID: PMC8858730 DOI: 10.1016/j.jor.2022.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Posterior pelvic ring injuries can be fixed using iliosacral screws, plates or bars. Another promising modality is spinopelvic fixation or triangular osteosynthesis, indicated in vertical instability and sacral fractures associated with spinopelvic dissociation. QUESTION/PURPOSE This systematic review and pooled analysis was conducted to analyze the outcomes (functional and radiological) of the use of spinopelvic fixation, as well as assess the associated complications and neurological recovery. METHODS A systematic review of literature was performed from the PubMed/Medline, EMBASE and the SCOPUS databases. All studies reporting on spinopelvic fixations, with a minimum follow up of 1 year were included in the review. Pooled analysis was done for the outcome and complication rates. The MINORS Tool was used for assessing the risk of bias. RESULTS A total of 22 studies were included with average follow-up between 12 and 86.4 months. There were 7 prospective and 15 retrospective case series. The functional outcomes were excellent/good in 90% cases, across 8 studies (95% CI 84-95%); radiological outcomes were excellent/good in 97% cases (95% CI 94-100%) across 5 studies. The most commonly reported complications were hardware prominence in 21.3% (95% CI 11.6,30.9%) and infections in 7.2% cases (95% CI 4.8,9.5%). 73% of the patients reported partial or complete improvement in their neurological condition. CONCLUSION Spinopelvic fixation is an effective method in vertical instability of the pelvis and sacral fractures with spinopelvic dissociations, with good to excellent radiological and functional outcomes. However, adequate precautions are needed to avoid infections and wound complications.
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Good CR, Orosz LD, Thomson AE, Schuler TC, Haines CM, Bhatt FR, Boyd D, Grossman KM, Roy R, Jazini E. Robotic-guidance allows for accurate S2AI screw placement without complications. J Robot Surg 2021; 16:1099-1104. [PMID: 34853954 DOI: 10.1007/s11701-021-01345-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
The study design is retrospective, multi-surgeon, single-center review. The objective is to evaluate complication rates, revision rates, and accuracy grading for robotic-guided S2 alar-iliac (S2AI) screws. Sixty-five consecutive patients underwent S2AI fixation (118 screws) as part of a posterior spine fusion using robotic-guidance. Screws were placed percutaneously in 14 cases and 51 were placed in an open fashion by three board-certified spine surgeons using the Mazor core technology robotic systems (Mazor X, n = 42; Mazor XSE, n = 23). Medical charts were retrospectively reviewed for revisions and complications. All patients were followed for 90 days or greater. Postoperative CT scans were obtained in 22 of the 51 patients, allowing for 46 screws to be reviewed by an independent neuroradiologist who graded the screws for accuracy. There were no intraoperative or postoperative complications associated with S2AI screw placement. There were no revisions found to be related to the S2AI screw placement. All 46 screws evaluated with postoperative CT scans were reported as being at the highest level of accuracy, grade A, with a breach distance of 0 mm (no breach). The robotic-guided technique for S2AI screw placement is a reliable method to achieving pelvic fixation with low complication and revision rates. In addition, a high degree of accuracy can be achieved without relying on visible and tactile landmarks needed for the freehand technique or the additional radiation associated with fluoroscopic-guidance.
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Affiliation(s)
- Christopher R Good
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA.
| | | | - Alexandra E Thomson
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA
| | - Thomas C Schuler
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA
| | - Colin M Haines
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA
| | - Fenil R Bhatt
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA
| | - David Boyd
- Reston Radiology Consultants, Reston, VA, USA
| | | | - Rita Roy
- National Spine Health Foundation, Reston, VA, USA
| | - Ehsan Jazini
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Reston, VA, 20191, USA
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Seemann RJ, Hempel E, Rußow G, Tsitsilonis S, Stöckle U, Märdian S. Clinical and Patient-Related Outcome After Stabilization of Dorsal Pelvic Ring Fractures: A Retrospective Study Comparing Transiliac Fixator (TIFI) and Spinopelvic Fixation (SPF). Front Surg 2021; 8:745051. [PMID: 34912842 PMCID: PMC8666530 DOI: 10.3389/fsurg.2021.745051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: Aim of this retrospective cohort study was the comparison of the transiliac fixator (TIFI) and spinopelvic fixation (SPF) for fixation of dorsal pelvic ring fractures in terms of clinical outcome, complications, and quality of life. Methods: Thirty-eight patients (23 men, 15 women; mean age 47 ± 19 years) with dorsal pelvic ring fractures (type-C-injuries after AO/OTA) that have been stabilized by either TIFI (group TIFI, n = 22) or SPF (group SPF, n = 16) between May 2015 and December 2018 were retrospectively reviewed. Outcome measurements included demographic data, perioperative parameters, and complications and were obtained from the medical information system. Quality of life was assessed using the German version of the short form 36 (SF-36) and short muskuloskeletal function assessment (SMFA-D). Clinical results were assessed using Merle d'Aubigné-Score, Iowa Pelvic Score, and Majeed Pelvic Score. Results: Both groups show relatively good post-operative results, which has previously been reported. Quality of life was comparable in both groups. Group TIFI was slightly superior regarding complication rates, cutting/suture time, and fluoroscopy time. Group SPF seemed to be superior regarding pain and pelvic scores. Conclusion: None of the methods could demonstrate significant superiority over the other. Management of pelvic injuries remains a highly individual challenge adapted to the individual patients' condition. Nevertheless, if fractures allow for stabilization with TIFI, the use of this method should be taken into consideration as a less invasive and more tissue-conserving approach.
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Affiliation(s)
- Ricarda Johanna Seemann
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik Hempel
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gabriele Rußow
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin, Germany
| | - Serafeim Tsitsilonis
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin, Germany
| | - Ulrich Stöckle
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sven Märdian
- Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Qiao B, Liu J, Ni W, Shui W, Luo G, Guo S. Unilateral lumbopelvic fixation for AO/OTA Type C1 and C2 pelvic fractures: Clinical efficacy and preliminary experiences in 23 patients. Injury 2021; 52:2333-8. [PMID: 34053773 DOI: 10.1016/j.injury.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the clinical outcomes and preliminary experiences of unilateral lumbopelvic fixation for patients with AO/OTA Type C1 and C2 pelvic fractures. MATERIALS AND METHODS Between May 2014 and Dec 2017, 23 consecutive patients with AO/OTA Type C1 and C2 pelvic factures were treated by unilateral lumbopelvic fixation. Estimated blood loss, operation duration, reduction quality, functional outcomes using Majeed scores and complications were evaluated. Subgroup analysis was used to assess the influence of unilateral lumbopelvic fixation on different type of pelvic fractures. RESULTS Fifteen patients with Type C1 pelvic fractures and eight patients with Type C2 fractures underwent unilateral lumbopelvic fixation respectively. The mean follow-up time till May 2019 was 34.3 ± 9.9 months (range 17-60 months). Mean estimated blood loss was 473 ml and mean operation duration was 156 min during unilateral lumbopelvic fixation. The mean vertical displacement of pelvis decreased from 10.1 ± 4.9 mm to 3.1 ± 1.9 mm after unilateral lumbopelvic fixation. Majeed score assessments were available for 22 patients. Of these, 13 patients were graded as excellent, 8 were good and one was fair. The results of subgroup analysis showed that there was no difference of estimated blood loss, operation duration, postoperative displacements of pelvis and Majeed scores between the patients with Type C1 and C2 fractures. CONCLUSION Unilateral lumbopelvic fixation could provide a well reduction quality and was an effective treatment for AO/OTA Type C1 and C2 pelvic fractures. STUDY DESIGN Retrospective evaluation of 23 consecutive patients with AO/OTA Type C1 and C2 pelvic fractures treated by unilateral lumbopelvic fixation.
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Gierig M, Liu F, Weiser L, Lehmann W, Wriggers P, Marino M, Saul D. Biomechanical Effects of a Cross Connector in Sacral Fractures - A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:669321. [PMID: 34124023 PMCID: PMC8188498 DOI: 10.3389/fbioe.2021.669321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Fangrui Liu
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Lukas Weiser
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, United States
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11
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Shetty AP, Renjith KR, Perumal R, Anand SV, Kanna RM, Rajasekaran S. Posterior Stabilization of Unstable Sacral Fractures: A Single-Center Experience of Percutaneous Sacroiliac Screw and Lumbopelvic Fixation in 67 Cases. Asian Spine J 2020; 15:575-583. [PMID: 33355847 PMCID: PMC8561155 DOI: 10.31616/asj.2020.0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/13/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This is a retrospective study. Purpose Recent advances in intraoperative imaging and closed reduction techniques have led to a shifting trend toward surgical management in every unstable sacral fracture. This study aimed to evaluate the clinicoradiological outcome of the sacroiliac (SI) screw and lumbopelvic fixation (LPF) techniques and thereby delineate the indications for each. Overview of Literature Optimal management guidelines for unstable sacral fractures are still lacking probably due to the rarity of these injuries and varying fixation trends. Methods Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon's four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed's functional grading system and Matta's radiological criteria. The minimum follow-up period was 2 years. Results Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved. Conclusions Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.
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Affiliation(s)
- Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | | | - Ramesh Perumal
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Sri Vijay Anand
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India
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12
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Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine J 2020; 14:694-701. [PMID: 33108835 PMCID: PMC7595822 DOI: 10.31616/asj.2020.0384] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.
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Affiliation(s)
- Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Taek Kwon
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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13
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Yilmaz E, Hoffmann MF, von Glinski A, Kruppa C, Hamsen U, Schmidt CK, Oernek A, Koenigshausen M, Dudda M, Schildhauer TA. Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation. Sci Rep 2020; 10:14878. [PMID: 32913181 DOI: 10.1038/s41598-020-71498-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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14
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Patel PD, Canseco JA, Houlihan N, Gabay A, Grasso G, Vaccaro AR. Overview of Minimally Invasive Spine Surgery. World Neurosurg 2020; 142:43-56. [PMID: 32544619 DOI: 10.1016/j.wneu.2020.06.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine surgery (MISS) has continued to evolve over the past few decades, with significant advancements in technology and technical skills. From endonasal cervical approaches to extreme lateral lumbar interbody fusions, MISS has showcased its usefulness across all practice areas of the spine, with unique points of access to avoid pertinent neurovascular structures. Adult spine deformity has also recognized the importance of minimally invasive techniques in its ability to limit complications and to provide adequate sagittal alignment correction and improvements in patients' functional status. Although MISS has continued to make significant progress clinically, consideration must also be given to its economic impact and the learning curve surgeons experience in adding these procedures to their armamentarium. This review examines current innovations in MISS, as well as the economic impact and future directions of the field.
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Weil YA, Khoury A, Mosheiff R, Kaplan L, Liebergall M, Schroeder JE. Robotic assisted fixation of sacral fractures: A pilot study. OTA Int 2019; 2:e046. [PMID: 33937674 DOI: 10.1097/OI9.0000000000000046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022]
Abstract
Objectives: Sacral fractures that require fixation are a challenge for the orthopaedic surgeon. Due to anatomical consideration, implant insertion is not risk free, and requires a steep learning curve. A robotic system has been successfully used in pedicle screws insertion and can be also used for iliosacral screws. The aim of the study was to demonstrate the use of the robot in the treatment of unstable sacral fractures. Design: Retrospective case series. Setting: An academic level I trauma center. Patients: Fourteen patients with sacral fractures were eligible for robotic assisted treatment. These included 9 high-energy fractures, 4 osteoporotic fractures, and 1 pathological fracture. Intervention: Fixation constructs included iliosacral screws, transiliac screws, lumbopelvic fixation, sacroplasty, or a combination of the above techniques. A Renaissance robot was mounted on a multidirectional bridge that was attached to the patients spine and implant trajectories were planned either on preoperative or intraoperative 3D scans. Guide wires were inserted percutaneously and screws were placed subsequently. Main outcome measurements: Accuracy of implant placement, operating room and fluoroscopy time. Results: Mean patient age was 36 (17–84), and number of screws, including iliosacral and pedicular ranged 1–14 per patient (average 4.25). Mean operative time was 150 minutes (range 90–300). Average fluoroscopic time was 18 seconds (7–42) for 2D and 40 seconds (12–72) for 3D imaging. All fractures healed, no hardware failure was observed. All hardware was always within bony confines, and no procedure-related neurological deficits were observed. Conclusion: Robotic assisted fixation of sacral fracture is a safe and reproduceable method, allowing precise and accurate implant placement.
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Abstract
Multi-planar transverse, U-type, and vertical sacral fractures occur from high energy trauma or as pathologic fractures and often have associated neurologic and extremity injuries. Modern treatment algorithms fall into two broad categories: 1) percutaneous posterior pelvic fixation (iliosacral or transiliac-transsacral screws) or 2) lumbopelvic fixation. Posterior pelvic screw fixation is minimally invasive but typically requires restricted weight bearing until fracture union. In many cases, lumbopelvic fixation allows for a closed reduction and provides stability to allow full weight bearing immediately after surgery; however, this fixation is often removed in a second surgery after fracture healing. Lumbopelvic fixation was originally described as an open procedure, minimally invasive lumbopelvic fixation is a recent variation and has shown promising results with less morbidity. We present a case series of unstable U-type sacral fractures treated with minimally invasive lumbopelvic fixation with staged hardware removal to illustrate the advantages and complications associated with this new technique. Ten patients with U-type sacral fractures underwent minimally invasive lumbopelvic fixation from 2016 to 2019. Six patients underwent scheduled hardware removal an average of 3.5 (range 1.9-5.5) months after index surgery. Two patients did not undergo hardware removal due to short life expectancy and diagnosis of pathologic fractures. One patient was lost to follow-up. One patient had failed fracture reduction and went on to sacral malunion that required a late sacral extension osteotomy to restore her ability to stand upright. Final disposition of all nine patients with follow-up was normal standing upright posture and normal ambulation without assistive device. There were no late displacements on postoperative upright radiographs. Complex sacral fractures are a challenging injury that can be treated with percutaneous posterior pelvic or lumbopelvic fixation. Lumbopelvic fixation offers the advantages of closed reduction to restore pelvic incidence and immediate weight bearing but has greater surgical morbidity than percutaneous posterior pelvic fixation and often requires hardware removal. The morbidity of lumbopelvic fixation may be reduced with minimally invasive techniques. Minimally invasive lumbopelvic fixation is a treatment option to be considered for complex sacral fractures.
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Affiliation(s)
- Darshan S Shah
- Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, USA
| | - Taylor Bates
- Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, USA
| | - Justin Fowler
- Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, USA
| | - Patrick Osborn
- Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, USA
| | - Anton Y Jorgensen
- Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, USA
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Camacho JE, Usmani MF, Strickland AR, Banagan KE, Ludwig SC. The use of minimally invasive surgery in spine trauma: a review of concepts. J Spine Surg 2019; 5:S91-S100. [PMID: 31380497 DOI: 10.21037/jss.2019.04.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting post-traumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.
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Affiliation(s)
- Jael E Camacho
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashely R Strickland
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelley E Banagan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven C Ludwig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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18
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Li P, Qiu D, Shi H, Song W, Wang C, Qiu Z, Zhao C, Zhou D. Isolated Decompression for Transverse Sacral Fractures with Cauda Equina Syndrome. Med Sci Monit 2019; 25:3583-3590. [PMID: 31089068 PMCID: PMC6532556 DOI: 10.12659/msm.916483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical outcomes of isolated decompression for patients with transverse sacral fractures and cauda equina syndrome, which have been rarely reported before. MATERIAL AND METHODS Twelve neurological impaired patients with transverse sacral fracture from January 2010 to March 2017 treated in our institution were evaluated. All patients went through isolated decompression and were followed for a minimum of 12 months. Fracture causes, classifications, associated injury, radiologic results, clinical outcomes using the Majeed index, and neurological outcomes using the Gibbons criteria were evaluated. RESULTS Motor vehicle accidents and falling injuries were the major causes of trauma. The average time from trauma to surgery was 89.8 days. Eleven patients underwent laminectomy with no more than 3 segments resected and 1 patient had S1-S4 excised. Three patients with fracture involving the lumbopelvic joint had L5 laminectomy. All patients achieved bony union, with 7 patients (63.6%) showing satisfactory pelvic outcome. Average Gibbons scores improved from 2.8 to 1.9 at 18-month average follow-up, but most patients were left with residual pain. No surgical-related complications were seen in any patients. CONCLUSIONS Isolated decompression can be considered for patients who present a stable sacrum with non-displaced fracture or an old fracture that shows fracture healing. Favorable pelvic outcomes and neurological recovery, along with acceptable stability, can be acquired.
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Affiliation(s)
- Pengyu Li
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Daodi Qiu
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Hongbiao Shi
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Chunhui Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Zhen Qiu
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Chuang Zhao
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang R, Yin Y, Li S, Guo J, Hou Z, Zhang Y. Sacroiliac screw versus a minimally invasive adjustable plate for Zone II sacral fractures: a retrospective study. Injury 2019; 50:690-696. [PMID: 30792004 DOI: 10.1016/j.injury.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/13/2019] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. METHODS Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up. RESULTS Thirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222). CONCLUSION MIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.
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Affiliation(s)
- Ruipeng Zhang
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
| | - Yingchao Yin
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
| | - Shilun Li
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
| | - Jialiang Guo
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
| | - Zhiyong Hou
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
| | - Yingze Zhang
- Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
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Mendel T, Heinecke M, Klauke F, Göhre F, Hofmann GO, Ullrich BW. Versorgung instabiler Verletzungen des hinteren Beckenringes – bewährte Methoden und neue Konzepte. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s10039-018-0389-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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