Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study

Radiographic and clinical evaluation of external pedicle screw fixation as a definitive solution for selective acetabular fractures: a retrospective analysis

BACKGROUND

Acetabular fractures typically require open surgery to restore hip joint function. Openness may lead to serious tissue damage, increased bleeding, and the risk of nerve and vascular damage. Minimally invasive closed reduction or percutaneous fixation aims to minimize additional harm to patients and provide reliable fixation to promote fracture recovery and functional rehabilitation. This study aimed to assess the radiographic and clinical effectiveness of pedicle screw external fixation as a definitive treatment approach for selective acetabular fractures.

METHODS

The present study enrolled 43 patients with acetabular fractures who were categorized into three groups based on their definitive treatment plans: pedicle screw external fixation group, traditional external fixation stent fixation group, and open reduction internal fixation group, comparing the operative duration and the time required for fracture healing. Fracture reduction was evaluated using the Tornetta and Matta grading system, and postoperative clinical outcomes were analyzed using the Majeed score. Analyze three surgical methods by comparing clinical indicators and prognostic references.

RESULTS

Among the 43 patients, there were 12 cases in the pedicle screw external fixation group, 14 cases in the traditional external fixation stent fixation group, and 17 cases in the open reduction internal fixation group. There were no significant differences in age, gender, injury mechanism, Injury Severity Score (ISS), or other demographic factors among the three groups. The reduction of fractures with internal fixation was significantly better than that with external fixation(p = 0.032). Operative duration and quality of reduction did not significantly differ between the pedicle screw external fixation group and the traditional external fixation stent fixation group. However, the pedicle screw external fixation group exhibited distinct advantages in postoperative quality of life (p = 0.041) and a lower incidence of loose fixing screws compared to the traditional external fixation stent fixation group.

CONCLUSION

Compared to traditional external fixation stent fixation, pedicle screw external fixation represents a superior definitive treatment option for acetabular fractures due to its stability and improved patient quality of life.

Laparoscopic treatment of fourteen cases of pelvic ring disruption: a case series

PURPOSE

Open surgical approaches for the treatment of anterior pelvic arc lesions are associated with several complications. We present the first retrospective descriptive case series on the use of laparoscopy as an alternative.

METHODS

This descriptive, retrospective, single-centre study enrolled all patients who underwent laparoscopy for the treatment of pelvic ring disruption between May 2020 and March 2022. The primary outcome was the procedure failure rate based on conversion to open surgery. Secondary outcomes were the duration of the surgical procedure, x-ray exposure, length of hospitalisation, postoperative pain assessment, and functional scores at the last follow-up.

RESULTS

The study included two females and 12 males. The mean age of the study participants was 44.2 (23-67) years. In total, nine (64.3%) patients had pubic symphysis disjunction, four (28.6%) had bilateral fractures of the obturator frames, and one (7%) had both. None of the patients required conversion to open surgery. The median operating times for symphysis pubis disruption, obturator frame fracture, and patients with both injuries were 90.0 (60-120), 135 (105-180), and 240 min, respectively. The median overall operating time was 102.5 (60-240) min. The median Iowa Pelvic Score and Majeed Functional Score at the last follow-up were 87 (70-99) and 84 (70-100), respectively.

CONCLUSION

Laparoscopic internal fixation is a reliable treatment for pelvic ring disruption. The clinical and radiological outcomes of our patients suggest the usefulness of this technique as an alternative to open approaches.

Biomechanical evaluation of percutaneous anterograde and retrograde screw implantation for superior ramus pubis fractures: a finite element analysis

OBJECTIVE

To evaluate the biomechanical characteristics of percutaneous anterograde and retrograde screw implantation for superior ramus pubis fractures.

METHODS

Mimics software was used to reconstruct the normal pelvis. 3-Matic software was used to establish a model for superior ramus pubis fracture, and percutaneous anterograde/retrograde screw implantation was used to simulate the treatment of a superior ramus pubis fracture. After material assignment by Mimics software, Ansys software simulated the force of a standing position with a 600 N load on an S1 vertebral endplate and then compared the mechanical stability.

RESULTS

After simulating the fracture at five points, the effect of anterograde and retrograde screw implantation on the displacement and stress of the pelvis and the left pubic bone were found to be similar. When anterograde screw implantation was used, screw displacement at each point was 1.10 mm, 1.04 mm, 1.10 mm, 1.10 mm, and 1.07 mm; the stress at each point was 14.95 MPa, 11.50 MPa, 18.60 MPa, 18.07 MPa, and 18.37 MPa. When retrograde screw implantation was used, screw displacement at each point was 0.62 mm, 0.62 mm, 0.70 mm, 0.76 mm, and 0.87 mm; and the stress at each point was 5.13 MPa, 4.03 MPa, 6.61 MPa, 9.74 MPa, and 11.55 MPa respectively.

CONCLUSIONS

When assessing the treatment of superior ramus pubis fractures from a biomechanical perspective, we found that if the distance between the fracture line and the insertion point is less than 70 mm, it is recommended to use retrograde screw implantation.

[Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures]

OBJECTIVE

To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.

METHODS

Between January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated.

RESULTS

All patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%.

CONCLUSION

For unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.

[Research progress on minimally invasive treatment of anterior pelvic ring fracture]

OBJECTIVE

To summarize the related research results of minimally invasive treatment of anterior pelvic ring fracture, and to improve the understanding of minimally invasive treatment of anterior pelvic ring fracture.

METHODS

The literature of minimally invasive treatment of anterior pelvic ring fracture at domestic and overseas in recent years was reviewed, and the reduction and fixation methods of minimally invasive treatment were summarized and analyzed.

RESULTS

The pelvic reduction frame may be an effective auxiliary method for minimally invasive reduction of pelvis. The fixation methods of anterior pelvic ring include percutaneous screw fixation, stent fixation, and percutaneous plate fixation.

CONCLUSION

One kind of fixation is not applicable to all types of anterior pelvic ring fracture, and the fixation method should be selected according to the type of fracture and the patient's condition to minimize the complications.