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Öztürk V, Çelik M. Letter to the Editor regarding: Laparoscopic treatment of fourteen cases of pelvic ring disruption: a case series. Vinet M, Moullac D, David G, et al., Int Orthop. 2024 Apr 18. INTERNATIONAL ORTHOPAEDICS 2024; 48:1933-1934. [PMID: 38727805 DOI: 10.1007/s00264-024-06213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Vedat Öztürk
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Malik Çelik
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
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Märdian S, Maleitzke T, Niemann M, Salmoukas K, Stöckle U. [Imaging examination procedures, navigation and minimally invasive procedures in acetabular surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:89-99. [PMID: 36645450 DOI: 10.1007/s00113-022-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/17/2023]
Abstract
Acetabular fractures still pose a special challenge even today. Considering the increasing case numbers, especially in the geriatric patient group, modern imaging examination procedures represent an essential pillar of the diagnostics. Especially in this vulnerable patient group, minimally invasive methods are necessary, which can be guaranteed by intraoperative navigation; however, the choice of surgical access and implants is also made based on the existing morphological characteristics of fractures, which highlights the importance of an imaging modality that is as detailed as possible. Last but not least, new developments concerning the surgical treatment of these injuries are also based on this. This article summarizes the current state of the techniques and the available literature.
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Affiliation(s)
- Sven Märdian
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - T Maleitzke
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Niemann
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Julius Wolff Institut, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - K Salmoukas
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - U Stöckle
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Hartel MJ, Althoff G, Wolter S, Ondruschka B, Dietz E, Frosch KH, Thiesen DM. Full endoscopic anterior intrapelvic plate osteosynthesis: a cadaveric feasibility study. Arch Orthop Trauma Surg 2023; 143:365-371. [PMID: 35041081 PMCID: PMC9886590 DOI: 10.1007/s00402-022-04346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
In this investigation, it was assumed that it must be possible to visualize the intrapelvic aspect as accustomed by pelvic surgeons using the anterior intrapelvic (modified Stoppa) approach. Moreover, it was hypothesized, that plate mountings will not only be possible for the symphysis but also at the supra- and infrapectineal aspect as well as to the posterior column. Ten anonymized cadaveric specimens were included in this study. A standard laparoscopic totally extraperitoneal (TEP) approach was used. A total of 10 landmarks were defined that are usually within reach in the open anterior intrapelvic (AIP) approach. Moreover, five different plate mountings were tested. The locations were chosen in accordance with the indication spectrum suitable for open surgery through the traditional AIP approach. It was possible to gain intrapelvic visibility in seven of ten cases. In all of those seven cases, it was technically possible to place plates to the symphysis, superior pubic ramus, as well as longer anterior column plates up to the aspect posterior of the acetabulum. In the last four of the seven cases, it was possible to mount plates to the infrapectineal aspect as well as the posterior column, too. The team, previously trained in arthroscopic surgical techniques as well as pelvic trauma surgery, observed a steep learning curve. This investigation demonstrated, that endoscopic anterior intrapelvic plate osteosynthesis was feasible in the majority of the cases in a series of ten cadaveric models. New instruments will be needed such as extra-long rasp elevators, ball-spikes as well as devices to hold and position plates and extra-long self-holding screwdrivers. With these, endoscopic pelvic surgery will likely be a realistic option for selected pelvic trauma cases in the future.
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Affiliation(s)
- Maximilian J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
| | - Gerrit Althoff
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eric Dietz
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Darius M Thiesen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Hutchings L, Roffey DM, Lefaivre KA. Fragility Fractures of the Pelvis: Current Practices and Future Directions. Curr Osteoporos Rep 2022; 20:469-477. [PMID: 36342642 DOI: 10.1007/s11914-022-00760-9] [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] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To summarise the current evidence and clinical practices for patients with fragility fractures of the pelvis (FFP). RECENT FINDINGS FFPs are an increasingly prevalent and recognised problem in the elderly population. Recent evidence indicates they have a significant impact on function, morbidity and mortality. While traditional management of FFPs was predominantly non-surgical, surgical options have been increasingly used, with a range of surgical methods available. To date, limited consensus exists on the optimal strategy for suitable patient selection, and clinical trials in this population have proved problematic. The management of FFPs requires a multi-faceted approach to enhance patient care, including adequate pain control, minimisation of complications and optimisation of medical management. Early return to mobilisation should be a key treatment goal to maintain functional independence. The selection of patients who will maximally benefit from surgical treatment, and the most appropriate surgical strategy to employ, remains contentious.
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Affiliation(s)
- Lynn Hutchings
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
- Division of Orthopaedic Trauma, Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 3rd Floor, DHCC, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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Küper MA, Stöckle U, Stuby F, Trulson A. Clinical Experience with the New EASY (Endoscopic Approach to the Symphysis) Preparation Technique for Injuries of the Anterior Pelvic Ring. ZEITSCHRIFT FÜR ORTHOPÄDIE UND UNFALLCHIRURGIE 2022; 161:211-217. [PMID: 35961324 DOI: 10.1055/a-1851-5389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Abstract
Background High-energy injuries of the anterior pelvic ring and especially disruptions of the pubic symphysis usually require surgical stabilization. There is a conflict between
biomechanical stability and size in the surgical approach. We have previously presented a minimally invasive approach for symphyseal plating.
Methods Our current endoscopic surgical technique is presented step-by-step and is illustrated in a video. The results and courses of the first seven patients treated with the EASY
preparation are presented.
Results In all seven patients, the EASY preparation was successful. In four of the seven patients with an anterior pelvic ring injury, we performed a complete endoscopic plate
osteosynthesis of the pubic symphysis. One patient gave consent only for endoscopic preparation, in one patient, we converted to open plate due to ventilation problems, and in one patient,
the superior pubic rami fracture was stable. There were no surgical complications.
Conclusion The EASY is a feasible minimally invasive preparation technique to stabilize anterior pelvic ring injuries in the most biomechanically stable manner by performing plate
osteosynthesis. However, further scientific monitoring is necessary to improve the technique and validate our data.
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Affiliation(s)
- Markus Alexander Küper
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Germany
| | - Ulrich Stöckle
- Centrums für Muskuloskeletale Chirurgie, Charite University Hospital Berlin, Berlin, Germany
| | - Fabian Stuby
- Unfallklinik, BG Unfallklinik Murnau, Murnau, Germany
| | - Alexander Trulson
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Murnau, Murnau, Germany
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Küper MA, Trulson A, Stuby FM, Stöckle U. "Total endoscopic anterior pelvic approach (TAPA) - A new approach to the internal fixation of the symphysis". Injury 2022; 53:1295-1296. [PMID: 35016777 DOI: 10.1016/j.injury.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Markus A Küper
- BG Trauma Center Tübingen, Department for Traumatology and Reconstructive Surgery, Tübingen, Germany.
| | - Alexander Trulson
- BG Trauma Center Murnau, Department of Trauma Surgery, Murnau am Staffelsee, Germany
| | - Fabian M Stuby
- BG Trauma Center Murnau, Department of Trauma Surgery, Murnau am Staffelsee, Germany
| | - Ulrich Stöckle
- Charité University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
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7
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Küper MA, Trulson A, Johannink J, Hirt B, Leis A, Hoßfeld M, Histing T, Herath SC, Amend B. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study. J Robot Surg 2022; 16:1401-1407. [PMID: 35147842 DOI: 10.1007/s11701-022-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
Pelvic ring injuries or acetabular fractures present a challenge to trauma surgeons. Recently, endoscopic dissection techniques for visualization of the anterior pelvic ring and acetabulum have been presented. Robotic-assisted surgical systems offer advantages in terms of improved visualization and easier instrument handling. The aim of this pilot anatomic study was to verify the feasibility of robotic-assisted plate osteosynthesis on the anterior pelvic ring and acetabulum. The experiment was performed on a human whole body specimen. The DaVinci system with standard instruments as used in RARP was used. After docking the system, the anterior pelvic ring was first prepared as previously described for the endoscopic techniques. This was followed by dissection of both acetabula analogous to pelvic lymphadenectomy as performed during RARP. After the dissection was performed along the pelvic brim up to the iliosacral joint, the complete anterior column of the acetabulum including quadrilateral surface and incisura ischiadica major could be visualized. Finally, robotic-assisted endoscopic plate osteosynthesis was performed on the symphysis and anterior acetabular column as previously described in the endoscopic techniques. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum is feasible with the available robotic-assisted systems. Due to the excellent freedom of movement of the robotic arms, combined with the magnifying 3D visualization of the system, highly accurate preparation of the situs in preparation for plate osteosynthesis can be performed. The question of reduction of dislocated fractures remains open and is the subject of further investigation. Compared with conventional laparoscopy, robotic-assisted preparation nevertheless appears to offer an advantage in view of the complexity of the operation.
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Affiliation(s)
- Markus A Küper
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Alexander Trulson
- Department for Traumatology, Orthopedics and Surgery, BG Trauma Center, Murnau am Staffelsee, Germany
| | - Jonas Johannink
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Artur Leis
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Max Hoßfeld
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Tina Histing
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Steven C Herath
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Bastian Amend
- Department for Urology, University Hospital Tübingen, Tübingen, Germany
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Kabir K, Lingohr P, Jaenisch M, Hackenberg RK, Sommer N, Ossendorff R, Welle K, Gathen M. Total endoscopic anterior pelvic approach (TAPA) - A new approach to the internal fixation of the symphysis. Injury 2022; 53:802-808. [PMID: 34635336 DOI: 10.1016/j.injury.2021.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 02/02/2023]
Abstract
This study presents a detailed documentation of a total endoscopic anterior pelvic approach (TAPA) for plate fixation of a symphyseal disruption. The purpose of this work is to describe a minimally invasive technique as a possible method for reducing complications and hospitalization. Other goals included giving technical recommendations and assessing potential pitfalls and problems of this new surgical approach. Surgery was performed in an interdisciplinary setting by an experienced orthopaedic and general surgeon. The first endoscopic approach used to visualize the injury was the same as is used for endoscopic hernia surgery. The repositioning of the symphysial rupture was achieved either through external fixation or indirectly with traction and a pelvic binder. Plate positioning and fixation were achieved through two additional, minimally invasive incisions. The endoscopic approach shows multiple advantages, such as no detachment of the rectus abdominis muscle and smaller skin incisions. Furthermore, this approach could lessen the incidence of hernia and postoperative pain. We see the presented technique as a simple and innovative surgical method for treating symphyseal disruption.
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Affiliation(s)
- Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Nils Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Robert Ossendorff
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany.
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Küper MA, Ateschrang A, Hirt B, Stöckle U, Stuby FM, Trulson A. Laparoscopic Acetabular Surgery (LASY) - vision or illusion? Orthop Traumatol Surg Res 2021; 107:102964. [PMID: 34033917 DOI: 10.1016/j.otsr.2021.102964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 02/03/2023]
Abstract
Displaced acetabular fractures usually require open surgical approaches. Aim of this cadaver study was to evaluate a laparoscopic approach to prepare the anterior acetabular column and the quadrilateral plate in analogy to the laparoscopic pelvic lymphadenectomy. The laparoscopic preparation and anatomy is presented and illustrated step by step in a human cadaver followed by a modular plate osteosynthesis of the anterior column involving the quadrilateral plate is performed via a minimally invasive approach using standard laparoscopic instruments. In conclusion we could demonstrate that the laparoscopic preperitoneal preparation of the acetabulum according to the laparoscopic pelvic lymphadenectomy provides more free range for the surgical instruments compared to a previously described total extraperitoneal approach. The development of specific reduction tools and implants is under investigation. Until then, at least the laparoscopic preparation could be introduced in the clinical setting in the near future. TYPE OF STUDY: Technical note - Cadaver study.
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Affiliation(s)
- Markus Alexander Küper
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany.
| | - Atesch Ateschrang
- Ev. Stift St. Martin, Department for Orthopedics and Traumatology, Koblenz, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, Eberhard Karls University, Tübingen, Germany
| | - Ulrich Stöckle
- Charité University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Fabian Maria Stuby
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
| | - Alexander Trulson
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
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Regenbogen S, Beck M, Lang M, Küper MA, Stuby FM, Trulson A. Endoscopically assisted implant removal of a symphyseal pelvic plate - A case report. Trauma Case Rep 2021; 36:100536. [PMID: 34584926 PMCID: PMC8450239 DOI: 10.1016/j.tcr.2021.100536] [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: 09/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The approach-related morbidity rate in the care of pelvic fractures is still high. Endoscopic procedures are known to significantly reduce access-related complications. Recently, a new endoscopically assisted implantation technique for plate osteosynthesis on the anterior pelvic ring has been described as the “Endoscopic Approach to the Symphysis”. Case report We present a case of a 29-year old male with a pelvic injury (AO type 61B2.3a) initially treated with a supraacetabular external fixator. After one week the definitive stabilization was performed by an endoscopically assisted symphyseal plating as well as a percutaneous iliosacral screw on the right side. One year after primary surgery, we performed an endoscopically assisted removal of the symphyseal plate using standard laparoscopic instruments. Results We demonstrate the feasibility of an endoscopically assisted implant removal at the anterior pelvic ring. No complications occurred during the procedure. The patient was discharged after a regular time of surveillance and with an adequate decline of pain. Discussion While we were able to show that the endoscopically assisted implantation as well as the removal of a plate osteosynthesis on the anterior pelvic ring is possible, there is still further research necessary, especially regarding the development of specific endoscopic instruments. This should enable operating times similar to the standard open procedures.
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Affiliation(s)
| | - Markus Beck
- Department for Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Michael Lang
- Department for Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Markus A Küper
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Fabian M Stuby
- Department for Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Alexander Trulson
- Department for Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
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11
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Jordan MC, Jäckle V, Scheidt S, Gilbert F, Hölscher-Doht S, Ergün S, Meffert RH, Heintel TM. Trans-obturator cable fixation of open book pelvic injuries. Sci Rep 2021; 11:13463. [PMID: 34188088 PMCID: PMC8241833 DOI: 10.1038/s41598-021-92755-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/15/2021] [Indexed: 01/13/2023] Open
Abstract
Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Veronika Jäckle
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Scheidt
- Department of Orthopaedic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Fabian Gilbert
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU München, Marchioninistr. 15, 81377, München, Germany
| | - Stefanie Hölscher-Doht
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy, Julius-Maximilians-University Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Timo M Heintel
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Kabir K, Welle K, Lingohr P, Jaenisch M, Roos J, Gathen M. APACHE-Anterior Plating of the Acetabulum in Hemi-Endoscopic Technique: An Alternative Method for Internal Fixation of the Acetabulum. Arthrosc Tech 2021; 10:e1815-e1819. [PMID: 34336580 PMCID: PMC8322669 DOI: 10.1016/j.eats.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 02/03/2023] Open
Abstract
Injuries of the acetabulum are often challenging in treatment and aftercare. One reason is the required surgical approach, which has high complication rates, including vascular lesion, hernias, and wound infection. We present an alternative endoscopic-assisted approach for the internal fixation of acetabular fractures to avoid the Pfannenstiel incision. An endoscopic approach similar to that used for endoscopic hernia surgery was used. The ilioinguinal approach's lateral window was used to achieve reduction and insertion of a reconstruction plate. The purpose of this study is to describe a minimally invasive technique as a possible method to reduce hospitalization and complications. Another goal is to give detailed technical recommendations and to assess the potential pitfalls of this surgical approach. The APACHE technique is a safe and suitable minimally-invasive approach for the successful treatment of complex acetabular fractures and can be considered in similar cases.
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Affiliation(s)
- Koroush Kabir
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Kristian Welle
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Philipp Lingohr
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Jonas Roos
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn
| | - Martin Gathen
- Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn,Address correspondence to Martin Gathen, M.D., University Hospital of Bonn, Dept. of Orthopedics and Trauma Surgery, Venusberg-Campus 1, 53127 Bonn, Germany.
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Jordan MC, Jäckle V, Scheidt S, Eden L, Gilbert F, Heintel TM, Jansen H, Meffert RH. [Outcome after plate stabilization of symphyseal diastasis]. Unfallchirurg 2020; 123:870-878. [PMID: 32347368 PMCID: PMC7653790 DOI: 10.1007/s00113-020-00804-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hintergrund Die Symphysensprengung mit entsprechender Diastase kann durch eine Symphysenplatte stabilisiert werden. Fragestellung Welche Beckenverletzungen werden mit einer Symphysenplatte stabilisiert und wie ist das Outcome? Material und Methoden Retrospektive Auswertung von 64 Patienten über einen Untersuchungszeitraum von 24 Monaten. Ergebnisse Es waren 56 Patienten männlich, 8 weiblich und das mittlere Alter betrug 44 Jahre (SD ± 17). Unfälle im Straßenverkehr waren der führende Grund für die Beckenverletzung. Die Verteilung nach AO-Klassifikation zeigte sich wie folgt: 14-mal B1-, 10-mal B2-, 5‑mal B3-, 23-mal C1-, 9‑mal C2- und 3‑mal C3-Verletzungen. Die Verteilung nach Young und Burgess ergab: 9‑mal APC-I-, 18-mal APC-II-, 13-mal APC-III-, 9‑mal LC-I-, 3‑mal LC-II-, 2‑mal LC-III- und 10-mal VS-Verletzungen. Der mittlere Injury Severity Score (ISS) betrug 32 und die mittlere stationäre Verweildauer 29 Tage (pos. Korrelation p ≤ 0,001). Im Verlauf war eine radiologische Implantatlockerung bei 52 Patienten nachweisbar. Therapierelevante Komplikationen gab es in 14 Fällen. Hierbei war das Implantatversagen (n = 8) der Hauptgrund für eine operative Revision. Diskussion Obwohl die radiologische Implantatlockerung häufig beobachtet wird, ist sie nur selten Grund für einen Revisionseingriff. Kommt es hingegen zum vollständigen Implantatversagen, tritt dies meist innerhalb der ersten postoperativen Wochen auf und ist revisionsbedürftig. Eine frühzeitige Abklärung durch Röntgenbildgebung sollte bei Verdacht erfolgen.
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Affiliation(s)
- Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland.
| | - Veronika Jäckle
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Sebastian Scheidt
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Lars Eden
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Fabian Gilbert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Timo M Heintel
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Hendrik Jansen
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 8, 97080, Würzburg, Deutschland
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Küper MA, Trulson A, Stuby FM, Stöckle U, Konrads C. Complications of surgical approaches for stabilization of pelvic ring injuries: Analysis of pitfalls and how to avoid them. J Orthop 2020; 20:261-267. [PMID: 32467654 PMCID: PMC7240181 DOI: 10.1016/j.jor.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022] Open
Abstract
Pelvic-ring-injuries are bony and/or ligamentous disruptions that might lead to pelvic instabilities and asymmetries. For surgical treatment, knowledge of the different possible approaches and stabilization-techniques is essential. From 2003 to 2017, we analyzed all complications in operative and non-operative treatment of pelvic-ring-injuries in our institution. Besides complication rates, we describe the reachable anatomical structures for different surgical approaches to the pelvic-ring focusing on strategies to reduce surgical complications. Of 1848 patients with a pelvic fracture, 1463 patients had a pelvic-ring-fracture. We found an overall complication-rate of 14.4%. For reducing approach-related morbidity, preoperative planning and knowledge of approach-related complications is important.
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Affiliation(s)
- Markus A. Küper
- Department for Traumatology and Reconstructive Surgery, BG Klinik Tübingen, University of Tübingen, Tübingen, Germany
| | | | - Fabian M. Stuby
- Department for Trauma Surgery, BG Klinik Murnau, Murnau, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité – University Medical Center, Berlin, Germany
| | - Christian Konrads
- Department for Traumatology and Reconstructive Surgery, BG Klinik Tübingen, University of Tübingen, Tübingen, Germany
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Küper MA, Trulson A, Minarski C, Stuby F, Stöckle U, Konrads C. Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:144-152. [PMID: 31797336 DOI: 10.1055/a-1023-4756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Injuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.
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Affiliation(s)
| | - Alexander Trulson
- Department for Trauma and Orthopaedic Surgery, BG Trauma Hospital Murnau
| | | | - Fabian Stuby
- Department for Trauma and Orthopaedic Surgery, BG Trauma Hospital Murnau
| | - Ulrich Stöckle
- Centre for Musculoskeletal Surgery, Charité University Medicine Berlin
| | - Christian Konrads
- Department for Trauma and Reconstructive Surgery, BG Hospital Tubingen
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