[3D image enhancer-adjusted percutaneous triangular stabilization of geriatric pelvic ring fractures : Operation technique and indications]

Robot-Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation

Objective

To investigate the surgical strategy, safety, and efficacy of close reduction and robot‐aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation.

Methods

Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot‐aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow‐up.

Results

There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow‐up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015).

Conclusions

Robot‐aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.

Percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing despite high revision rates

This is a monocentric, retrospective study to analyze radiological findings as well as perioperative and postoperative complications in patients who underwent percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis. From August 2017 to December 2018, 20 patients were treated surgically. Thirteen patients (65%) were followed-up and received a CT scan of the pelvis after an average time of 14.8 months. A total of 5 patients (38%) had to undergo revision surgery, 2 patients (15%) immediately, 3 patients (23%) in the interval. In 84.6% no fracture line was visible in the sacrum. Fracture healing of the anterior pelvic ring was observed in all cases. Our results show that percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing. Radiological signs of loosening were observed in 62%, an implant removal due to symptomatic loosening was necessary in 23%.