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Notov D, Knorr E, Spiegl UJA, Osterhoff G, Höch A, Kleber C, Pieroh P. The clinical relevance of fixation failure after pubic symphysis plating for anterior pelvic ring injuries: an observational cohort study with long-term follow-up. Patient Saf Surg 2024; 18:17. [PMID: 38778372 PMCID: PMC11112942 DOI: 10.1186/s13037-024-00401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Open reduction and plate fixation is a standard procedure for treating traumatic symphyseal disruptions, but has a high incidence of implant failure. Several studies have attempted to identify predictors for implant failure and discussed its impact on functional outcome presenting conflicting results. Therefore, this study aimed to identify predictors of implant failure and to investigate the impact of implant failure on pain and functional outcome. METHODS In a single-center, retrospective, observational non-controlled cohort study in a level-1 trauma center from January 1, 2006, to December 31, 2017, 42 patients with a plate fixation of a traumatic symphyseal disruption aged ≥ 18 years with a minimum follow-up of 12 months were included. The following parameters were examined in terms of effect on occurrence of implant failure: age, body mass index (BMI), injury severity score (ISS), polytrauma, time to definitive treatment, postoperative weight-bearing, the occurrence of a surgical site infection, fracture severity, type of posterior injury, anterior and posterior fixation. A total of 25/42 patients consented to attend the follow- up examination, where pain was assessed using the Numerical Rating Scale and functional outcome using the Majeed Pelvic Score. RESULTS Sixteen patients had an anterior implant failure (16/42; 37%). None of the parameters studied were predictive for implant failure. The median follow-up time was six years and 8/25 patients had implant failure. There was no difference in the Numerical Rating Scale, but the work-adjusted Majeed Pelvic Score showed a better outcome for patients with implant failure. CONCLUSION implant failure after symphyseal disruptions is not predictable, but appears to be clinically irrelevant. Therefore, an additional sacroiliac screw to prevent implant failure should be critically discussed and plate removal should be avoided in asymptomatic patients.
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Affiliation(s)
- Dmitry Notov
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Eva Knorr
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Ulrich J A Spiegl
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
- Clinic for Trauma Surgery and Orthopaedics, Munich Harlaching, Sanatoriumspl. 2, 81545, München, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Christian Kleber
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Philipp Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Nana CT, Ngo-Yamben MA, Fokam P, Mahamat A, Bombah FM, Boukar ME, Kenedy M, Chichom-Mefire A. Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study. J Orthop Surg Res 2022; 17:198. [PMID: 35379270 PMCID: PMC8981602 DOI: 10.1186/s13018-022-03088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unstable pelvic fractures are severe and life-threatening injuries with high morbi-mortality rates. Management of these fractures is a major challenge in orthopaedic practice in limited resource communities. The aim of this study is to evaluate the functional outcome of unstable pelvic fractures managed in a hospital with limited diagnostic and therapeutic facilities. METHODOLOGY This was a hospital-based prospective observational study carried out from 1st of January 2009 to 31st of December 2018 at the Limbe Regional Hospital, a level III health institution in the South-West region of Cameroon. RESULTS A total of 68 patients were included in the study. The ages ranged from 18 to 80 years with a mean age of 39 ± 5 years. The average follow-up duration at the latest visit was 36 months (range 3-84 months). There were 59 cases that were evaluated. The overall average Majeed score was fair. Poor outcomes were noted in patients aged 60 years and above, those with co-morbidities, and those managed conservatively. CONCLUSION Although the functional outcomes following unstable pelvic fractures have improved with modernised diagnostic and therapeutic modalities, it is not the case in poor resource settings where the lack of these modalities makes the management challenging, consequently affecting the functional outcome.
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Affiliation(s)
| | - M A Ngo-Yamben
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Pius Fokam
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Ali Mahamat
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - F M Bombah
- Department of Surgery and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - M Ekani Boukar
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Muluem Kenedy
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - A Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Rojas C, Ewertz E, Hormazábal JM. Fixation failure in patients with traumatic diastasis of pubic symphysis: impact of loss of reduction on early functional outcomes. J Orthop Surg Res 2021; 16:661. [PMID: 34742331 PMCID: PMC8572449 DOI: 10.1186/s13018-021-02802-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Failure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 and 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed’s functional scores.
Methods Single center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty-seven patients with a mean age 45.7 ± 14.4 years were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed’s functional scores at minimum 6 months follow-up were compared according to the presence of FF and loss of reduction. Results Fifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64.4 ± 13.04 and 81.8 ± 15.65, respectively (p = 0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11.3 [70.5 vs 81.8] (p = 0.092) and 22.7 [59.1 vs 81.8] (p = 0.001), respectively. Significant association of FF with AO classification was noted. (OR 12.6; p = 0.002). Conclusions Differences in MMS in the analyzed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.
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Affiliation(s)
- Claudio Rojas
- Department of Orthopaedic Surgery, Hospital del Trabajador de Santiago, Ramón Carnicer 185, 7501239, Santiago, Chile.,Department of Orthopaedic Surgery, Clínica Dávila, Recoleta 464, 8431657, Santiago, Chile
| | - Ernesto Ewertz
- Department of Orthopaedic Surgery, Clínica Dávila, Recoleta 464, 8431657, Santiago, Chile.
| | - Jose Miguel Hormazábal
- Department of Orthopaedic Surgery, Hospital del Trabajador de Santiago, Ramón Carnicer 185, 7501239, Santiago, Chile
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Herteleer M, Boudissa M, Hofmann A, Wagner D, Rommens PM. Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2021; 48:3711-3719. [PMID: 33693977 PMCID: PMC9532279 DOI: 10.1007/s00068-021-01625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.
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Affiliation(s)
- Michiel Herteleer
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany.
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Alexander Hofmann
- Department of Traumatology and Orthopaedics, Westpfalz-Clinics Kaiserslautern, Kaiserslautern, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
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Banierink H, ten Duis K, Wendt K, Heineman E, IJpma F, Reininga I. Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature. PLoS One 2020; 15:e0233226. [PMID: 32678840 PMCID: PMC7367481 DOI: 10.1371/journal.pone.0233226] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pelvic ring injuries are one of the most serious traumatic injuries with large consequences for the patients' daily life. During recent years, the importance of the patients' perception of their functioning and quality of life following injury has increasingly received attention. This systematic review reports on self-reported physical functioning and quality of life after all types of pelvic ring injuries. METHODS The online databases MEDLINE-PubMed and Ovid-EMBASE were searched for studies published between 2008 and 2019 to identify published evidence of patient-reported physical functioning and quality of life after which they were assessed for their methodological quality. RESULTS Of the 2577 articles, 46 were reviewed in full-text, including 3049 patients. Most studies were heterogeneous, with small cohorts of patients, a variety of injury types, treatment methods and use of different, often non-validated, outcome measures. The overall methodological quality was moderate to poor. Nine different PROMs were used, of which the Majeed Pelvic Score (MPS), SF-36 and EQ-5D were the most widely used. Mean scores respectively ranged from 75-95 (MPS), 53-69 (SF-36, physical functioning) and 0.63-0.80 (EQ-5D). CONCLUSIONS Physical functioning and quality of life following pelvic ring injuries seem fair and tend to improve during follow-up. However, differences in patient numbers, injury definition, treatment strategy, follow-up duration and type of PROMs used between studies hampers to elucidate the actual effects of pelvic ring injuries on a patient's life. IMPLICATIONS OF KEY FINDINGS Physicians and researchers should use valid and reliable patient-reported outcome instruments on large cohorts of patients with properly defined injuries to truly evaluate physical functioning and quality of life after pelvic ring injuries. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO International prospective register of systematic reviews; registration number CRD42019129176.
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Affiliation(s)
- Hester Banierink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus Wendt
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
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Vaidya R, Martin AJ, Roth M, Nasr K, Gheraibeh P, Tonnos F. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1671-1678. [DOI: 10.1007/s00264-016-3387-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/20/2016] [Indexed: 01/13/2023]
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