1
|
Morita T, Takigawa T, Ishihara T, Taoka T, Ishimaru T, Kanazawa T, Tada K, Omori T, Yagata Y, Toda K, Nakago K, Ito Y. Minimally invasive surgery technique for unstable pelvic ring fractures with severe vertical shear displacement: A retrospective study. Orthop Traumatol Surg Res 2023; 109:103528. [PMID: 36565742 DOI: 10.1016/j.otsr.2022.103528] [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] [Received: 05/23/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unstable pelvic fractures, especially vertical shear fractures, require surgery for correct reduction, rigid fixation, and improved postoperative outcomes. Herein, we assess the effectiveness of our minimally invasive procedure for the management of unstable pelvic fractures. HYPOTHESIS We hypothesized that this procedure would be useful for the management of unstable pelvic fractures. PATIENTS AND METHODS This study included 28 patients with unstable pelvic fractures (vertical shear injuries; AO types C1-3) treated using minimally invasive surgery for spinopelvic fixation (MIS-SP) between 2014 and 2020 (mean follow-up time, 15 months). The MIS-SP requires four percutaneous pedicle screws and four iliac screw insertions. Subsequently, reduction and fixation are performed. RESULTS The mean preoperative displacement of the posterior pelvic elements in craniocaudal correction was 17.6 (range, 9.0-32.2) mm. The mean length of the craniocaudal reduction was 16.5 (8.1-30.1) mm, with a mean reduction rate of 93.5% (78%-100%). The mean length of the mediolateral reduction was 11.3 (3.9-19.6) mm, with a mean reduction rate of 87.3% (76%-100%). DISCUSSION Our novel reduction and fixation procedure is a powerful, minimally invasive option for the treatment of unstable pelvic ring fractures. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Takuya Morita
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan.
| | - Tomoyuki Takigawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takeshi Ishihara
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takuya Taoka
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takahiko Ishimaru
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Tomoko Kanazawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Keitaro Tada
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takao Omori
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yukihisa Yagata
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kazukiyo Toda
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kie Nakago
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yasuo Ito
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| |
Collapse
|
2
|
Kamatani Y, Okuda A, Maegawa N, Matsumori H, Shigematsu H, Kawamura K, Fukushima H, Tanaka Y. Minimally invasive 360-degree pelvic ring fixation using a combination of crab-shaped fixation and pelvic internal fixator for unstable pelvic ring fracture: A case report. Trauma Case Rep 2021; 36:100540. [PMID: 34660871 PMCID: PMC8502949 DOI: 10.1016/j.tcr.2021.100540] [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: 09/28/2021] [Indexed: 11/26/2022] Open
Abstract
Surgery with both anterior and posterior fixation is recommended for unstable pelvic ring fractures; nonetheless, the surgical method remains controversial. Crab-shaped fixation is a minimally invasive and strong posterior fixation method using spinal instruments that can reduce vertical dislocations. The use of pelvic internal fixator as a minimally invasive anterior fixation method has been reported. It is recommended in cases where there is an open wound in the lower abdomen or damage to the pelvic organs. Conversely, to the best of our knowledge, there has been no report on the combined use of crab-shaped fixation and pelvic internal fixator to date. We performed a minimally invasive 360-degree fixation using a combination of crab-shaped fixation and pelvic internal fixator for an unstable pelvic ring fracture (AO-C2) and sacral fracture (Denis zone II) with 15-mm vertical dislocation. The sacral fracture was accompanied by a large bone fragment in the spinal canal, which was suspected to have caused neuropathy. Therefore, in addition to posterior fixation, we performed decompression and removed the bone fragment. Postoperative computed tomography revealed that the sacral vertical dislocation was reduced to 7.5 mm. The patient started getting out of bed on postoperative day 2. His neuropathy improved after surgery. Owing to abdominal discomfort, pelvic internal fixator was extracted at 3 months postoperatively. Bone fusion was completed, and posterior fixation was removed at 9 months postoperatively. Two years after, the patient walks independently and has returned to work. Minimally invasive 360-degree pelvic ring fixation is a treatment option for an unstable pelvic ring fracture (AO-C2). CSF360 is a modified CSF surgical technique. Free bone fragment and 360° pelvic ring fixation CSF and INFIX were performed. Unstable pelvic ring fractures can be fixed to 360° of circumference.
Collapse
Affiliation(s)
- Yoshiyuki Kamatani
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Hiroaki Matsumori
- Kashiba Asahigaoka Hospital, Department of Orthopedic Surgery, 839 Uenaka, Kashiba City, Nara 639-0265, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan
| |
Collapse
|
3
|
Kempen DHR, Delawi D, Altena MC, Kruyt MC, van den Bekerom MPJ, Oner FC, Poolman RW. Neurological Outcome After Traumatic Transverse Sacral Fractures: A Systematic Review of 521 Patients Reported in the Literature. JBJS Rev 2019; 6:e1. [PMID: 29870419 DOI: 10.2106/jbjs.rvw.17.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The purpose of this study was to determine the neurological outcome after transverse sacral fractures in patients with neurological impairment. METHODS A systematic review of the English, French, German, and Dutch literature was conducted. All study designs, including retrospective cohort studies and case reports, describing transverse sacral fractures were included. Two authors independently extracted the predefined data and scored the neurological impairment according to the Gibbons classification after the trauma and at the time of follow-up. The neurological outcomes were pooled according to the Gibbons classification. RESULTS No randomized controlled trials or prospective case series were found. A total of 139 articles were included, consisting of 81 case reports and 58 retrospective case series involving 521 patients. Regardless of the type of management, neurological recovery of at least 1 Gibbons category was reported in 62% of these patients. A comparison of the neurological outcome of nonoperatively treated patients and surgically treated patients showed similar neurological recovery rates. For the surgically treated patients, fixation of the fracture resulted in a better neurological improvement compared with an isolated decompression. CONCLUSIONS This review could not provide evidence of improved neurological recovery after surgical treatment compared with nonoperative treatment. When surgical treatment was considered, there was a low level of evidence that fixation of the fracture results in better neurological improvement compared with isolated decompression. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- D H R Kempen
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - D Delawi
- Department of Orthopaedic Surgery, Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - M C Altena
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - M C Kruyt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M P J van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - F C Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries. Eur J Trauma Emerg Surg 2019; 46:1437-1444. [PMID: 31011759 DOI: 10.1007/s00068-019-01137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Lumbosacral plexus injuries usually occur in patients with severe, multiple traumas requiring intensive care, affecting gait function. The purpose of the present study was to identify the initial factors associated with gait outcome in lumbosacral plexus injuries caused by traumas. METHODS We retrospectively identified 664 patients with pelvic fractures caused by trauma between 2006 and 2017. The lumbosacral plexus injuries were electrodiagnostically confirmed in 30 patients (4.5%). Demographic, injury-related, fracture-related and electrodiagnostic factors were compared between patients with long-term unassisted gait outcomes to those with assisted gait outcomes, with an average of 27 months elapsing after the trauma. RESULTS Eleven patients (36.7%) remained in the assisted gait group during the follow-up period. Complex pelvic trauma, rather than the severity of trauma to the entire body, was associated with a poor gait outcome. Among the various causes of injury, pedestrians struck by vehicles were associated with assisted gait outcomes. The number of anatomic locations involved in pelvic fractures, pelvic ring instability by Tile classification, and the proportion of unstable sacral fractures were higher in patients with assisted gait outcomes compared with those having unassisted gait outcomes. Weaknesses in the initial hip extensor, knee flexor, ankle dorsiflexor and ankle plantar flexor were observed significantly more often in patients with assisted gait outcomes. The Dumitru and Wilbourn's scale of the anterior and posterior sacral plexus was significantly higher in the assisted gait group. CONCLUSIONS Gait outcome after lumbosacral plexus injury is associated with the range and stability of the pelvic fracture and the severity of the anterior and posterior sacral plexus injury. Poor gait outcome was associated with the severity of the trauma to the pelvis rather than that to the entire body.
Collapse
|
5
|
Okuda A, Maegawa N, Matsumori H, Kura T, Mizutani Y, Shigematsu H, Iwata E, Tanaka M, Masuda K, Yamamoto Y, Tada Y, Kogeichi Y, Takano K, Asai H, Kawai Y, Urisono Y, Kawamura K, Fukushima H, Tanaka Y. Minimally invasive spinopelvic "crab-shaped fixation" for unstable pelvic ring fractures: technical note and 16 case series. J Orthop Surg Res 2019; 14:51. [PMID: 30767783 PMCID: PMC6376779 DOI: 10.1186/s13018-019-1093-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes. Methods Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed. Results The average surgical time was 158 min (range, 117–230 min), with an intraoperative bleeding volume of 299 ml (range, 80–480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4–9.0 mm), to < 10 cm. Correction was retained in all cases. Conclusions Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.
Collapse
Affiliation(s)
- Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan. .,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Hiroaki Matsumori
- Department of Orthopedic Surgery, Kashiba Asahigaoka Hospital, Kashiba, Nara, Japan
| | - Tomohiko Kura
- Department of Orthopedic Surgery, Kura Hospital, Ikoma, Nara, Japan
| | - Yasushi Mizutani
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Eiichiro Iwata
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Keisuke Masuda
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Tada
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yohei Kogeichi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Keisuke Takano
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
6
|
Affiliation(s)
- Joan Pirrung
- Joan Pirrung is a trauma program manager and Donna Mower-Wade is a trauma program advanced practice nurse at Christiana Care Health System in Newark, Del
| | | |
Collapse
|