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Meuser AH, Henyš P, Höch A, Gänsslen A, Hammer N. Evaluating the stability of external fixators following pelvic injury: A systematic review of biomechanical testing methods. J Mech Behav Biomed Mater 2024; 153:106488. [PMID: 38437754 DOI: 10.1016/j.jmbbm.2024.106488] [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: 05/25/2023] [Revised: 10/31/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs. METHODS A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials. RESULTS Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques. DISCUSSION AND CONCLUSION An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.
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Affiliation(s)
- Annika Hela Meuser
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Liberec, Czech Republic
| | - Andreas Höch
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - Axel Gänsslen
- Clinic for Trauma Surgery, Orthopaedics and Hand Surgery, Wolfsburg Hospital, Wolfsburg, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Division of Biomechatronics, Fraunhofer IWU, Dresden, Germany.
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Cavalcanti Kussmaul A, Kuehlein T, Langer MF, Ayache A, Unglaub F. The Treatment of Closed Finger and Metacarpal Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:855-862. [PMID: 37963039 PMCID: PMC10840131 DOI: 10.3238/arztebl.m2023.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures. METHODS This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature. RESULTS The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis. CONCLUSION Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
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Affiliation(s)
- Adrian Cavalcanti Kussmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Titus Kuehlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Martin F. Langer
- Dept. for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster, Muenster
| | - Ali Ayache
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
- Mannheim Faculty of Medicine of the Ruprecht-Karls Heidelberg University, Mannheim
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Zheng YQ, Chen LL, Shen JZ, Gao B, Huang XC. Biomechanical evaluation of seven fixation methods to treat pubic symphysis diastasis using finite element analysis. J Orthop Surg Res 2022; 17:189. [PMID: 35346277 PMCID: PMC8961909 DOI: 10.1186/s13018-022-03078-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pubic symphysis diastasis (PSD) hinders the connection between bilateral ischia and pubic bones, resulting in instability of the anterior pelvic ring. PSD exceeding 25 mm is considered disruptions of the symphyseal and unilateral/bilateral anterior sacroiliac ligaments and require surgical intervention. The correct choice of fixation devices is of great significance to treat PSD. This study aimed to evaluate the construct stability and implant performance of seven fixation methods to treat PSD using finite element analysis.
Methods
The intact skeleton-ligament pelvic models were set as the control group. PSD models were simulated by removing relevant ligaments. To enhance the stability of the posterior pelvic ring, a cannulated screw was applied in the PSD models. Next, seven anterior fixation devices were installed on the PSD models according to standard surgical procedures, including single plates (single-Plate group), single plates with trans-symphyseal cross-screws (single-crsPlate group), dual plates (dual-Plate group), single cannulated screws, dual crossed cannulated screws (dual-canScrew group), subcutaneous plates (sub-Plate group), and subcutaneous pedicle screw-rod devices (sub-PedRod group). Compression and torsion were applied to all models. The construct stiffness, symphyseal relative micromotions, and von Mises stress performance were recorded and analyzed.
Results
The construct stiffness decreased dramatically under PSD conditions. The dual-canScrew (154.3 ± 9.3 N/mm), sub-Plate (147.1 ± 10.2 N/mm), and sub-PedRod (133.8 ± 8.0 N/mm) groups showed better ability to restore intact stability than the other groups (p < 0.05). Regarding regional stability, only single-plate fixation provided unexpected regional stability with a diastasis of 2.1 ± 0.2 mm (p < 0.001) under a compressive load. Under a rotational load, the single-crsPlate group provided better regional angular stability (0.31° ± 0.03°, p < 0.001). Stress concentrations occurred in the single-Plate, sub-Plate, and sub-PedRod groups. The maximum von Mises stress was observed in the single-plate group (1112.1 ± 112.7 MPa, p < 0.001).
Conclusion
The dual-canScrew fixation device offers ideal outcomes to maintain stability and prevent failure biomechanically. The single-crsPlate and dual-Plate methods effectively improved single-Plate device to enhance regional stability and disperse stresses. The subcutaneous fixation devices provided both anterior pelvic ring stability and pubic symphysis strength.
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Pan ZH, Chen FC, Huang JM, Sun CY, Ding SL. Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis. J Orthop Surg Res 2021; 16:467. [PMID: 34315524 PMCID: PMC8314600 DOI: 10.1186/s13018-021-02618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using the Tornetta and Matta grading system and finite element analyses (FEA). Methods In a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n = 30) or INFIX (n = 33). The main outcome measures were the Majeed score, incidence of complications, and adverse outcomes, and fixation stability as evaluated by finite element analysis. Results Sixty-three patients were included in the study, with an average age of 34.4 and 36.2 in modified group and conventional group, respectively. Two groups did not differ in terms of the injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a rate of higher satisfactory results according to the Tornetta and Matta grading system than the conventional group (73.33% vs 63.63%) as well as a higher Majeed score (81.5 ± 10.4 vs 76.3 ± 11.2), and these differences were statistically significant at 6 months post-surgery. FEA showed that MPSRF was stiffer and more stable than INFIX and had a lower risk of implant failure. Conclusions Both MPSRF and INFIX provide acceptable biomechanical stability for the treatment of unstable anterior pelvic ring fractures. However, MPSRF provides better fixation stability and a lower risk of implant failure, and can thus lead to better clinical outcomes. Therefore, MPSRF should be more widely applied to anterior pelvic ring fractures Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02618-9.
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Affiliation(s)
- Zhi-Hong Pan
- Zhoujiadu Community Health Service Center, Pudong New Area, Shanghai, 200126, People's Republic of China
| | - Fan-Cheng Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jun-Ming Huang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Cheng-Yi Sun
- Department of Foot Ankle Surgery Beijing Tongren Hospital, Capital Medical University, No. 1, Dongjiaomin Lane, DongCheng District, Beijing, 100730, People's Republic of China
| | - Sheng-Long Ding
- Department of Foot Ankle Surgery Beijing Tongren Hospital, Capital Medical University, No. 1, Dongjiaomin Lane, DongCheng District, Beijing, 100730, People's Republic of China.
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Barrientos-Mendoza C, Brañes J, Wulf R, Kremer A, Barahona M, León S. The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures. Eur J Trauma Emerg Surg 2021; 48:3737-3746. [PMID: 34097076 DOI: 10.1007/s00068-021-01711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. METHODS We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. RESULTS A total of 47 patients were included, of which 25 were females. The median age was 44 years (interquartile range 23-59). Median follow-up duration was 14 months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11 weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10 weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6 mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. CONCLUSION Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.
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Affiliation(s)
- Cristián Barrientos-Mendoza
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile. .,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile. .,Orthopaedics Department, Hip and Pelvis Unit, Clínica Santa María, Santiago, Chile.
| | - Julián Brañes
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile.,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Rodrigo Wulf
- Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Alex Kremer
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile
| | - Maximiliano Barahona
- Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | - Sebastián León
- Orthopaedics Department, Hospital San José, San Jose 1196, 8380219, Santiago, Region Metropolitana, Chile.,Orthopaedics Department, Hospital Clínico de La Universidad de Chile, Santiago, Chile
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Sun X, Yan H, Wang J, Liu Z, Tian W, Jia J. Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture. Medicine (Baltimore) 2020; 99:e20652. [PMID: 32791662 PMCID: PMC7386985 DOI: 10.1097/md.0000000000020652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation.We retrospectively reviewed 18 patients (aged 25-62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed.The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation.Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.
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Affiliation(s)
- Xiaochen Sun
- Department of Orthopaedic Surgery, Tianjin Haihe Hospital
| | - Huimin Yan
- Department of Orthopaedic Surgery, Tianjin Haihe Hospital
| | - Jianmin Wang
- Department of Orthopaedic Surgery, Da Feng Tong Ren hospital of Yancheng, Jiangsu
| | - Zhaojie Liu
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Wei Tian
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Jian Jia
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
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Becker CA, Kammerlander C, Kußmaul AC, Woiczinski M, Thorwächter C, Zeckey C, Sommer F, Linhart C, Weidert S, Suero EM, Böcker W, Greiner A. Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study. Biomed Eng Online 2019; 18:38. [PMID: 30925898 PMCID: PMC6441140 DOI: 10.1186/s12938-019-0648-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/13/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Operative procedures for unstable pelvic ring fractures remain controversially discussed. Minimally invasive treatment options for pelvic ring fractures have several benefits for the patient. But they can also provide disadvantages. Anterior subcutaneous pelvic fixation (INFIX) has shown promising biomechanical results in pelvic ring fractures, but there is a high complication rate of nerve injuries. An additional screw to the INFIX seems to be more stable. The aim of this study is to compare biomechanical stability of a new modified unilateral INFIX fixing the unilateral injured pelvic ring with the standard INFIX. METHODS 24 composite synthetic full pelvises were used in this study. 4 groups each with a number of six pelvic specimens were randomly assigned. A C1.3-type pelvic fracture was made with an osteotomy of the sacrum and an osteotomy of the anterior pelvic ring. Fracture fixation was performed within the four groups: (1) unilateral INFIX, (2) "extended" unilateral INFIX + additional pubic ramus pedicle screw, (3) bilateral INFIX, (4) "extended" bilateral INFIX + additional pubic ramus pedicle screw. All specimens were cyclic loaded with 200 N until maximum of 300 N. Distance/dislocation of the fracture fragments were detected with 3D-ultrasound measuring system. Stiffness was calculated. RESULTS Extended unilateral INFIX showed the lowest mean dislocation. Lowest rotational stability was displayed by the standard bilateral INFIX. A significant difference (P = 0.04) was shown between the extended unilateral INFIX and the "standard" bilateral INFIX in terms of rotational stability. Extended unilateral INFIX showed significantly improved stability of anterior fracture dislocation (P = 0.01) and unilateral INFIX showed the highest rotational stiffness. Anterior fixation stiffness of the unilateral INFIX was significantly improved using an additional symphysis/pubic ramus screw (P = 0.002). CONCLUSION Extended unilateral INFIX (+ additional pubic ramus pedicle screw) is a feasible minimally invasive treatment for anterior pelvic ring fractures. Higher stability and lower probability of bilateral nerve damage is provided by the extended unilateral INFIX compared to the standard bilateral INFIX.
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Affiliation(s)
- Christopher A Becker
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Kammerlander
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Christian Zeckey
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Sommer
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Linhart
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Simon Weidert
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Eduardo M Suero
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Axel Greiner
- Department of General Trauma & Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany.
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Schmal H, Froberg L, S Larsen M, Südkamp NP, Pohlemann T, Aghayev E, Goodwin Burri K. Evaluation of strategies for the treatment of type B and C pelvic fractures: results from the German Pelvic Injury Register. Bone Joint J 2018; 100-B:973-983. [PMID: 29954203 DOI: 10.1302/0301-620x.100b7.bjj-2017-1377.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality. Results Operative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery. Conclusion Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.
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Affiliation(s)
- H Schmal
- Department of Orthopaedics and Traumatology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark and Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - L Froberg
- Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M S Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N P Südkamp
- Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - E Aghayev
- Spine Centre Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - K Goodwin Burri
- Swiss Medical Registries and Data Linkage (SwissRDL), Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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