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Bi C, Yin G, Cao L, Lin H, Wang J. Modified pedicle screw-rod fixation versus open reduction plate fixation for the management of pubic symphysis diastasis: A retrospective study. J Orthop 2024; 57:29-34. [PMID: 38948501 PMCID: PMC11208946 DOI: 10.1016/j.jor.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Objective Surgical intervention and fixation is the recognized measurement to treat pubic symphysis diastasis caused by high-energy trauma. The purpose of this retrospective study was to assess the clinical application of modified pedicle screw-rod fixation (modified PSRF) and open reduction plate fixation (ORPF) for treating pubic symphysis diastasis. Methods The data of this retrospective analysis were collected from 32 patients with pubic symphysis diastasis managed with modified PSRF or ORPF from January 2012 to December 2017, with or without posterior fixation. Indicators of clinical assessments including operating time, intraoperative blood loss, relevant surgical complications as well as follow-up were recorded. Majeed scores were performed for functional evaluation, as well as Matta criteria were applied to evaluate the quality of reduction. Results The average time from injury to operation was 2.9 days in modified PSRF group and 3.2 days in ORPF group. Significant differences regarding average operation time (41.8 min versus 64.3 min) and average intraoperative blood loss (46.6 ml versus 304.6 ml) were presented between modified PSRF groups and ORPF group. Neither Majeed scores nor Matta evaluation showed a significant difference between two groups. In ORPF group, the incision infection occurred in one patient and two patients developed loosening of screws. In modified PSRF group, loosening of screws was found in one patient during the operative procedure and one patient experienced femoral nerve palsy. Irritation to the lateral femoral cutaneous nerve (LFCN) was detected in two patients in modified PSRF group. Conclusions Satisfactory clinical outcomes were provided with applications of both fixation methods for treating pubic symphysis diastasis. Modified PSRF, as a minimal invasive technique, could serve as an effective and reasonable option for treating pubic symphysis diastasis.Level of evidence: III: retrospective cohort study.Trial registration: researchregistry3906.
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Affiliation(s)
- Chun Bi
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, PR China
| | - Gang Yin
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, PR China
| | - Lei Cao
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, PR China
| | - Haodong Lin
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, PR China
| | - Jiandong Wang
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, PR China
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Luo AJ, Wang A, Lai CY, Yu YH, Hsu YH, Chou YC, Chen IJ. Higher pelvic incidence values are a risk factor for trans-iliac trans-sacral screw malposition in sacroiliac complex fracture treatment. J Orthop Traumatol 2023; 24:51. [PMID: 37735320 PMCID: PMC10513998 DOI: 10.1186/s10195-023-00728-0] [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: 03/01/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Percutaneous iliosacral (IS) screw fixation and trans-iliac trans-sacral (TITS) screw fixation are clinically effective treatments of posterior pelvic sacroiliac fractures. In order to accurately assess the sacrum position relative to the pelvis, pelvic incidence (PI) is a commonly utilized radiographic parameter in sagittal view. This study aimed to investigate and compare the surgical outcomes and radiographic parameters of IS or TITS screw fixations for the treatment of posterior sacroiliac complex fractures with different PI values. MATERIALS AND METHODS The data on patients with posterior pelvic sacroiliac fractures who underwent percutaneous IS or TITS screw fixations, or both, at a single level I trauma center between January 2017 and June 2020 were reviewed. We documented the patient characteristics and fracture types, reviewed surgical records, and measured the radiographic parameters via plain films and multi-planar computed tomography (mpCT) images. Radiographic variations in PI, sacral slope, pelvic tilt, sacral dysmorphism, pelvic ring reduction quality, screw deviation angles, screw malposition grading, and iatrogenic complications were documented and analyzed. RESULTS A total of 85 patients were included, and 65 IS and 70 TITS screws were accounted for. Patients were divided into two groups according to screw fixation method and further divided into four sub-groups based on baseline PI values. The PI cutoff values were 49.85° and 48.05° in the IS and TITS screw groups, respectively, according to receiver operating characteristic analysis and Youden's J statistic. Smaller PI values were significantly correlated with sacral dysmorphism (p = 0.027 and 0.003 in the IS and TITS screw groups, respectively). Patients with larger PI values were at a significantly increased risk of screw malposition in the TITS screw group (p = 0.049), with no association in the IS screw group. Logistic regression confirmed that a larger PI value was a significant risk factor for screw malposition in the TITS screw group (p = 0.010). The post-operative outcomes improved from poor/fair (at 6 months) to good/average (at 12 months) based on the Postel Merle d'Aubigné and Majeed scores, with no significant differences between subgroups. CONCLUSIONS Both percutaneous IS and TITS screw fixations are safe and effective treatments for posterior pelvic sacroiliac fractures. Due to the higher risk of screw malposition in patients with larger PI values, it is crucial to identify potential patients at risk when performing TITS screw fixation surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- An-Jhih Luo
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Angela Wang
- Department of Orthopedic Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan ROC
| | - Chih-Yang Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Ying-Chao Chou
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - I-Jung Chen
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
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Abo-Elsoud M, Awad MI, Abdel Karim M, Khaled S, Abdelmoneim M. Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study. World J Orthop 2023; 14:562-571. [PMID: 37485427 PMCID: PMC10359749 DOI: 10.5312/wjo.v14.i7.562] [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: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/19/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture.
AIM To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.
METHODS A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score.
RESULTS The results revealed a statistically significant difference between both groups (P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (P = 0.513). A lower surgical site infection rate was noticed in the INFIX group (P = 0.007).
CONCLUSION Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Mostafa I Awad
- Department of Trauma and Orthopedics, Mataria Teaching Hospital, Cairo 4540046, Egypt
| | - Mahmoud Abdel Karim
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Sherif Khaled
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Mohamed Abdelmoneim
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
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Timmer RA, Mostert CQB, Krijnen P, Meylaerts SAG, Schipper IB. The relation between surgical approaches for pelvic ring and acetabular fractures and postoperative complications: a systematic review. Eur J Trauma Emerg Surg 2022; 49:709-722. [PMID: 36434301 PMCID: PMC10175345 DOI: 10.1007/s00068-022-02118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
Material and Methods
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
Results
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher–Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4–8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
Conclusion
External fixation of pelvic fractures is associated with highest complications rates including SSI’s and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
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Patel S, Aggarwal S, Jindal K, Kumar V, Sharma S. Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:787-803. [PMID: 33426606 DOI: 10.1007/s00402-020-03742-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages. QUESTIONS/PURPOSES This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries. METHODS A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm, to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool. RESULTS A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4 months to a maximum of 54 months. Comparative meta-analysis (n = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46 mL; 95% CI - 207.54 to - 145.38) and shorter operative time (mean difference = 26.43 min, 95% CI - 31.79 to - 21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83-3.05) and functional outcome scores (mean difference = - 2.51, 95% CI - 5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860-0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34-89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1-41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5-13.3%); rates of other complications were low. Significant heterogeneity was noted in the pooled analysis of blood loss, operative time, functional outcome, HO and LFCN injury. The overall strength of evidence was found to be weak. CONCLUSION The INFIX technique can be considered as a viable alternative to symphyseal plating for unstable pelvic ring injuries. It has the advantages of shorter operative times and less blood loss, along with comparable functional outcomes, when compared to plating. Overall, good functional outcomes can be expected. However, well-designed, multi-center randomized controlled trials are needed to conclusively prove the benefit of this technique.
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Affiliation(s)
- Sandeep Patel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vishal Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhartha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wang P, Ali SH, Fei C, Zhang B, Wei X, Wang H, Cong Y, Deng H, Fu Y, Zhang K, Zhuang Y. Management of LC Type I (LC-1) Pelvic Injuries with Complete Sacral Fracture: Comparison of Solitary Anterior Fixation with Combined Anterior-Posterior Fixation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3918794. [PMID: 35087907 PMCID: PMC8789421 DOI: 10.1155/2022/3918794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Management of LC-1 type pelvic injuries, particularly in patients with complete sacral fracture (LC-1 PICSF, OTA type 61-B2.1), remains controversial. Specific indications for solitary fixation remain unclear, and there is a paucity of outcomes data in comparison to combined fixation. We undertook a retrospective study in patients with LC-1 PICSFs to compare outcomes between solitary anterior fixation and combined anterior-posterior fixation. METHODS A retrospective cohort study was conducted with enrollment from 2016 to 2018 at a single tertiary-referral center in China. Adults with operatively managed LC-1 PICSFs were enrolled. Patients with sacral displacement < 1 cm as assessed by axial CT received solitary anterior ring fixation (group A); patients with displacement ≥ 1 cm received combined fixation of both the anterior and posterior rings (group B). Reduction was confirmed by manipulation under anesthesia. Patients followed up for at least 24 months postoperatively. Primary outcome was function (Majeed score). Secondary outcomes included intraoperative characteristics, pain (VAS score), quality of fracture reduction (Tornetta and Matta radiographic grading), rate of nonunion, early weight-bearing status, and complication rate. RESULTS 68 (89%) of 76 enrolled patients completed follow-up. Patients in group A exhibited improved operative times, less time under fluoroscopy, and less blood loss as compared to group B. There were no significant differences between groups A and B regarding quality of fracture reduction, rate of union, functional outcomes, or rate of complications. Notably, group B patients were more likely to achieve full early weight-bearing. CONCLUSION LC-1 PFCSFs can get benefits from ORIF; the treatment algorithm should be differently made following the degree of the sacral fractures displacement. Less than 1 cm sacral fracture displacement may get good functional outcomes from solitary anterior fixation. However, for the sacral fractures displacement greater or equal to 1 cm, both the anterior and posterior pelvic rings should be surgical stabilization.
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Affiliation(s)
- Pengfei Wang
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Syed Haider Ali
- Institute for Global Orthopaedics & Traumatology, University of California, 2550 23rd St., Bldg.9, 2nd Floor San Francisco, CA, 94110 San Francisco, USA
| | - Chen Fei
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Binfei Zhang
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Xing Wei
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Hu Wang
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Yuxuan Cong
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Hongli Deng
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Yahui Fu
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
| | - Yan Zhuang
- Department of Orthopedics and Traumatology, Xi'an Honghui Hospital, Xi'an Jiao Tong University Health Science Center, Xi'an, No. 555, East Friendship Road, 710054 Xi'an City, Shaanxi Province, China
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Haemophilic Pelvic Pseudotumour: A New Surgical Option. Healthcare (Basel) 2021; 9:healthcare9101269. [PMID: 34682949 PMCID: PMC8536013 DOI: 10.3390/healthcare9101269] [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] [Received: 08/08/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1–2% of haemophilic patients. Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.
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Vaidya R, Amar K, Woodbury D, Washington A. Infection after the use of INFIX in Pelvic Ring Injuries. SICOT J 2021; 7:46. [PMID: 34494963 PMCID: PMC8425278 DOI: 10.1051/sicotj/2021047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The purpose of this study is to report on infection with anterior subcutaneous internal pelvic fixation (INFIX) for pelvic ring injuries and the outcomes of treatment. METHODS An IRB-approved retrospective study was performed using trauma databases of a level one and level two trauma center from 2012-2018. Infection after the INFIX procedure was diagnosed in 10 of 179 cases. Treatment included formal irrigation and debridement, removal of the hardware, and culture-specific antibiotics. Patients were followed for a minimum of 12 months. Recorded outcomes include X-rays, Majeed scores, and the presence of any loss of reduction using reduction parameters. RESULTS Time to detect the infection was 54.2 ± 24.3 days (range 24-90, median 56 days). Staphylococcus aureus was the most common bacteria isolated. The average follow-up was 830 ± 170 days (range 575-1088 days). All patients went on to the radiographic union. There were no recurrent infections or osteomyelitis at the latest follow-up. Patients maintained their reduction after INFIX removal (KI), and Majeed scores ranged from 72 to 96 (seven good, three excellent). DISCUSSION Infections after using the INFIX procedure were dealt with by irrigating and debriding the wounds, removing the INFIX with culture-specific antibiotics for 2-6 weeks. Implants were maintained for at least 25 days, and there was no loss of reduction. There were no long-term sequelae noted in this small series or the literature review included in this paper.
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Affiliation(s)
- Rahul Vaidya
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Karun Amar
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Derrek Woodbury
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
| | - Austen Washington
- Detroit Medical Center, 5th Floor Heart Hospital, 311 Mack Avenue, Detroit, Michigan 48201, USA
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Alencar DF, Azi ML, Souza RAR, Silva LR, Costa HL, Sadgursky D, Daltro G. Functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) technique for pelvic ring injuries: A case series. Injury 2021; 52 Suppl 3:S54-S59. [PMID: 34088467 DOI: 10.1016/j.injury.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior external fixation is a well-established technique for treating pelvic ring injuries, but many complications are associated with it. The subcutaneous anterior internal fixator (INFIX) technique is associated with reduced complication rates and is less uncomfortable for patients. OBJECTIVE This study evaluated functional outcomes among patients with pelvic ring injuries treated using the INFIX method. PATIENTS AND METHODS In this retrospective case series, patients treated using the INFIX technique were reviewed for functional outcomes, using the Iowa Pelvic Score (IPS). Thirty-four patients, of mean age 39.2 years, were evaluated after a mean follow-up of 1.2 years. RESULTS Twenty-three of the 34 patients experienced reduction classified as excellent, and eleven as good, with no instances of moderate or poor reduction. One patient developed implant exposure and infection during follow-up. Twenty-six ultimately experienced an excellent or good functional result. The average final IPS was 79.4 (range: 48-100). CONCLUSION Our results reinforce prior evidence that the INFIX method is safe for fixating pelvic ring lesions. Most of our patients also experienced excellent or good functional recovery, suggesting that this technique is a viable option for treating certain pelvic ring injuries.
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Affiliation(s)
- Daniel Figueiredo Alencar
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - Matheus Lemos Azi
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - Roberto Almeida Rego Souza
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - Lucas Rebouças Silva
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - Humberto Lima Costa
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil.
| | - David Sadgursky
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia Conselheiro Almeida Couto square S/N, 40050-410, Salvador, Bahia, Brazil
| | - Gildásio Daltro
- Professor Edgard Santos University Hospital, Federal University of Bahia, Augusto Viana St S/N, Canela, 40110-060, Salvador, Bahia, Brazil.
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Wu S, Chen J, Yang Y, Chen W, Luo R, Fang Y. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. J Orthop Surg Res 2021; 16:350. [PMID: 34059111 PMCID: PMC8165806 DOI: 10.1186/s13018-021-02387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
Background This study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures. Methods Intraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification. Results Twenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up. Conclusion INFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures. Trial registration ChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.
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Affiliation(s)
- Shuang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jialei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yun Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rong Luo
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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Sharma S, Aggarwal S, Patel S, Kumar V, Jindal K, Sinha A. INFIX-safe and effective surgical option for complex fracture patterns of the anterior pelvic ring: A prospective single center study. J Orthop 2021; 23:142-149. [PMID: 33536724 DOI: 10.1016/j.jor.2021.01.004] [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: 11/26/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022] Open
Abstract
Background Complex fracture patterns of anterior pelvic ring are a challenge and usually needs extensive surgeries. The purpose of this study was to evaluate INFIX as a minimally invasive procedure for such injuries in terms of feasibility, outcomes and complications in the Indian population. Methods Patients with complex fracture patterns of anterior pelvic ring were selected for anterior INFIX application along with standard posterior stabilization. Outcomes were assessed radiographically by Matta's criteria and amount of displacement. Post-operative CT scan for relation of implant to vital structures and Doppler at varying hip flexion for possible vascular occlusion was used. Functional outcomes included both disease specific scores (Majeed score, IOWA pelvic score) and quality of life scores (SMFA, SF-12). Complications were also noted. Results 12 cases out of 112 patients had complex fracture pattern of the anterior ring. Most common injury pattern were LC-3 and VS (n = 6 and 3) Young and Burgess type. The average follow up was 6 months. Fracture reduction as per Matta's criteria was excellent in 10 (83.3%) cases and good in 2 (16.6%) cases with functional outcomes excellent in 11 cases, and a mean Majeed score of 92.67 ± 5.8. The average SMFA score was 51 ± 4.39 and mean SF-12 scores for physical and mental health were 48.493 ± 6.74 and 56.370 ± 4.04 respectively. Complications noted were lateral femoral cutaneous nerve palsy (1/24 nerves), skin dehiscence (n = 2), infection (n = 2) and sacral nonunion (n = 1). Conclusion INFIX is a safe and effective minimally invasive technique for addressing complexfracture patterns involving the anterior half of pelvic ring with excellent fracture reduction, radiological and functional outcomes and predictable fracture healing.
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Affiliation(s)
- Sushank Sharma
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Sandeep Patel
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
| | - Karan Jindal
- Department of Orthopaedics Surgery, Pgimer, Chandigarh, India
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12
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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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Abstract
OBJECTIVES To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature. DATA SOURCES Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018. STUDY SELECTION Search words used were: Majeed, pelvis, and outcome. DATA EXTRACTION Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score. DATA SYNTHESIS Descriptive statistics were used to report the outcome of our findings. CONCLUSIONS Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.
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Kumbhare C, Meena S, Kamboj K, Trikha V. Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review. J Clin Orthop Trauma 2020; 11:970-975. [PMID: 33191998 PMCID: PMC7656471 DOI: 10.1016/j.jcot.2020.06.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Subcutaneous screw rod system which is popularly known as Pelvic internal fixator (INFIX) has emerged as an alternative to external fixators in management of unstable pelvic injuries. INFIX has shown various advantages over external fixation such as reduced infection rate and patient morbidity. However, it has its own set of complications such as lateral femoral cutaneous nerve injury, heterotopic ossification, femoral nerve palsy etc. We intended to conduct a systematic review of the current literature to assess outcomes and complications with INFIX technique of fixation. METHODS A comprehensive search of literature was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and online database of EMBASE, PubMed, Medline and Scopus was searched for all studies in English language till March 2020. Included studies were reviewed for demographic data, fracture type/classification, radiological outcome and functional outcomes. The inclusion criteria were: 1. Studies in English language 2. Clinical studies reporting use of INFIX technique in pelvis fracture where clinical and radiological outcomes were reported. RESULTS Twenty-two studies fulfilling inclusion and exclusion criteria were included in this systematic review with total of 619 patients. Radiographic parameters and outcome measures were infrequently reported. Fixation with INFIX in these fractures leads to 87% excellent to good radiological results and 84% excellent to good functional results. Complications include lateral femoral cutaneous nerve irritation (25.3%), heterotopic ossification (24.7%), infection (3%), and femoral nerve palsy (1.6%); which is likely related to placing the bar and screws too deep. CONCLUSION This analysis supports the use of INFIX in management of unstable pelvis fractures where anterior fixation is required.
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Affiliation(s)
- Chetan Kumbhare
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India
| | - Sanjay Meena
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India
| | - Kulbhushan Kamboj
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India,Corresponding author.
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences and Associated JPN ApexTrauma Centre, New Delhi, India
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15
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Modified internal fixator for anterior pelvic ring fractures versus conventional two-screw fixation. Eur J Trauma Emerg Surg 2019; 47:533-539. [PMID: 31147724 DOI: 10.1007/s00068-019-01164-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/27/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE The present study aims to evaluate the short-term clinical effects and complications of modified three-screw fixation and conventional two-screw fixation for treating anterior pelvic ring fractures. METHODS A retrospective study of 51 patients with type B fractures was performed. 25 patients (modified group) were treated with modified three-screw fixation and the other 26 patients (conventional group) with conventional two-screw fixation. Outcome measures included operation time, intraoperative blood loss, hospital stays, postoperative complications and the Majeed score at postoperatively 2 months, 3 months, 1 year and the time of implant removal. RESULTS The mean operative times and mean blood loss for modified three-screw fixation versus conventional two-screw fixation bilateral were 54.8 ± 10.7 min versus 32.3 ± 9.9 min, and 153.3 mL versus 550.0 mL (p < 0.001), respectively. However, the Majeed score was better in modified group at postoperatively 2 months (75.6 ± 9.5 vs. 69.7 ± 8.3, p = 0.008) and 3 months (80.3 ± 10.7 vs. 75.1 ± 11.9, p = 0.014). There was no statistical difference between two groups at the time of implant removal (82.1 ± 9.3 vs. 80.9 ± 8.8, p = 0.272) and postoperatively 1 year (83.5 ± 7.8 vs 82.6 ± 8.2, p = 0.723). No patients experienced surgical wound infection, deep vein thrombosis, delayed union or nonunion, implant loosening or rupture. One patient complained of tardive unilateral thigh pain at postoperatively 4 months in conventional group. CONCLUSIONS Both modified three-screw fixation and conventional two-screw fixation could ultimately afford satisfactory clinical and radiological outcomes with less complication for anterior pelvic ring fractures. The modified three-screw fixation might have better biomechanical strength and faster pelvic rehabilitation.
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Yin Y, Luo J, Zhang R, Li S, Jiao Z, Zhang Y, Hou Z. Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture. Sci Rep 2019; 9:2578. [PMID: 30796253 PMCID: PMC6385294 DOI: 10.1038/s41598-019-39068-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to compare the clinical outcomes in patients with unstable anterior pelvic ring fractures after treatment with anterior subcutaneous internal fixator (INFIX) or plate fixation. We performed a retrospective study from August 2015 to October 2017. A consecutive series of 74 patients who underwent surgical treatment of their anterior pelvic ring (35 treated with INFIX and 39 treated with plates) were studied. Data collected included patients’ demographic data, injury severity score (ISS), AO/OTA classification, injury mechanism, time to surgery, procedure time, and blood loss. The quality of postoperative reduction were assessed by postoperative radiographs using the Tornetta and Matta method. Functional outcome was evaluated using Majeed scoring system. In the INFIX group, ten patients developed LFCN paralysis, one patient suffered from superficial infection. Three screw loosening cases and two wound infection cases occurred in the plate group. INFIX is relatively minimally invasive and time-saving than the reconstruction plate in the treatment of anterior pelvic ring fracture. However, plate fixation increases the rate of anatomic reduction of the pelvic anterior ring fracture. Plates also provide a higher functional outcome compared with INFIX. INFIX is especially suitable in patients with urological injury, which can also decrease the wound infection rate.
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Affiliation(s)
- Yingchao Yin
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Junhao Luo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Shilun Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Zhenqing Jiao
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China. .,Chinese Academy of Engineering, Beijing, 100088, P. R. China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P. R. China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P. R. China
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Wang J, Cao L, Wu J, Wang Q, Bi C. Clinical and radiological short-term outcomes of pubic symphysis diastasis treated with modified pedicle screw-rod fixation. Eur J Trauma Emerg Surg 2018; 46:865-871. [PMID: 30443777 DOI: 10.1007/s00068-018-1050-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Pubic symphysis diastasis with an incidence of approximately 20% in pelvic fractures is a severe lesion which needs to be treated properly. The objective of this retrospective study was to describe and evaluate the clinical and radiological outcomes including its advantages and limitations of this modified minimal invasive technique. METHODS Totally 29 patients with pubic symphysis diastasis, with or without posterior ring instability, were treated by modified pedicle screw-rod fixation (modified PSRF) between January 2010 and December 2016. The duration from injury to surgery, operation time, intraoperative blood loss as well as complications were recorded. During follow-up, the functional outcomes were assessed according to the Majeed evaluation criteria 1 year postoperatively. The evaluation of the postoperative reduction quality was carried out according to Matta criteria. RESULTS According to Tile classification, there were 9 cases of Type B1 underwent only anterior-modified PSRF and 20 cases of Type C1 experienced anterior-modified PSRF combined with posterior fixation. The duration from injury to operation, operation time and intraoperative blood loss were 3.27 days (range 1-6 days), 42.07 min (range 38-45 min), and 46.14 ml (range 40-55 ml). The results of reduction quality were rated as excellent in 16, good in 11 and fair in 2 based on Matta criteria. The Majeed functional scores ranged from 68 to 95 and there were excellent in 15, good in 12 and fair in 2. No patients experienced incision infection. Slight loosening of middle-two screws was verified during follow-up in one patient. Two patients underwent femoral nerve palsy. Irritation to the LFCN was detected in four patients. CONCLUSIONS Modified PSRF can be performed as an alternative to manage pubic symphysis diastasis due to its merits of minimal invasive, less blood loss, less soft tissue injuries as well as shorter operation time, even with the early weight-bearing. TRIAL REGISTRATION Researchregistry3905.
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Affiliation(s)
- Jiandong Wang
- Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.,Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Lei Cao
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Jianhong Wu
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Qiugen Wang
- Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China. .,Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
| | - Chun Bi
- Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
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Abstract
INTRODUCTION The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and radiographic outcomes, and compare these with alternative fixation methods. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search on PubMed and Google Scholar was performed. Articles included were in the English language or English translations and published between 2007 and 2018. Studies included were appraised with narrative data synthesis. RESULTS Twenty-five articles with 496 patients were included. These included 17 case series, with 3 case reports reporting adverse events. CONCLUSIONS ASIPF and the appropriate posterior fixation resulted in healing of pelvic ring injuries in 99.5% of cases. Indications include unstable pelvic ring injuries with the appropriate posterior fixation. Radiographic parameters and outcome measures were infrequently reported. ASIPF is a valuable tool for reduction and fixation in unstable pelvic ring injuries. Complications include lateral femoral cutaneous nerve irritation (26.3%); heterotopic ossification (36%); infection (3%); and femoral nerve palsy (1%), which is likely related to placing the bar and screws too deep.
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