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Berk T, Zderic I, Varga P, Schwarzenberg P, Berk K, Grüneweller N, Pastor T, Halvachizadeh S, Richards G, Gueorguiev B, Pape HC. Substitutional semi-rigid osteosynthesis technique for treatment of unstable pubic symphysis injuries: a biomechanical study. Eur J Trauma Emerg Surg 2023; 49:2569-2578. [PMID: 37555991 PMCID: PMC10728235 DOI: 10.1007/s00068-023-02333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND/PURPOSE The surgical fixation of a symphyseal diastasis in partially or fully unstable pelvic ring injuries is an important element when stabilizing the anterior pelvic ring. Currently, open reduction and internal fixation (ORIF) by means of plating represents the gold standard treatment. Advances in percutaneous fixation techniques have shown improvements in blood loss, surgery time, and scar length. Therefore, this approach should also be adopted for treatment of symphyseal injuries. The technique could be important since failure rates, following ORIF at the symphysis, remain unacceptably high. The aim of this biomechanical study was to assess a semi-rigid fixation technique for treatment of such anterior pelvic ring injuries versus current gold standards of plate osteosynthesis. METHODS An anterior pelvic ring injury type III APC according to the Young and Burgess classification was simulated in eighteen composite pelvises, assigned to three groups (n = 6) for fixation with either a single plate, two orthogonally positioned plates, or the semi-rigid technique using an endobutton suture implant. Biomechanical testing was performed in a simulated upright standing position under progressively increasing cyclic loading at 2 Hz until failure or over 150,000 cycles. Relative movements between the bone segments were captured by motion tracking. RESULTS Initial quasi-static and dynamic stiffness, as well as dynamic stiffness after 100,000 cycles, was not significantly different among the fixation techniques (p ≥ 0.054).). The outcome measures for total displacement after 20,000, 40,000, 60,000, 80,000, and 100,000 cycles were associated with significantly higher values for the suture technique versus double plating (p = 0.025), without further significant differences among the techniques (p ≥ 0.349). Number of cycles to failure and load at failure were highest for double plating (150,000 ± 0/100.0 ± 0.0 N), followed by single plating (132,282 ± 20,465/91.1 ± 10.2 N), and the suture technique (116,088 ± 12,169/83.0 ± 6.1 N), with significantly lower values in the latter compared to the former (p = 0.002) and no further significant differences among the techniques (p ≥ 0.329). CONCLUSION From a biomechanical perspective, the semi-rigid technique for fixation of unstable pubic symphysis injuries demonstrated promising results with moderate to inferior behaviour compared to standard plating techniques regarding stiffness, cycles to failure and load at failure. This knowledge could lay the foundation for realization of further studies with larger sample sizes, focusing on the stabilization of the anterior pelvic ring.
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Affiliation(s)
- Till Berk
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | | | - Karlyn Berk
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Niklas Grüneweller
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Trauma Surgery and Orthopedics, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld‑Bethel, Burgsteig 13, 33617, Bielefeld, Germany
| | - Tatjana Pastor
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
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Cavazos DR, Mansour DT, Vaidya R, Oliphant BW. Percutaneous Treatment of Locked Pubic Symphysis with the Anterior Subcutaneous Pelvic Fixator (INFIX): A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00088. [PMID: 37733912 DOI: 10.2106/jbjs.cc.23.00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
CASE A 54-year-old woman was involved in a motor vehicle collision and sustained a lateral compression type 1 pelvic ring fracture with pubic symphyseal dislocation or a "locked pubic symphysis." Her injury failed to reduce with closed reduction maneuvers under anesthesia and necessitated a percutaneous reduction using a distraction force applied through supra-acetabular placed pedicle screws. This anterior subcutaneous internal pelvic fixator (INFIX) was also used to stabilize the injury. CONCLUSION This is the first reported case where a locked pubic symphysis, which failed standard closed reduction measures, was reduced and stabilized through a percutaneous technique, using the INFIX.
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Affiliation(s)
- Daniel R Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Devone T Mansour
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Rahul Vaidya
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Bryant W Oliphant
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
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Koppe D, Pretzer J, Heumann P, Salmoukas K, Dietl C, Goll M, Ekkernkamp A. [Complex pelvic trauma : A case report with special consideration of the accompanying urogenital injury]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:67-71. [PMID: 35380265 PMCID: PMC9842583 DOI: 10.1007/s00113-022-01170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 01/21/2023]
Abstract
The following case report shows a young male patient with a complex pelvic trauma due to a traffic accident. In addition to the pelvic ring fracture, he also suffered a severe accompanying injury to the efferent urinary tract in combination with extensive damage of the lumbosacral plexus. Multiple extensive operations were necessary to address the C3 fracture of the pelvic ring and the bladder injury. Due to an infection a wound healing disorder subsequently occurred, which necessitated a myocutaneous flap plasty. This case highlights the complexity of this injury and confirms the necessity for an interdisciplinary individualized treatment.
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Affiliation(s)
- David Koppe
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland.
| | - Jana Pretzer
- Klinik für Urologie und Neuro-Urologie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland
| | - Peter Heumann
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
| | - Katharina Salmoukas
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
| | - Carlo Dietl
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
| | - Moritz Goll
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
| | - Axel Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, Schwerpunkt Wirbelsäulen- und Beckenchirurgie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland
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Jordan MC, Bröer D, Fischer C, Heilig P, Gilbert F, Hölscher-Doht S, Kalogirou C, Popp K, Grunz JP, Huflage H, Jakubietz RG, Ergün S, Meffert RH. Development and preclinical evaluation of a cable-clamp fixation device for a disrupted pubic symphysis. COMMUNICATIONS MEDICINE 2022; 2:164. [PMID: 36550296 PMCID: PMC9780275 DOI: 10.1038/s43856-022-00227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage. METHODS To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility. RESULTS We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation. CONCLUSION We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.
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Affiliation(s)
- Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - David Bröer
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Christian Fischer
- Headmade Materials, Langhausstraße 9, 97294, Unterpleichfeld, Germany
| | - Philipp Heilig
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Fabian Gilbert
- Center of Musculoskeletal Medicine, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Hölscher-Doht
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Charis Kalogirou
- Department of Urology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Kevin Popp
- Additive Manufacturing Research Unit, SKZ Technology Center, Friedrich-Bergius-Ring 22, 97076, Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rafael G Jakubietz
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy, Julius-Maximilians-University Würzburg, Koellikerstraße 6, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Bott A, Nicol G, Odutola A, Halliday R, Acharya MR, Ward A, Chesser TJS. Long-term patient reported sexual and urological dysfunction in males after operatively treated pelvic ring injuries Do generic outcome measures identify genitourinary health problems? Injury 2022; 53:2139-2144. [PMID: 35246326 DOI: 10.1016/j.injury.2022.01.048] [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: 09/06/2020] [Revised: 01/03/2022] [Accepted: 01/29/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A consecutive series of 177 male patients, with high energy pelvic ring injuries, were treated operatively in our institution. The purpose of this study was to evaluate long-term sexual and urological dysfunction in these patients using validated disease specific patient reported outcome measures (PROMs), and identify if sexual and urological dysfunction is detectable from generic outcome scores used in the assessment of pelvic ring injury at a minimum of 10 years follow-up (range 10-22). METHODS Surviving patients were contacted to complete validated PROMs to examine genitourinary and global functional outcome. Fifty-two male participants, had a mean age of 44-years-old (range,16-69) and ISS of 17 at time of injury. Mean duration follow-up of 15 years. The primary outcome measures were the Sexual Health Inventory for Men (SHIM) and the Modular Questionnaire for Male Lower Urinary Tract Symptoms (MLUTS). Secondary outcomes were the EQ-5D and Short Form 36. Responses were tested for correlation between generic and disease-specific PROMs and analyzed for association with genitourinary injury and age as risk factors of poor outcome. RESULTS Genitourinary injuries occurred in 7 patients (13%), and ten patients (19%) had documented neurological dysfunction following injury. Satisfactory general functional outcome was reported with EQ-5D-3L VAS score of 71. However, 80% report some level of sexual dysfunction with 37% reporting it as severe. MLUTS mean symptom score was 9 (range, 0 - 26) and bothersomeness score was 21 (range, 0-90). There was poor correlation between urological and sexual dysfunction scores and between the disease specific and generic scores. CONCLUSION In operatively treated pelvic ring injuries, validated disease specific PROMs, (SHIM and MLUTs) identified a significant impact to both sexual and urological patient health, with 37% reporting severe sexual dysfunction. Longstanding sexual and/or urological dysfunction can be a source of significant psychological impact that this study has shown is not identifiable using generic PROMs; EQ-5D-3L and SF-36. To gain a holistic understanding of the functional outcome of patients following a pelvic injury, urological and sexual dysfunction must not be overlooked.
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Affiliation(s)
- Alasdair Bott
- Southmead Hospital, Bristol, BS10 6NB, United Kingdom.
| | - Graeme Nicol
- Ninewells Hospital, Dundee, DD2 1SG, United Kingdom
| | - Adekoyejo Odutola
- Weston General Hospital, Weston-Super-Mare, BS23 4TQ, United Kingdom
| | - Ruth Halliday
- North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 6NB, United Kingdom
| | - Mehool R Acharya
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
| | - Anthony Ward
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
| | - Timothy J S Chesser
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
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Dyson S, Thomson K. The recognition of pain and learned behaviour in horses which buck. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herteleer M, Boudissa M, Hofmann A, Wagner D, Rommens PM. Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2021; 48:3711-3719. [PMID: 33693977 PMCID: PMC9532279 DOI: 10.1007/s00068-021-01625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.
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Affiliation(s)
- Michiel Herteleer
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany.
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Alexander Hofmann
- Department of Traumatology and Orthopaedics, Westpfalz-Clinics Kaiserslautern, Kaiserslautern, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
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Current Trends in the Surgical Treatment of Open-Book Pelvic Ring Injuries: An International Survey Among Experienced Trauma Surgeons. J Orthop Trauma 2019; 33 Suppl 2:S61-S65. [PMID: 30688862 DOI: 10.1097/bot.0000000000001411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the open-book, rotationally unstable (OTA/AO type 61-B1.1) pelvic ring injury, the posterior sacroiliac complex is believed to remain intact. Therefore, anterior ring stabilization alone has been the standard treatment recommendation. However, treatment failures using this method have caused a reconsideration of this management strategy. Anterior plus posterior fixation is the main alternative. In the absence of any specific new guidelines, the choice of treatment currently relies on the preference of the treating surgeon. The objective of this survey was to determine the relative use of anterior plus posterior fixation, as opposed to the standard anterior fixation alone, for the treatment of open-book pelvic ring injuries. METHODS An international group of 176 practicing trauma surgeons experienced in pelvic ring fracture fixation participated in an AO Foundation survey asking for their preferred standard surgical fixation (anterior alone or anterior plus posterior combined) for OTA/AO type 61-B1.1 open-book pelvic fractures. RESULTS Anterior plate fixation alone (group 1) was preferred by 56% of the survey participants, and combined anterior plus posterior fixation (group 2) was preferred by 44%. Statistical analysis revealed that group 1 participants were significantly older than group 2 participants (P = 0.03) and had more years of surgical experience (P = 0.02). CONCLUSIONS Concern regarding the inadequacy of anterior fixation alone has led many surgeons, especially those more recently in practice, to add posterior fixation, despite limited data to determine its indications. No doubt the OTA/AO type B 1.1 pelvic ring disruption actually represents a wide spectrum of injury. Further study is needed to determine the best fixation method.
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Duramaz A, Ilter MH, Yıldız Ş, Edipoğlu E, İpek C, Bilgili MG. The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures. Eur J Trauma Emerg Surg 2019; 46:807-816. [PMID: 30617402 DOI: 10.1007/s00068-018-01067-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to identify the incidence of new sexual dysfunction reported by the patient in surgical treatment of pelvic ring injuries, and to describe the relationship between new sexual dysfunction and type of fracture. METHODS Ninety-five patients who were operated for pelvic fracture were included in the study. Patients were evaluated according to age, gender, marital status, body mass index, trauma mechanism, fracture classification, genitourinary injury, accompanying injury, injury severity score, surgical technique, fixation material, duration of operation, functional outcomes, blood loss, complications, and sexual dysfunction. Functional outcomes were assessed with Female Sexual Functioning Index (FSFI), International Index of Erectile Function-5 (IIEF5), Arizona Sexual Experience Scale (ASEX), and Modified Majeed's pelvic outcomes grading scale (MPS). RESULTS Genitourinary symptoms were erectile dysfunction (ED) in 13 men, ejaculatory dysfunction in 9 men, and dyspareunia in 23 women. Urethral stricture developed in 4 males and 1 female with the urethral injury. FSFI score, ASEX score, and MPS score showed the statistically significant difference between the fracture types (p = 0.021, p = 0.032 and p = 0.020, respectively). There were no significant difference between fracture types in terms of the IIEF5 score, and no significant relationship between fracture type and ED development (p = 0.141). CONCLUSION Anteroposterior compression (APC) is the most common cause of sexual dysfunction in both sexes, independent of surgery. In addition, the most common cause of ED in men is vertical shear (VS). Especially patients with APC and VS injuries should be multidisciplinary evaluated with gynecology, urology, and psychiatry departments.
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Affiliation(s)
- Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Mehmet Hakan Ilter
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Şükrü Yıldız
- Department of Gynecology and Obstetrics, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Erdem Edipoğlu
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Cem İpek
- Department of Urology, Kanuni Sultan Süleyman Education and Research Hospital, Atakent St. Number 46, 34307, Küçükçekmece, Istanbul, Turkey
| | - Mustafa Gökhan Bilgili
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, 34147, Bakırköy, Istanbul, Turkey
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Service CA, Moses RA, Majercik SD, Hotaling JM, Keihani S, Rothberg D, Myers JB. Urethral Trauma Following Pelvic Fracture From Horseback Saddle Horn Injury Versus Other Mechanisms of Pelvic Trauma. Urology 2018; 124:260-263. [PMID: 30447268 DOI: 10.1016/j.urology.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/26/2018] [Accepted: 11/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the rate of urethral trauma and pubic symphysis diastasis in saddle horn injury, which occurs when horseback riders are bucked into the air and land with their perineum striking the rigid saddle horn, compared to pelvic fracture from other mechanisms. METHODS A retrospective review was performed of male patients presenting to our level-1 trauma center with pelvic ring fractures between January 1, 2001 and December 30, 2016. Demographics, injury severity score, mechanism of injury (saddle horn vs other), pubic symphysis diastasis, and lower genitourinary (GU) injuries (bladder and urethra) were identified in the trauma registry. Chart review confirmed accuracy of lower GU trauma. RESULTS A total of 1195 males presented with pelvic ring fractures, average age 43 years (SD 19 years). Of these, 87 of 1195 (7%) presented with lower GU injuries. Saddle horn injuries had a higher rate of lower GU injuries, 12/60 (20%) versus 75 of 1135 (7%) [P = .001]. In those with lower GU injuries, 47 of 87 (54%) had urethral injury. The rate of urethral injury was significantly higher in the saddle horn cohort, 10 of 12 (83%) versus 37 of 75 (49%) [P = .03]. Furthermore, rate of pubic symphysis diastasis was higher amongst saddle horn injuries, 12 of 12 (100%) versus other mechanisms 39 of 75 (52%) [P = .001]. CONCLUSION We found that urethral injury and pubic symphysis diastasis were higher in patients with saddle horn injury compared to other mechanisms of pelvic ring disruption. Clinicians should be aware of these associations when treating pelvic fracture following equestrian injuries.
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Affiliation(s)
- Chad A Service
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | - Rachel A Moses
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - David Rothberg
- Department of Orthopedics, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
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Does Posterior Fixation of Partially Unstable Open-Book Pelvic Ring Injuries Decrease Symphyseal Plate Failure? A Biomechanical Study. J Orthop Trauma 2018; 32 Suppl 1:S18-S24. [PMID: 29373447 DOI: 10.1097/bot.0000000000001083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recent clinical study suggests an advantage to adding an iliosacral screw to the anterior fixation construct for anteroposterior compression type-2 (OTA/AO type 61-B1), partially unstable open-book pelvic ring injuries. Others have described stress examination to determine any required supplemental fixation. However, biomechanical studies investigating iliosacral fixation requirements for this injury are lacking. Our objective was to determine whether adding an iliosacral screw to symphyseal plate fixation decreases displacement in a well-defined open-book pelvic ring injury model. METHODS An open-book pelvic ring injury was created in 10 human cadaveric pelves by unilaterally releasing the sacrospinous, sacrotuberous, and anterior sacroiliac ligaments plus transection of the pubic symphysis, approximating the classically described anteroposterior compression type-2 (APC-2) injury. Specimens were divided into 2 groups: (1) symphyseal plating and (2) plating plus an iliosacral screw. Using a standard bilateral stance model loaded at 550 N, displacement measurements were obtained at 210,000 and 500,000 cycles. RESULTS Three specimens failed before 210,000 cycles because of technical errors and were excluded from analysis. For the remaining 7, there was no significant difference in displacement between the 2 groups, and none sustained implant failure. Post hoc analysis showed that a large sample size (45/group) would be required to detect any difference with 80% power, indicating a small effect size with limited clinical application. CONCLUSIONS Adding an iliosacral screw to the symphyseal plate fixation does not provide improved biomechanical outcome in classically described APC-2 injuries. Clinically, stress examination may be useful to determine the need for supplemental posterior fixation in APC-2 injuries.
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Vaidya R, Martin AJ, Roth M, Nasr K, Gheraibeh P, Tonnos F. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1671-1678. [DOI: 10.1007/s00264-016-3387-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/20/2016] [Indexed: 01/13/2023]
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Eastman JG, Krieg JC, Routt MLC. Early failure of symphysis pubis plating. Injury 2016; 47:1707-12. [PMID: 27282685 DOI: 10.1016/j.injury.2016.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/30/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Operative fixation of a disrupted symphysis pubis helps return alignment and stability to a traumatized pelvic ring. Implant loosening or failure has been demonstrated to commonly occur at some subacute point during the postoperative period. The purpose of this study is to report on a series of patients with traumatic pelvic ring disruptions to determine the incidence and common factors associated with early postoperative symphyseal plate failure before 7 weeks. MATERIALS AND METHODS 126 patients retrospectively identified with unstable pelvic injuries treated with open reduction and plate fixation of the symphysis pubis and iliosacral screw fixation. Preoperative and postoperative radiographs, computed tomography (CT) images, and medical chart were reviewed to determine symphyseal displacement preoperatively and postoperatively, time until plate failure, patient symptoms and symphyseal displacement at failure, subsequent symphyseal displacement, incidence of additional surgery, and patient weight bearing compliance. RESULTS 14 patients (11.1%) sustained premature postoperative fixation failure. 13 patients had anteroposterior compression (APC)-II injuries and 1 patient had an APC-III injury. Preoperative symphyseal displacement was 35.6 millimeters (mm) (20.8-52.9). Postoperative symphyseal space measurement was 6.3mm (4.7-9.3). Time until plate failure was 29days (5-47). Nine patients (64.2%) noted a pop surrounding the time of failure. Symphyseal space measurement at failure was 12.4mm (5.6-20.5). All patients demonstrated additional symphyseal displacement averaging 2.6mm (0.2-9.4). Two patients (14.2%) underwent revision. Four patients (28.5%) were non-compliant. CONCLUSION Premature failure of symphysis pubis plating is not uncommon. In this series, further symphyseal displacement after plate failure was not substantial. The presence of acute symphyseal plate failure alone may not be an absolute indication for revision surgery. Making patient education a priority could lead to decreased postoperative non-compliance and potentially a decreased incidence of implant failure. Posterior pelvic ring fixation aides overall pelvic ring stability and may help minimize further displacement after early postoperative symphyseal plate failure. Further functional outcome and biomechanical studies surrounding early symphyseal plate failure are needed.
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Affiliation(s)
- Jonathan G Eastman
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, USA.
| | - James C Krieg
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Milton L Chip Routt
- Department of Orthopaedic Surgery, University of Texas, Health Sciences Center at Houston, TX, USA
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Lumsdaine W, Weber DG, Balogh ZJ. Pelvic fracture-specific scales versus general patient reported scales for pelvic fracture outcomes: a systematic review. ANZ J Surg 2016; 86:687-90. [DOI: 10.1111/ans.13651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- William Lumsdaine
- Division of Surgery, Department of Traumatology; John Hunter Hospital and University of Newcastle; Newcastle New South Wales Australia
| | - Dieter G. Weber
- Division of Surgery, Department of Traumatology; John Hunter Hospital and University of Newcastle; Newcastle New South Wales Australia
| | - Zsolt J. Balogh
- Division of Surgery, Department of Traumatology; John Hunter Hospital and University of Newcastle; Newcastle New South Wales Australia
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Avilucea FR, Whiting PS, Mir H. Posterior Fixation of APC-2 Pelvic Ring Injuries Decreases Rates of Anterior Plate Failure and Malunion. J Bone Joint Surg Am 2016; 98:944-51. [PMID: 27252439 DOI: 10.2106/jbjs.15.00723] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biomechanical studies suggest that augmenting anterior fixation of the pelvic ring with posterior fixation increases stability. Prior clinical studies have assessed radiographic outcomes following plate fixation of the symphysis. However, to our knowledge, none have directly compared the radiographic and clinical outcomes of anterior plate fixation alone with the outcomes of such plate fixation with the addition of posterior percutaneous screw fixation in the treatment of a partially disrupted hemipelvis. We attempted to determine whether use of an anterior symphyseal plate alone is adequate to control sagittal and coronal plane rotation and prevent malunion of an anteroposterior compression type-2 (APC-2) pelvic ring injury. METHODS The records of all skeletally mature patients with a traumatic pelvic disruption treated from 2004 to 2014 with an anterior symphyseal plate with or without a posterior iliosacral screw were retrospectively reviewed. Patients with an APC-2 pelvic ring injury evidenced by computed tomography (CT) were included in the study and divided into 2 groups: (1) fixation of the symphysis with an anterior 3.5-mm 6-hole plate alone and (2) the same anterior fixation supplemented posteriorly with a percutaneous partially threaded 7.0 or 7.3-mm iliosacral screw. Postoperative CT scans were reviewed to assess the reduction of the pelvic ring and the position of all implants. The patients were followed for a minimum of 6 months or until the fixation failed. Examined data included demographic factors, type of and time to fixation failure, and presence of malunion. Univariate and multivariate statistical analyses were completed. RESULTS One hundred and thirty-four patients met the inclusion criteria. Ninety-two (69%) underwent combined anterior and posterior fixation, and 42 (31%) had anterior fixation alone. The average age and duration of follow-up were 38 years and 7.2 months, respectively. Anterior plate fixation failed in 5 patients (5%) in the combined-fixation group and in 17 patients (40%) in the anterior-only group (p < 0.0001). Malunion was identified in 1 patient (1%) in the combined group and in 15 (36%) in the anterior-only cohort (p < 0.0001). CONCLUSIONS Our study indicated that use of an anterior plate and a supplemental posterior screw for fixation of APC-2 pelvic ring injuries significantly decreases the rate of anterior plate failure and malunion compared with use of an anterior plate alone. The potential for selection and detection bias introduced by our study design limited the strength of this conclusion. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Frank R Avilucea
- Trauma Division, Vanderbilt Orthopaedic Institute, Nashville, Tennessee
| | - Paul S Whiting
- Trauma Division, Vanderbilt Orthopaedic Institute, Nashville, Tennessee
| | - Hassan Mir
- Trauma Division, Vanderbilt Orthopaedic Institute, Nashville, Tennessee
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Anatomic relationship between the spermatic cord and the pubic tubercle: are our clamps injuring the cord during symphyseal repair? J Orthop Trauma 2015; 29:290-4. [PMID: 25470564 DOI: 10.1097/bot.0000000000000265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Traditional repair of the disrupted pubic symphysis includes application of pointed clamps to the pubic tubercles and/or pubic body for fracture reduction. Recent studies have reported rates of sexual dysfunction of 42%-90% after repair of these injuries. The purpose of this study is to define the anatomy of the spermatic cord relative to the pubic tubercle and other local structures to assess the risk of sustaining an iatrogenic injury during clamp placement. METHODS Eight intact lower-half fresh male human cadavers were dissected. A window of skin and subcutaneous tissue was excised to expose the low abdominal wall and penile root. Pubic tubercles were identified by palpation and marked. The spermatic cord was identified at the superficial inguinal ring and followed into the scrotum, and any anatomical abnormalities were recorded. The relationship and distance of the spermatic cord to the pubic tubercle, insertion of the inguinal ligament and abdominal wall musculature, and pubic symphysis were recorded. Photographs were taken of the superficial and deep anatomy. RESULTS Spermatic cords were found to follow a consistent course after exiting the inguinal canal at the lower abdomen: they coursed inferior and medial to a position lateral to the pubic tubercles. In all cases, the spermatic cord lay adjacent, directly lateral to the tubercle with an average separation of 0.8 mm (range, 0-2 mm). The average distances from the lateral aspect of the tubercle and the medial border of the spermatic cord to the pubic symphysis were 26 and 27 mm, respectively. Qualitatively, even with direct visualization, it was not feasible to apply a pointed tenaculum to the pubic tubercles without piercing the spermatic cord, unless one manually retracted the latter. CONCLUSIONS The spermatic cord is located lateral and immediately adjacent to the pubic tubercle after it exits the inguinal canal and passes into the scrotum. As such, the spermatic cord seems to be at a significant risk of sustaining injury when pointed forceps are placed on the tubercles, as is often recommended during the repair of pubic diastasis.
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Odutola AA, Sabri O, Halliday R, Chesser TJS, Ward AJ. High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries. Clin Orthop Relat Res 2012; 470:2173-84. [PMID: 22350654 PMCID: PMC3392396 DOI: 10.1007/s11999-012-2257-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 01/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. QUESTIONS/PURPOSES We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. METHODS We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). RESULTS New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73). CONCLUSIONS Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adekoyejo A. Odutola
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Omar Sabri
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Ruth Halliday
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Timothy J. S. Chesser
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
| | - Anthony J. Ward
- Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE UK
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Collinge C, Archdeacon MT, Dulaney-Cripe E, Moed BR. Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality? Clin Orthop Relat Res 2012; 470:2148-53. [PMID: 22552765 PMCID: PMC3392370 DOI: 10.1007/s11999-012-2340-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described. QUESTIONS/PURPOSES We therefore determined the incidence and characterized radiographic implant failures in patients undergoing symphyseal plating after disruption of the pubic symphysis. METHODS We retrospectively reviewed 165 adult patients with Orthopaedic Trauma Association (OTA) 61-B (Tile B) or OTA 61-C (Tile C) pelvic injuries treated with symphyseal plating at two regional Level I and one Level II trauma centers. Immediate postoperative and latest followup anteroposterior radiographs were reviewed for implant loosening or breakage and for recurrent diastasis of the pubic symphysis. The minimum followup was 6 months (average, 12.2 months; range, 6-65 months). RESULTS Failure of fixation, including screw loosening or breakage of the symphyseal fixation, occurred in 95 of the 127 patients (75%), which resulted in widening of the pubic symphyseal space in 84 of those cases (88%) when compared with the immediate postoperative radiograph. The mean width of the pubic space measured 4.9 mm (range, 2-10 mm) on immediate postoperative radiographs; however, on the last radiographs, the mean was 8.4 mm (range, 3-21 mm), representing a 71% increase. In seven patients (6%), the symphysis widened 10 mm or more; however, only one of these patients required revision surgery. CONCLUSIONS Failure of fixation with recurrent widening of the pubic space can be expected after plating of the pubic symphysis for traumatic diastasis. Although widening may represent a benign condition as motion is restored to the pubic symphysis, patients should be counseled regarding a high risk of radiographic failure but a small likelihood of revision surgery. LEVEL OF EVIDENCE Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cory Collinge
- Harris Methodist Fort Worth Hospital and John Peter Smith Orthopaedic Surgery Residency Program, 800 5th Street, Suite 500, Fort Worth, TX 76104 USA
| | - Michael T. Archdeacon
- Department of Orthopaedic Surgery, University of Cincinnati Academic Medical Center, Cincinnati, OH USA
| | - Elizabeth Dulaney-Cripe
- Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH USA
| | - Berton R. Moed
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St Louis, MO USA
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Abstract
OBJECTIVES Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome. DESIGN Prospective collection of functional outcomes data. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Eighty-seven women with mean age of 33.5 years and mean Injury Severity Score of 23.1 were included. The Orthopaedic Trauma Association classification included 32 B-type and 55 C-type fractures. Four were open fractures and six had bladder ruptures. INTERVENTION Forty-nine patients were treated operatively and 38 nonoperatively. MAIN OUTCOME MEASUREMENTS Musculoskeletal Functional Assessment (MFA) questionnaires were completed after a minimum of 16 months and a mean of 41 months of follow-up. RESULTS The mean MFA score was 33. Only 15 women (17.2%) had MFA scores comparable with an uninjured reference value (9.3), and 34 (39.1%) had better than the reference value for prior hip injury (25.5). Anteroposterior compression injuries had worse scores versus other patterns (48.3 vs 31.0, P = 0.01), and trends toward worse outcomes were noted after symphyseal disruption (P = 0.11) and transsymphyseal plating (P = 0.09). Sacral fracture or sacroiliac injury, amount of initial or final displacement, and type of posterior ring treatment were not associated with MFA scores. Mean scores were 32.3 after surgery and 34.0 after nonoperative management (P = 0.67). Functional outcomes were not related to age or Injury Severity Score, but isolated pelvis fractures had better MFA scores (21.1 vs 35.5, P = 0.008) and worse MFA scores (41.7 vs 29.1, P = 0.004) were seen with other lower extremity fractures. Those with bladder ruptures (n = 6) also had poor outcomes, mean MFA 50.0 (P = 0.078). CONCLUSIONS Wide variation is seen in functional outcome of women after high-energy pelvic ring fracture as measured by the MFA with mean scores demonstrating substantial residual dysfunction. Better outcomes were noted after isolated fractures and in women who had not sustained other fractures in their lower extremities. History of bladder rupture or anteroposterior compression injury was associated with poor MFA scores. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Radiological analysis, operative management and functional outcome of open book pelvic lesions: a 13-year cohort study. Injury 2011; 42:1012-9. [PMID: 21232742 DOI: 10.1016/j.injury.2010.11.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/17/2010] [Accepted: 11/17/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED We present the clinical and radiological outcome of a 13-year cohort study of 38 open book pelvic lesions. All patients were treated in one Level I Trauma centre. In the posterior pelvis, sacro-iliac diastasis was seen in 31 patients, sacral fracture in 7. In all patients with sacro-iliac diastasis, the pubic bone was inferiorly displaced on the primary ap pelvic overview on the side of injury. All but one patient was treated with open reduction and internal fixation of the symphysis pubis. Additional stabilization of the posterior pelvis was done in 9 patients. 32 patients were seen after a median follow up of 84 months. Majeed score and SF-36 questionnaire were used. Functional outcome was excellent with a mean Majeed score of 95.7. Comparing our data with the SF-36 score of the normal German population, the mean value of the 'role-physical' and the 'physical function' categories was significantly lower for patients treated with an open book lesion. There was a tendency towards a better outcome in open book lesions with sacral fracture. There was a tendency towards worse outcome for the patients with additional dorsal stabilization. Male impotence was the single most important lesion of neurological origin which persisted two years after open book lesion. CONCLUSION Functional outcome after surgical treatment of open book pelvic lesions is good. External rotation and accompanying inferior displacement of the ipsilateral hemipelvis may be a sign of partial lesion of the posterior sacroiliac complex. Identification of patients who need additional posterior stabilization remains difficult.
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