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Zhu Z, Tan B, Wei D, Tang X, Yuan J, Hu J, Liao F. Percutaneous robot-assisted screw fixation for nondisplaced pelvic fractures: a good choice? Int Orthop 2023; 47:1601-1608. [PMID: 36991283 DOI: 10.1007/s00264-023-05794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To compare the merits and demerits of percutaneous robot-assisted screw fixation for nondisplaced pelvic fractures with other treatments via long-term follow-up. METHODS This was a retrospective analysis of nondisplaced pelvic fractures treated between January 2015 and December 2021. The number of fluoroscopy exposures, operative duration, intraoperative blood loss, surgical complications, screw placement accuracy and Majeed score were compared among the nonoperative group (24 cases), open reduction and internal fixation (ORIF) group (45 cases), free-hand empirical screw fixation (FH) group (10 cases) and robot-assisted screw fixation (RA) group (40 cases). RESULTS There was less intraoperative blood loss in the RA and FH groups than in the ORIF group. The number of fluoroscopy exposures in the RA group was lower than that in the FH group but much higher than that in the ORIF group. There were five cases of wound infection in the ORIF group and no surgical complications in the FH or RA group. The medical expenses were higher in the RA group than in the FH group, with no significant difference from the ORIF group. The Majeed score was lowest in the nonoperative group three months after injury (64.5±12.0) but lowest in the ORIF group one year after injury (88.6±4.1). CONCLUSION Percutaneous RA for nondisplaced pelvic fractures is effective and minimally invasive and does not increase medical expenses compared with ORIF. Therefore, it is the best choice for patients with nondisplaced pelvic fractures.
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Affiliation(s)
- Zongdong Zhu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Bo Tan
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Dan Wei
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Xiaoming Tang
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Jiabin Yuan
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Jiang Hu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China
| | - Feng Liao
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32# W. Sec 2, 1st Ring Rd, Qingyang District, Chengdu, 610072, China.
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Hussain Z, Parmeshwar SS, Jain A, Chandra A. Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures- A case series. J Clin Orthop Trauma 2023; 37:102091. [PMID: 36632341 PMCID: PMC9827374 DOI: 10.1016/j.jcot.2022.102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/26/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction The operative fixation of pelvic ring injuries and associated acetabulum fractures presents a challenging scenario to most of the orthopaedic trauma surgeons. Current development of anatomically contoured reconstruction (ACR) plates gained popularity in fixing complex pelvic ring fractures. This study was done to assess the functional and radiological outcomes using of lateral wall stainless steel (LWSS) calcaneal plates in posterior pelvic ring injuries and displaced iliac blade fractures. Materials and methods Retrospectively selected eight cases of pelvic ring injuries planned for fixing posterior pelvic instability and iliac blade fractures using LWSS plates. Mean follow-up was 18 months (Range 12-26 months). Results Average time for radiological bony union achieved in 18 weeks (Range 13-22). Seven patients returned to their normal work. Average Majeed score was 60 (Range 50-68). Mean duration of surgery was 160 min (Range 120-200). Conclusion This technique can be routinely used as supplementary fixation for posterior pelvic ring instability and iliac blade fractures. LWSS calcaneal plates showed no screw breakage or implant failure. Further this technique was cost effective in developing countries with limited resources.
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Affiliation(s)
- Zakir Hussain
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Amit Jain
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Abhishek Chandra
- Department of Trauma Surgery, AIIMS Rishikesh, Uttarakhand, India
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Verma V, Sen RK, Tripathy SK, Aggarwal S, Sharma S. Factors affecting quality of life after pelvic fracture. J Clin Orthop Trauma 2020; 11:1016-1024. [PMID: 33192004 PMCID: PMC7656473 DOI: 10.1016/j.jcot.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Functional outcome and health-related quality of life (HRQOL) after pelvis fracture is suboptimal; majority of the patients do not return to their preinjury activities. Many researchers reported that late morbidity in pelvis fracture is associated with severity of the fracture, associated trauma, pelvic fracture-related complications and methods of treatment. MATERIAL AND METHODS One hundred and twelve patients with pelvis fracture who were treated either conservatively (n = 88) or surgically (n = 24) with a minimum of two years follow up were evaluated clinically and radiologically. The clinical outcome was evaluated using Majeed score and self-reported Short Musculoskeletal Function Assessment (SMFA). Their HRQOL was evaluated using the 36-item Short Form Survey (SF-36) and WHOQOL-BREF questionnaires. The fracture-displacement in the anterior or posterior pelvis ring was measured from the anteroposterior radiograph or inlet/outlet view. RESULTS The average Majeed score was 76.65 ± 14.73 (range, 36 to 96). There were 81 patients with good to excellent outcomes and 31 patients with poor to fair outcomes. The average SF-36 Physical Component Summary (PCS) score was 47.71 ± 7.88 (range, 27.3 to 61.5) and SF-36 Mental Component Summary (MCS) was 49.20 ± 9.37 (range, 23.1 to 56.8). The functional level of the general population in the physical and mental domain was achieved in 48.23% and 65.3% of pelvic-fractured patients respectively. General population norms were achieved in 56.3%, 63.4%, 65.2% and 84.8% of patients in WHOQOL-BREF domain one, two, three and four respectively. The patients had significantly worse functional outcome and HRQOL if residual displacement was > 1 cm. Age, sex, associated injuries and injury mechanism were not affecting the HRQOL in patients with acceptable residual displacement of ≤ 1 cm. CONCLUSION Pelvic fracture with the residual displacement of ≤ 1 cm in the sacroiliac joint/symphysis pubis result in better functional outcome and HRQOL. Injury mechanism and associated injury have no impact on the HRQOL if the residual displacement is within the acceptable limit.
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Affiliation(s)
- Vishal Verma
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sujit Kumar Tripathy
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
- Corresponding author. Dept of Orthopaedics AIIMS, Bhubanewar, Sijua Patrapada, Bhubaneswar, 751019, India.
| | - Sameer Aggarwal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh Sharma
- Dept. of Biostatistics, Punjab University, Chandigarh, India
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Abou-Khalil S, Steinmetz S, Mustaki L, Leger B, Thein E, Borens O. Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients. Eur J Orthop Surg Traumatol 2020; 30:877-884. [PMID: 32140838 DOI: 10.1007/s00590-020-02646-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. MATERIAL AND METHODS Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. RESULTS The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. CONCLUSION The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques.
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Affiliation(s)
- Sami Abou-Khalil
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Laurent Mustaki
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Leger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
| | - Eric Thein
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Abhishek SM, Prashanth, Azhar AL, Vijay GB, Harshal K. Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring. Malays Orthop J 2015; 9:23-27. [PMID: 28611905 PMCID: PMC5393130 DOI: 10.5704/moj.1511.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. MATERIALS & METHODS Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. RESULTS Twenty one (51.22%) and thirteen (31.70%) patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17%) were able to return to their original occupation with or without minor adjustments. CONCLUSION Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring.
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Affiliation(s)
- S M Abhishek
- Department Of Orthopedics, Dr. Vaishampayan Memorial Government Medical College, Solapur, India
| | - Prashanth
- Department Of Orthopedics, Dr. Vaishampayan Memorial Government Medical College, Solapur, India
| | - A L Azhar
- Department Of Orthopedics, Dr. Vaishampayan Memorial Government Medical College, Solapur, India
| | - G B Vijay
- Department Of Orthopedics, Dr. Vaishampayan Memorial Government Medical College, Solapur, India
| | - K Harshal
- Department Of Orthopedics, Dr. Vaishampayan Memorial Government Medical College, Solapur, India
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