Réduction et fixation à foyer ouvert versus vissage ilio-sacré percutané des lésions postérieures instables de l’anneau pelvien

Abstract

BackgroundSurgical stabilization of posterior pelvic ring fractures can be achieved by either open or closed methods. They all provide a comparable biomechanical stability. The aim of the present study is to compare the clinical results of both techniques for treating posterior pelvic ring injuries. Material and methodsSeventy patients operated for unstable posterior pelvic ring disruptions were retrospectively reviewed. We compared 35 patients treated by open reduction internal fixation (ORIF group) versus 35 patients stabilized by using closed reduction and percutaneous iliosacral screw fixation (CRIF group) under fluoroscopic guidance. ResultsAccording to pelvic outcome scoring system of Pohlemann et al., 28 patients out of the ORIF group obtained good or excellent results (20 excellent and 8 good), 5 fair and 2 poor. In the CRIF group, 30 patients obtained good or excellent results (25 excellent and 5 good), 4 fair and 1 poor, P=0.64). The average intraoperative blood loss in the ORIF group was 500cc with average blood transfusion of 2 units (1000cc) compared to blood loss 150cc in CRIF group, with average blood transfusion of 1 unit (500cc) (P=0.002). No intraoperative complications were reported in the ORIF group while operative guide wires were broken in two cases in the CRIF group, (P=0.16). There were no neurological complications observed in the ORIF group, but 1 radiculopathy (L5 root palsy) occurred in the CRIF group (P=0.317). In the ORIF group, 3 patients had superficial wound infection and 1 patient had deep infection while in the CRIF group, we noted only 1 case of deep infection, (P=0.083). ConclusionNo difference was noticed between ORIF and CRIF. The technical decision is variable according to time of surgery, fracture types, patient general condition, skin condition, presence of ipsilateral fractures of the acetabulum and feasibility of the closed reduction. More studies are needed to identify prognostic factors related to quality of the reduction that we need for the creation of decisional algorithm for ORIF versus CRIF. Level of evidenceLevel 4.