Robot-assisted surgery guided by damage control orthopaedics for pelvic fractures in polytrauma patients: preliminary results of 26 patients

Abstract

Objective To evaluate the safety and efficiency of robot assisted surgery guided by damage control orthopaedics(DCO) in polytraumatised patients with pelvic ring injuries. Methods A retrospective review of the pelvic fracture database was performed. Twenty-six patients who had sustained a pelvic fracture from September 2012 to December 2015 were suitable for robot-assisted minimally invasive internal fixation. They were 17 men and 9 women, aged from 23 to 58 years (average, 42.6 years). Their Injury Severity Score(ISS) ranged from 20 to 31 points (average, 21.3 years). According to Tile classification, 6 cases were type B2, 3 type B3, 9 type C2 and 8 type C3. Guided by DCO, the vital signs were stabilized by all means and the fractures treated by simple and temporary external fixation before the pelvic and other fractures were managed by the robot-assisted minimally invasive internal fixation. Demographics, times to operating room (TOR), time from acute stabilization to late definitive internal fixation (TAL), time for bone union, type of robot-assisted surgery for major fractures, length of stay (LOS), postoperative complications and mortality were recorded. The outcomes of the pelvis were evaluated at the final follow-up according to the Matta criteria. Results Of the 26 patients, robot-navigated percutaneous screwing was conducted with 23 sacroiliac screws in 19, with 9 ramus pubicus screws in 9, with 6 supraacetabular screws in 4, and with 4 both-column screws in 2 cases. TOR averaged 2.7 times, TAL 5.9 days, LOS at ICU 2.1 days, ICU ad-mission rate 46.2% (12 of 26), hospital LOS 7.3 days, and time for pelvic bone union 79.0 days. None patients had postoperative complications related to the pelvic fracture and no one died. According to the Matta criteria at the final follow-ups, 8 cases were excellent, 11 good, 5 fair and 2 poor, yielding an excellent and good rate of 73.1%. Conclusion Robot-navigated minimally invasive surgery plus DCO is effective, time saving and safe treatment for polytraumatised patients with pelvic ring injuries. Key words: Pelvis; Fractures, bone; Robotics; Surgical procedures, minimally invasive