Iliac Wing Fracture Research Articles

Rapid Prototyping and Reverse Engineering Application for Orthopedic Surgery Planning

This paper describes rapid prototyping (RP) and reverse engineering (RE) application for orthopedic surgery planning to improve the efficiency and accuracy of the orthopedic surgery. Using the symmetrical characteristics of the human body, CAD data of undamaged bone of the injured area are generated from a mirror transformation of undamaged bone data for the uninjured area. The physical model before the injury is manufactured from Polyjet RP process. The surgical plan, including the selection of the proper implant, pre-forming of the implant and decision of fixation positions, etc., is determined by a physical simulation using the physical model. In order to examine the applicability and efficiency of the surgical planning technology, two case studies, such as a distal tibia comminuted fracture and an iliac wing fracture of pelvis, are carried out. From the results of the examination, it has been shown that the RP and RE can be applied to orthopedic surgical planning and can be an efficient surgical tool.

Percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures

To present the technique for percutaneous placement of cannulated screws in the iliac wing, and to describe the surgical technique and the methods, the indication, the time, the key of operation and the clinic outcomes of the technique. Through the anatomy study of ilium, a wider columns structure at the posterior ilium was found, which was named "the posterior columns of pelvis", and then measure the parameter of the structure. Twelve patients with the injuries in the iliac wing and the anterior ring of pelvis were treated with percutaneous cannulated screws internal fixation. All of the fractures healed in the followed up period. Vertical replacement were all completely corrected. Two of the cases left behind slight rotary replacement, and no complication were found. The technique of percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures has the advantages of small trauma, less bleeding stiff fixation, which is an ideal and minimally invasive technique.

Cases from the Osler Medical Service at Johns Hopkins University

Presenting featuresA 40-year-old man with human immunodeficiency virus infection (CD4 count, 694/μL) and a history of sickle cell anemia was admitted for pain management after a right iliac wing fracture sustained in an assault. He denied recent fevers or respiratory symptoms. His medical history was remarkable for repeated vaso-occlusive crises and episodes of the acute chest syndrome, with resultant pulmonary hypertension and right-side heart failure. His physical examination was most notable for fever as high as 38.2°C, cervical and axillary adenopathy (2 cm), elevated jugular venous pressure, cardiomegaly, and hepatomegaly. His hematocrit was 19.5%, with a mean corpuscular volume of 91 fL; the platelet count was 176 000/μL; and the leukocyte count was 15 000/μL. He underwent a computed tomographic scan of the chest, abdomen, and pelvis (Figure 1), which revealed discrete lesions of low attenuation in the liver, the largest being 4.5 cm in diameter, and autoinfarction of the spleen.What is the diagnosis?

Changing Patterns of Pediatric Pelvic Fractures With Skeletal Maturation: Implications for Classification and Management

Orthopaedic traumatologists have recognized the unique fracture patterns and injury constellations of pediatric pelvic fractures. However, an understanding of the effect of advancing skeletal maturation is needed to avoid applying adult classifications and management. The authors determined how pelvic fracture patterns and management change with advancing skeletal maturity. At their pediatric trauma center, they identified 166 consecutive pelvic fractures. Eighty percent of patients had plain radiographs adequate to evaluate the triradiate cartilage. Physes were scored as open, narrowed, or closed. The Risser sign, fracture pattern, survival after injury, and need for open reduction and internal fixation were recorded. Ninety-seven patients (mean age 5.7 years) had an open triradiate or an "immature pelvis." Thirty-two patients (mean age 14 years) had a closed triradiate cartilage or a "mature pelvis." The immature group had a higher propensity for isolated pubic rami and iliac wing fractures. The mature group had a higher predilection for acetabular fractures and pubic or sacroiliac diastasis. All patients requiring open reduction and internal fixation had a mature pelvis. The incidences of specific pelvic fracture patterns between the two groups were statistically different. Management of fractures to the immature pelvis should focus on associated injuries. Once the triradiate cartilage has closed, adult pelvic fracture classifications and management principles should be used.

A prospective evaluation of the clinical presentation of pediatric pelvic fractures.

We sought to describe pediatric, blunt trauma patients with pelvic fracture (PF) and to evaluate pelvis examination sensitivity and specificity. We conducted a prospective study of blunt trauma patients at a Level I pediatric trauma center. A pediatric emergency medicine physician attempted to diagnose a PF, solely on the basis of the history and pelvis examination. Patients with blunt trauma but no pelvic fracture (NPF) were used as controls. We enrolled 140 patients (16 PF, 124 NPF), and no significant differences were found regarding median age, gender, injury mechanism, acuity, and medical outcome. Approximately 25% of PF patients had iliac-wing fractures; 37%, single pelvic ring; 25%, double pelvic ring; and 13%, acetabular fractures. Eleven patients with PF had an abnormal pelvis examination (69% sensitivity), compared with six NPF patients (95% specificity, negative predictive value 0.91). Pediatric patients with PF have low mortality and few complex fractures. The pelvis examination appears to have both high specificity and negative predictive value.

The unstable iliac fracture: a biomechanical evaluation of internal fixation

Neither plating nor lag screw fixation of a displaced iliac wing fracture as part of an unstable pelvic ring disruption has been studied biomechanically. The purpose of this study was to compare the stability of various combinations of fixation, specifically contrasting lag screws placed between the tables of the ilium with plating in different locations across the fracture line. Various combinations of these fixation implants were evaluated for an unstable iliac fracture. A longitudinal iliac fracture was created in each of six hemi-pelvic specimens prior to testing. Compressive force, up to 500 N or to the magnitude necessary to displace the fracture 2mm, was applied to the fracture line through the hemi-pelvis for each of the plate and lag screw combinations tested. There was no statistical difference between any of the implants or combinations tested. A single 3.5-mm reconstruction (cephalad) plate placed along the cephalad internal aspect of the iliac crest provided the least stability allowing 2 mm of displacement with a mean load of 80N. The two combinations of fixation that required the greatest loads for 2 mm of displacement were a single 3.5-mm lag (cephalad) screw inserted into the iliac crest between the tables of the ilium coupled with either a 3.5-mm reconstruction (brim) plate placed along the internal aspect of the inferior iliac fossa at the pelvic brim (239 N) or a 4.5-mm lag (brim) screw between the inner and outer tables at the inferior aspect of the fracture just above the greater sciatic nothch (225 N).

Complications of iliac crest bone graft harvesting.

Autologous bone grafts harvested from the iliac crest are commonly used in reconstructive orthopaedic surgery. Autologous bone is used to help promote bone healing in fractures and to provide structural support for reconstructive surgery. The results of autologous bone grafting are more predictable than the use of xenografts, cadaveric allografts, or synthetic bone substitutes because autologous bone grafts provide osteoinductive and osteoconductive properties, are not immunogenic, and are usually well incorporated into the graft site. In a retrospective review of 414 consecutive cases of iliac crest bone graft procedures performed at Brooke Army Medical Center from 1983 to 1993, 41 (10%) minor and 24 (5.8%) major complications were identified. Minor complications included superficial infections, superficial seromas, and minor hematomas. Major complications included herniation of abdominal contents through massive bone graft donor sites, vascular injuries, deep infections at the donor site, neurologic injuries, deep hematoma formation requiring surgical intervention, and iliac wing fractures. Harvesting of iliac crest bone graft can be associated with significant morbidity. However, with adequate preoperative planning and proper surgical technique, the incidence of these complications can be reduced.

Techniques for reduction and posterior fixation through the anterior approach.

Pelvic fractures, especially those of a Malgaigne type, frequently occur in patients who are polytraumatized. Sacroiliac disruption reflects a massive, disruptive energy force with concurrent soft tissue injury. Fixation through an anterior approach facilitates the accurate and stable fixation and avoids many soft tissue wound problems associated with open anterior approaches. The absolute indication for the approach is a posterior disruption of the sacroiliac joint with or without an iliac wing fracture that is unreducible by closed reduction techniques.

Operative stabilization of fracture dislocations of the sacroiliac joint.

Posterior fracture dislocations of the sacroiliac joint (crescent fracture) represent a subset of lateral compression pelvic fractures. The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the inferior 1/2 of the sacroiliac joint. The posterior superior iliac spine remains firmly attached to the sacrum by the strong posterior ligaments. As a result of this combination of bony and soft tissue injury, the hemipelvis is rotationally unstable, but because the sacrospinous and sacrotuberous ligaments remain intact the involved hemipelvis is stable to vertically applied forces. Operative stabilization is necessary to restore articular congruity of the sacroiliac joint, pelvic stability, and to allow early mobilization of the patient. Stabilization of the pelvis may be achieved through either an anterior or a posterior approach with or without transarticular fixation. A posterolateral approach to the crescent fracture and a method of stabilization using extraarticular fixation, intertable lag screws and outer table antiglide plates are described. The results of using this technique in 22 patients are reviewed.

Pelvic Fracture: A Complication of Iliac Crest Bone Grafting

The iliac crest is a common site for harvesting bone grafts. This paper describes an iliac wing fracture after bone graft was harvested from the iliac crest. The patient was treated nonoperatively with a good result. with minimization of the depth of the osteotomy cuts this complication may be avoided.

Small bowel entrapment in an iliac wing fracture

Small bowel entrapment in an iliac wing fracture

Anterior fixation of the sacroiliac joint

An unstable pelvic ring fracture requires surgical stabilization. The anterior ilioinguinal approach to the sacroilliac (SI) joint is recommended for a vertically, posteriorly, or laterally displaced hemipelvis because it allows for a direct visualization and it affords for an anatomic reduction of the SI joint. Other indications for use of the anterior approach include the need for fixation of associated acetabular, iliac wing, or symphyseal fractures. This technique is not applicable for fractures of the sacrum because of the proximity to the L5 nerve root. Biomechanical data supports the use of anterior plating for rigid osseous stabilization of the SI joint. Other techniques of internal fixation include transiliac screws, posterior tension band plate, and sacral bars. These methods place important neurologic and vascular structures at risk. Further, a posterior approach has inherent difficulty in reducing a SI disruption and may cause a higher incidence of skin necrosis. This article describes the advantages and the technique of anterior stabilization of the SI joint in the management of an unstable pelvic ring fracture.