Pelvic Acetabular Fractures Research Articles

Research progress of pelvic acetabular fractures combined venous thromboembolic disease

Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.

Knowledge and Practice of Pelvic and Acetabular Fractures Management Among Orthopaedics and Trauma Surgeons in Nigeria

Background: Pelvic-acetabular fractures are markers of high energy trauma and are associated with significant morbidity, mortality and management could be challenging. The inability to surgically manage these fractures appropriately in our centre and few publications on pelvic-acetabular fractures in Nigeria stimulated this study. Objectives: to find out how pelvic and acetabular fractures are managed and availability of investigating tools in Nigeria. Materials and methods: A questionnaire was uploaded for 7 weeks on the National orthopaedics and trauma surgeons’ forum. Questions on pelvic fractures management, knowledge and classification of pelvic fractures, preferred methods of pelvic fractures management- surgical or non-surgical, availability of advanced investigating tools and desire to acquire more skills /training were asked. Results: Eighty-five (33.2%) of the 256 members participated in the study. Preferred classification were Tile and Young-Burgess 46 (56.8%) and 29 (35.8 %) respectively. Thirty-six (43.9%) had Computerize Tomography scan (CT) while 19 (23.2%) had Magnetic Resonance Imaging (MRI) available in their place of practice. Twenty-eight (34.6%) would manage operatively, 8 (9.9%) would either operate or refer, while 23 (28.48%) would either manage non-operative or refer and outright non-operative in 7 (8.6%) of pelvic-acetabular fractures that require Open Reduction Internal Fixation (ORIF). Forty-six (56.8%) would refer patients; because of non-availability of skilled surgeon in 30(65.2%) and non-availability of operating tools in 32(69.6 %). Seventy-four (90.2%) would like to acquire skills in pelvic surgery. Conclusion: The health facilities were not adequately equipped with advanced imaging tools. Twenty-three percent of the respondents would consider managing pelvic fracture that requires ORIF non-operatively, while more than half would refer because of either non-availability of skilled pelvic surgeon or non-availably of operating tools. Majority of the respondents are interested in acquiring skills in pelvic surgery.

Prevalence and risk factors for proximal deep vein thrombosis at admission in patients with traumatic fractures: a multicenter retrospective study.

This study aimed to determine the associated risk factors for proximal deep vein thrombosis (DVT) in patients with lower extremity and pelvic-acetabular fractures. The medical records of 4,056 patients with lower extremity and pelvic-acetabular fractures were retrospectively reviewed. The patients were classified into proximal or non-proximal DVT groups. Logistic regression models were used to determine the independent risk variables for proximal DVT. The predictive value of the related risk factors was further analyzed using receiver operating characteristic curves. The prevalence of proximal DVT was 3.16%. Sex, body mass index (BMI), fracture site, injury mechanism, diabetes, coronary heart disease (CHD), injury-to-admission interval, hematocrit, platelet counts, and D-dimer levels differed significantly between the two groups. BMI ≥ 24.0 kg/m2, femoral shaft fractures, high-energy injury, diabetes, injury-to-admission interval >24 h were independent risk factors for proximal DVT. CHD decreased the risk of proximal DVT. The platelet and D-dimer had high negative predictive value for predicting proximal DVT formation, with cut-off values of 174 × 109/L and 2.18 mg/L, respectively. BMI ≥ 24.0 kg/m2, femoral shaft fractures, high-energy injury, diabetes, injury-to-admission interval >24 h were independent risk factors for proximal DVT in patients with lower extremity and pelvic-acetabular fractures. Platelet count and D-dimer level were effective indicators for excluding proximal DVT occurrence. CHD decreased the risk of proximal DVT.

Surgical Management and Functional Outcome of Acetabular Fractures – A Prospective Study

Abstract Context: Acetabulum fractures are commonly a result of high-velocity road traffic accidents and falls from height. These fractures were previously treated nonoperatively which had led to high morbidity causing secondary osteoarthritis, limping, instability, and chronic pain. Aims: To surgically manage the functional outcome of acetabular fractures. Settings and Design: The prospective study involves 28 patients of a tertiary care hospital at Bhubaneswar, for analysis of functional and radiological outcomes of surgical management of acetabular fractures. Subjects and Methods: Patients are chosen from emergency and outpatient on the criteria of age group 18–65 years, pelvi-acetabular fractures of 2-mm displacement, more than 3-week-old fracture, with or without hip dislocation. Inflammatory arthritis and pathological fractures patients were excluded. Surgery time was 173 min with a minimum of 110 min and a maximum of 240 min. Statistical Analysis Used: All the data were analyzed using SPSS 20 software. Results: Twelve patients had excellent (42%), seven patients had well (25%), seven patients had fair (25%), and two patients had poor (8%) functional outcomes. Two patients had restricted range of movement and pain on walking and had undergone total hip replacement after 1 year. The mean score in the anatomically reduced fracture is 16.4, imperfectly reduced is 14.4, and poorly reduced is 8. The average functional outcome score was 14.2 (range – 5–18). Conclusions: As the articular surface requires smooth congruity, anatomical fixation of fracture fragments is essential for early mobilization and better functional outcomes. Proper preoperative planning, anatomical reduction, adequate fixation, and early mobilization are required to achieve good functional outcomes in acetabular fractures.

Development and validation of a nomogram for predicting deep venous thrombosis in patients with pelvic and acetabular fractures: a retrospective cohort study

PurposeTo construct a novel nomogram model that can predict DVT and avoid unnecessary examination.MethodsPatients admitted to the hospital with pelvis/acetabular fractures were included between July 2014 and July 2018. The potential predictors associated with DVT were analyzed using Univariate and multivariable logistic regression analysis. The predictive nomogram was constructed and internally validated.Results230 patients were finally enrolled. There were 149 individuals in the non-DVT group and 81 in the DVT group. Following analysis, we obtained the final nomogram model. The risk factors included age (OR, 1.037; 95% CI, 1.013–1.062; P = 0.002), body mass index (BMI) (OR, 1.253; 95% CI, 1.120–1.403; P < 0.001); instant application of anticoagulant after admission (IAA) (OR, 2.734; 95% CI, 0.847–8.829; P = 0.093), hemoglobin (HGB) (OR, 0.970; 95% CI, 0.954–0.986; P < 0.001), D-Dimer(OR, 1.154; 95% CI, 1.016–1.310; P = 0.027) and fibrinogen (FIB) (OR, 1.286; 95% CI, 1.024–1.616; P = 0.002). The apparent C-statistic was 0.811, and the adjusted C-statistic was 0.777 after internal validations, demonstrating good discrimination. Hosmer and Lemeshow’s goodness of fit (GOF) test of the predictive model showed a good calibration for the probability of prediction and observation (χ2 = 3.285, P = 0.915; P > 0.05). The decision curve analysis (DCA) and Clinical impact plot (CIC) demonstrated superior clinical use of the nomogram.ConclusionsAn easy-to-calculate nomogram model for predicting DVT in patients with pelvic-acetabular fractures were developed. It could help clinicians to reduce DVT and avoid unnecessary examinations.

Fixation of pelvic acetabular fractures using 3D-printed fracture plates: a cadaver study

Open reduction and internal fixation of pelvic acetabular fractures are challenging due to the limited surgical exposure from surrounding abdominal tissue. There have been a number of recent trials using metallic 3D-printed pelvic fracture plates to simplify and improve various elements of these fracture fixation surgeries; however, the amount of time and accuracy involved in the design and implantation of customised plates have not been well characterised. This study recorded the amount of time related to the design, manufacture and implantation of six customised fracture plates for five cadaveric pelvic specimens with acetabular fracture, while manufacturing, and surgical accuracy was calculated from computed tomography imaging. Five of the fracture plates were designed within 9.5 h, while the plate for a pelvis with a pre-existing fracture plate took considerably longer (20.2 h). Manufacturing comprised 3D-printing the plates in Ti6Al4V with a sintered laser melting (SLM) 3D-printer and post-processing (heat treatment, smoothing, tapping threads). The manufacturing times varied from 27.0 to 32.5 h, with longer times related to machining a thread for locking-head screws with a multi-axis computer numerical control (CNC) mill. For the surface of the plate in contact with the bone, the root-mean-square errors of the print varied from 0.10 to 0.49 mm. The upper range of these errors was likely the result of plate designs that were relatively long with thin cross-sections, a combination that gives rise to high thermal stresses when using a SLM 3D-printer. A number of approaches were explored to control the trajectories of locking or non-locking head screws including guides, printed threads or hand-taps; however, the plate with CNC-machined threads was clearly the most accurate with screw angulation errors of 2.77° (range 1.05–6.34°). The implanted position of the plates was determined visually; however, the limited surgical exposure and lack of intra-operative fluoroscopy in the laboratory led to high inaccuracies (translational errors of 1.74–13.00 mm). Plate mal-positioning would lead to increased risk of surgical injury due to misplaced screws; hence, it is recommended that technologies that can control plate positioning such as fluoroscopy or alignment guides need to be implemented into customised plate design and implantation workflow. Due to the plate misalignment and the severe nature of some acetabular fractures comprising numerous small bone fragments, the acetabular reduction exceeded the clinical limit of 2 mm for three pelvises. Although our results indicate that customised plates are unsuitable for acetabular fractures comprising six or more fragments, confirmation of this finding with a greater number of specimens is recommended. The times, accuracy and suggested improvements in the current study may be used to guide future workflows aimed at producing customised pelvic fracture plates for greater numbers of patients.

Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society

SummaryPelvic-acetabular fractures lead to high mortality in elders and their association between different groups is not known. Our results indicate that older age with pelvic-acetabular fracture was significantly associated with mortality. This finding may help planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures.PurposePelvic or acetabular fractures are among main outcomes of low-energy trauma such as falls, especially in older adults. They represent approximately 3–8% of all fractures and are associated with a high mortality rate ranging from 4 to 28%. This study is aimed at comparing the incidence and trends of hip fractures and pelvic-acetabular fractures in the Taiwanese general population, gender differences in adults aged over 65 years, and mortality risk between pelvic or acetabular fractures and hip fractures and surgery trends in patients with these fractures.MethodsA retrospective study was conducted extracting data from the National Health Insurance Research Database of patients diagnosed with hip fracture and pelvic acetabular fracture between 2000 and 2018.ResultsOlder age with pelvic-acetabular fracture was significantly associated with increased mortality. No significant differences were found in comorbidities between the two fracture groups. Results provide clear epidemiological evidence for trends in pelvic-acetabular fractures in Taiwan and demonstrate the need for better strategies to manage these fractures and comorbidities, particularly in older adults.ConclusionFindings of this study may aid in planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures among older adults in Taiwan.

1514 Higher Mortality in Pelvic Acetabular Fractures Is Associated with Lower Body Mass Index

Abstract Aim Fractures of the pelvis and acetabulum can be life-threatening or life changing injuries. Multiple factors can contribute to outcome including age, frailty, and baseline nutritional status. The aim of this study was to identify if low BMI (&amp;lt;18.5) was a predictor of outcome for patients with such injuries in terms of morbidity and mortality. Method We retrospectively analysed 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre over a 4.5-year period (August 2015 - January 2020). Of these patients, 569 were admitted to the centre and included in our analysis. Data was collected on demographics, injury pattern, operative intervention, and complications. Comparison was made between patients that were underweight (BMI&amp;lt;18.5) and patients that were not, for in-hospital and post discharge complications including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months. Results Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with 3 times increased in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659). Conclusions This study suggests increased mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should consider these findings in initiating appropriate peri-operative optimisation for these patients.

Early versus delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma- a prospective study

BackgroundDelayed presentation of pelvic-acetabular fractures is a common scenario in developing countries and there is usually a delay of more than 24 h in their presentation. ObjectivesWe aim to comparatively analyse early(<24 h) versus delayed (>24 h) thromboprophylaxis with low molecular weight heparin (LMWH) in prevention of deep venous thrombosis (DVT) in Pelvic Acetabular fractures. MethodsPatients of pelvic-acetabular fractures who presented during 1 year of study period were divided into 2 groups after exclusion of patients with contraindications for thromboprophylaxis. Group A included patients who received LMWH prophylaxis within 24 h of injury. Group B included patients who received LMWH prophylaxis after 24 h of injury. All patients underwent CT venography at day 14 and were followed up with doppler ultrasound on 4th and 8th week. Results110 patients with pelvic-acetabular fractures were included after exclusion of 61 patients. 4 out of 29 patients in group A (13.8%) and 12 out of 81 patients (14.8%) in group B developed DVT. There was no significant difference in incidence of DVT between Group A and B (P value-0.893). ConclusionThere was no difference between early and delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma.

Internal fixation through rectus abdominis in the treatment of pelvic acetabular fractures and the reduction of intraoperative bleeding.

article: Observation on the effect of internal fixation through rectus abdominis approach in the treatment of pelvic acetabular fractures and the reduction of intraoperative bleeding - Panminerva Medica 2021 Oct 25 - Minerva Medica - Journals

Knowledge and Practice of Pelvic and Acetabular Fractures Management Among Orthopaedics and Trauma Surgeons in Nigeria

Background: Pelvic-acetabular fractures are markers of high energy trauma and are associated with significant morbidity, mortality and management could be challenging. The inability to surgically manage these fractures appropriately in our centre and few publications on pelvic-acetabular fractures in Nigeria stimulated this study.Objectives: to find out how pelvic and acetabular fractures are managed and availability of investigating tools in Nigeria.Materials and methods: A questionnaire was uploaded for 7 weeks on the National orthopaedics and trauma surgeons’ forum. Questions on pelvic fractures management, knowledge and classification of pelvic fractures, preferred methods of pelvic fractures management- surgical or non-surgical, availability of advanced investigating tools and desire to acquire more skills /training were asked. Results: Eighty-five (33.2%) of the 256 members participated in the study. Preferred classification were Tile and Young-Burgess 46 (56.8%) and 29 (35.8 %) respectively. Thirty-six (43.9%) had Computerize Tomography scan (CT) while 19 (23.2%) had Magnetic Resonance Imaging (MRI) available in their place of practice. Twenty-eight (34.6%) would manage operatively, 8 (9.9%) would either operate or refer, while 23 (28.48%) would either manage non-operative or refer and outright non-operative in 7 (8.6%) of pelvic-acetabular fractures that require Open Reduction Internal Fixation (ORIF). Forty-six (56.8%) would refer patients; because of non-availability of skilled surgeon in 30(65.2%) and non-availability of operating tools in 32(69.6 %). Seventy-four (90.2%) would like to acquire skills in pelvic surgery.Conclusion: The health facilities were not adequately equipped with advanced imaging tools. Twenty-three percent of the respondents would consider managing pelvic fracture that requires ORIF non-operatively, while more than half would refer because of either non-availability of skilled pelvic surgeon or non-availably of operating tools. Majority of the respondents are interested in acquiring skills in pelvic surgery

Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

A meta-analysis of modified Stoppa approach and ilioinguinal approach in open reduction and internal fixation of Pelviacetabular fractures

Background: The two common approaches to operate pelviacetabular fractures are Modified Stoppa Approach (MSA) and Ilioinguinal Approach (IA). The advantage of one approach over the other is debatable. Thus, this meta-analysis was undertaken to compare both the approaches and establish which approach is superior. Methods: A literature search was conducted using PubMed database for articles comparing MSA and IA for pelviacetabular fractures. Articles were included after thorough perusal by 2 trained authors in accordance with the Cochrane Handbook for potential risk. The articles were rated based on Jadad scale for quality assessment. The data extracted from the articles was evaluated and compared for operative time, intraoperative blood loss, reduction quality, clinical outcome, and complications. Results: Eventually only 5 articles fitting the inclusion criteria were included in the meta-analysis. Total patients in the MSA group were 186 and that in the IA group were 219. The advantage of MSA over IA was found in the significantly shorter operative time (p=0.0002), better reduction quality (p=0.03) and decreased intra operative blood loss (p=0.002). No difference was found in clinical outcome (p=0.63) and complication rates (p=0.34).Conclusion: Through this meta-analysis it was established that MSA does offer superior approach in treating pelviacetabular fractures in terms of operative time, reduction quality and intra operative blood loss but shows no difference when it comes to clinical outcome and complications.

Guidance for Treatment of Pelvic Acetabular Injuries with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System.

Pelvic acetabular fracture is a common kind of fracture, mostly caused by high energy injuries. It is associated with high mortality and disability rates. The aim of surgical treatment of pelvic acetabular fractures is to restore the symmetry and stability of the pelvic ring structure and the anatomical structure of acetabular. Open reduction internal fixation is often used for the treatment of such fractures, but open surgery is in cases of serious injury, more bleeding, and high risk of infection. With the development of minimally invasive technology and the concept of the bone channel structure, the percutaneous lag screw technique for the treatment of pelvic and acetabular fractures has been applied in clinical practice and has proven to be effective. However, the anatomical structure of the pelvis and acetabulum is complex, and there are many important nerves and vessels adjacent to it. Traditional fluoroscopy screw placement is prone to screw malposition, and even minor angle changes may lead to screw perforation and damage of nerve vessels. The problem of radiation exposure is also noteworthy. Robotic‐assisted surgery can be used to carry out screw position planning through preoperative imaging, intraoperative real‐time tracking, and mechanical arm assistance to ensure that the screw placement position is consistent with the planning. In this way, robotic‐assisted surgery can be used to accurately insert lag screws, and can reduce surgical risk and radiation exposure. This guide uses the TiRobot system as an example to describe the application of robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.

Hammering reverse guide wire technique for safe placement of anterior column retrograde in-tramedullary screw in pelvic and acetabular surgery

Objective To evaluate the efficacy and accuracy of hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery. Methods From September 2015 to March 2018, 46 patients with pelvic or/and acetabular fracture involving the anterior column were treated with hammering reverse guide wire technique for safe placement of anterior column retrograde intramedullary screw at Department of Orthopaedics, Lishui Municipal Central Hospital. They were 28 men and 18 women, aged from 21 to 85 years (mean, 55.6 years). There were 34 pelvic ring fractures, 9 acetabular fractures and 3 combined pelvic ring and acetabular fractures. After the anterior lateral spine of pubic tuberosity was drilled by a guide pin and drill bit as the entry point, a reverse guide wire was knocked into the bone lightly by a hammer. For each retrograde intramedullary screwing into the acetabular anterior column, we recorded operation time, fluoroscopic frequency, and attempts to establish an acceptable screw pathway by the guide pin. The accuracy of screwing and the quality of fracture reduction were evaluated by imaging examination. For each patient, we recorded fracture union time and complications. Functional recovery of the pelvis and acetabulum was assessed by postoperative physical examination at the last follow-ups. Results The operation time of retrograde intramedullary screwing for the 46 patients averaged 28.9 minutes (from 16 to 55 minutes); the fluoroscopy frequency averaged 16.3 times (from 9 to 35 times); an acceptable screw pathway was established by the first attempt in 43 of the 46 patients (93.5%) and re-established after adjustment of the guide pin in the other 3. Forty patients were followed up for an average of 15.2 months(from 6 to 36 months). Postoperative CT scan and three-dimensional reconstruction showed that all the screws had been placed safely and accurately in the acetabular anterior column. Implant loosening and fracture displacement occurred in one case and lower limb thrombosis in another. No nail breakage, fracture nonunion, incision necrosis or infection, neurovascular injury or femoral head necrosis was observed. All fractures united after an average of 14.7 weeks (from 12 to 18 weeks). According to the Majeed scoring at the last follow-ups, the pelvic and acetabular function was evaluated as excellent in 29 cases, as good in 9, and as fair in 2, giving an excellent and good rate of 95.0%. Conclusion Hammering reverse guide wire technique is an effective method for safe placement of anterior column retrograde intramedullary screw in pelvic and acetabular surgery, because it can increase accuracy of screwing and reduce intraoperative radiation, operation time and incidence of complications though it is simple. Key words: Pelvis; Acetabulum; Fractures, bone; Surgical procedures, minimally invasive; Fracture fixation, internal

The incidence and clinical significance of corona mortis vessel

Objective To explore the incidence and clinical significance of corona mortis vessels. Methods From December 2015 to December 2017, 48 patients with pelvic acetabular fractures were treated with the Stoppa approach, including 36 males and 12 females, aged 30 to 67 years, with an average age of 47.2±8.2 years. There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures. In the 48 patients, there were 6 pelvic fractures, 40 acetabular fractures and 2 pelvic combined with acetabular fractures. According to Judet-Letournel classification: there were 6 cases of anterior column fracture, 4 cases of anterior column with anterior wall fracture, 2 cases of anterior column with posterior transverse fracture, 4 cases of transverse fracture, 6 cases of T shape fracture and 20 cases of double column fracture. According to Tile classification, there were 2 cases of B1 type, 2 cases of B3 type, 2 cases of C1 type, and 2 cases of C2 type. The time from injury to surgery was 5 to 16 days, with an average of 8.3±2.8 days. All patients were treated with the Stoppa approach for reduction and fixation. The incidence, number and type of corona mortis vessels across the superior pubic branch, and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded. Results In the 52 hemi pelvis, there were 46 sides with an anastomotic blood vessel, and no anastomotic blood vessel was found in 6 sides, with the incidence of corona mortis vessels of 88.5% (46/52). Among them, 36 cases were venous type, with the incidence of 78.3% (36/46); 8 cases were arterial type, with the incidence of 17.4% (8/46); 2 cases were mixed type, with the incidence of 4.3%(2/46); corona mortis venous blood vessel diameter was 1.8-3.7 mm, with an average of 2.9±0.5 mm; arterial blood vessel diameter was 2.4-3.0 mm, with an average of 2.7±0.3 mm; the distance between the vessels and the pubic symphysis was 48-71 mm, with an average of 56.9±5.8 mm. Conclusion The corona mortis vessels are common, with the incidence through Stoppa approach about 88.5%. In the clinical treatment of pelvic acetabular fractures, we should pay attention to careful separation of pubic branches exposed by the Stoppa approach, especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage. Key words: Pelvis; Acetabulum; Fractures, bone; Blood vessels

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis.

Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of the pelvis is expanding and its results are promising. We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures. The mean time to surgery was 8.6 ± 2.4 days, and the mean intraoperative blood loss was 94.1 ± 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 ± 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 ± 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 ± 0.50. There were no cases of 30-day and 1-year mortality. 3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.

Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma centre.

Navigation assisted minimally invasive percutaneous screw fixation (MIS) for pelvi-acetabular fracture was recently advocated. We report 38 consecutive cases of pelvi-acetabular fractures treated with 3D navigation-guided MIS from 2015 to 2016. Ohe hundred and forty-three screws were inserted (59 sacroiliac, 45 retrograde anterior column, 34 supra-acetabular, three antegrade posterior-column and two subcristal). Navigation planning was mainly performed pre-operatively. The mean operative blood loss and time was 179ml and 141mins, respectively. The distance (deviation) between the planned and executed screw entry and tip measured by the navigation computer were 1.91and 1.94mm, respectively. There were no immediate or early surgical complications. Patients were followed for at least 6month; 79% had fracture healing at 4.3months on average, and 53% walked unaided by the sixmonth follow-up. The average visual analogue scale for pain was 2.69. We believe 3D navigation-guided MIS is a safe and effective surgical alternative in most pelvi-acetabular fractures.

Fixation of Pelvic–Acetabular Fractures Using a Midline-Modified Stoppa Approach: Clinical and Operative Outcomes: 採用改進Stoppa入路以下中線切口進行盤骨髖臼骨折: 臨床和手術結果

Background/PurposeThis served as the first report from our locality to evaluate the modified Stoppa approach, via a low-midline wound, for treating pelvic–acetabular fractures. MethodsA total of 17 polytrauma patients with pelvic and/or acetabular fractures were consecutively treated using the modified Stoppa approach. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the Modified Merle d’Aubigne Score, Harris Hip Score, and pain visual analogue scale. ResultsAmong the 17 patients, 11 had pelvic ring fractures, two had isolated acetabular fractures, and four had a combination of both. Excellent and anatomical reduction was achieved in 73.3% of pelvic fractures and 71.4% of acetabular fractures. Functional outcomes simulated a bimodal distribution. Age of patient and Injury Severity Score were significant predictors for functional results, whereas fracture characteristics and quality of reduction were not correlated with clinical outcomes in this series. We experienced a low complication rate. ConclusionExcellent exposure for fracture reduction and fixation with low complication rate was achieved with the modified Stoppa approach. We were encouraged by the results of this preliminary series for treating pelvic–acetabular fractures in polytrauma patients.

Application of internal iliac artery embolization and presetting abdominal aorta balloon for complicated pelvic fractures

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra-operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduction and internal fixation of pelvic fracture through lateral-rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospectively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classification, all 7 cases belonged to type C3 (3.2: 5 cases; C3.3: 2 cases), including 5 cases with limb fracture, 2 cases with craniocere-bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary external fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral-rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤ 60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra-operative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral-rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation. Key words: Pelvics; Fractures, bone; Embolization, therapeutic