Treatment Of Pelvic Fractures Research Articles

The iliac pillar – Definition of an osseous fixation pathway for internal and external fixation

BackgroundIncreasing numbers of unstable pelvic ring fractures, due to the ongoing demographic change and improvements in the rescue of high-energy traumatic events, are challenging trauma and orthopedic surgeons. While initial installation of an external fixation device is often necessary, placement of iliac crest pins can be difficult due to the complex osteology of the ilium. HypothesisWe aim to analyze (1) the length, localization and angulation of the iliac pillar and (2) to define the dimensions of the surgical corridor for a better understanding of pin entry point and trajectory, thus preventing shortcomings in anterior external fixation of pelvic ring injuries. MethodsTwenty hemipelvises from 10 fresh-frozen cadaveric torsos (3 female, 7 males; mean age 80.2 years) were harvested. The following measurements were taken with digital calipers: Location of the iliac pillar in relation to the anterior superior iliac spine and to the acetabulum roof, mean length and diameter of the iliac pillar, maximum diameter of the iliac pillar. In addition we measured the width of the different bone layers. ResultsThe mean length of the hourglass shaped iliac pillar was 107.04mm with a mean width of 17.0mm (min. 15.1; max. 19.2). The mean distance to the anterior superior iliac spine was 69.00mm (min. 64.8; max. 73.4). The mean maximum width of the iliac pillar was 12.16mm (min. 9.4; max. 13.8). Caudally the line describing the iliac pillar intercepts the cranial acetabular rim at 12 o’clock. The smallest mean diameter of the cancellous bone was 7.5mm±2.0. ConclusionThe iliac pillar is part of the complex osteology of the human pelvis. A cohesive description of its location and dimensions has been lacking. Successful treatment of pelvic fracture depends on an optimal preoperative planning, accurate overall reduction, and stable fixation. We described the origin and angulation to provide a good bone stock for external fixation pin and the width of the different bone layers. This study therefore contributes by facilitating a thorough understanding of pelvic osteology and describing the location and dimensions of an optimal osseous pathway. Level of evidenceAnatomical descriptive study.

Expert consensus on diagnosis and treatment of pelvic & acetabular fractures in the epidemic of Corona Virus Disease 2019

Expert consensus on diagnosis and treatment of pelvic & acetabular fractures in the epidemic of Corona Virus Disease 2019

Conservative management of pelvic fractures in dogs and cats in Algiers: Incidence and long-term clinical outcomes.

Aim:We performed a retrospective study to evaluate clinical complications and outcomes associated with non-operative management of pelvic fractures in dogs and cats and described owner satisfaction.Materials and Methods:Based on radiographic findings and fracture location, case records were classified into two groups. Group 1 included animals with acetabulum involvement that underwent conservative treatment plus femoral head-and-neck excision. Group 2 included animals without acetabulum involvement that underwent conservative treatment only. Compliance with rest instructions, time to locomotion recovery, and the evaluation of persistent lameness were data collected from the questionnaire. The level of satisfaction was classified as excellent, good, or bad. Clinical outcome was evaluated at least 10 months after the fracture.Results:Pelvic injuries included sacroiliac luxations (59.52%) and ilial body (35.7%), acetabular (21.4%), pubic (21.4%), and ischial (14.28%) fractures alone or combined. According to the owners, the proposed strategy yielded good to excellent outcomes in dogs and cats in this study, with 95.23% of animals regaining full function of their hind limbs. Two dogs had slight chronic lameness, and some degree of gait abnormality persisted.Conclusion:Because of financial constraints, the chronicity of fractures, or lack of surgical techniques, the surgical treatment of pelvic fractures may not be possible. Non-operative treatment can then be considered to allow the animal to return to acceptable function.

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures

Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures. Methods Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded. Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2. Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach

Pedicle screw internal fixation versus subcutaneous anterior pelvic internal fixation in treatment of pelvic anterior ring fractures

Objective To compare pedicle screw internal fixation (PSIF) and subcutaneous anterior pelvic internal fixation (APIF) in the treatment of pelvic anterior ring fractures. Methods A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery, The People’s Hospital of Henan Province from January 2014 to September 2018. Of them, 20 were treated by PSIF and 26 by APIF. In the PSIF group, there were 12 males and 8 females with an age of 47.8±2.4 years, and 6 cases of B1, 9 cases of type B2, 4 cases of type B3 and one case of type C1 by the Tile’s classification; in the APIF group, there were 16 males and 10 females with an age of 49.6±1.2 years, and 9 cases of B1, 8 cases of type B2, 5 cases of type B3, 2 cases of type C1 and 2 cases of type C2 by the Tile’s classification. The 2 groups were compared in terms of surgical or postoperative complications (including iatrogenic nerve injury, infection, implant failure and fracture nonunion), fracture reduction and therapeutic efficacy at the final follow-up. Results There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). The 46 patients were followed up for 9 to 18 months (mean, 13.5 months). In the PSIF and APIF groups, the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20) and 7.7%(2/26), those of infection 5.0%(1/20) and 3.8%(1/26), and those of skin discomfort 5.0% (1/20) and 7.7%(2/26), respectively. According to the Matta criteria, the fracture reduction at the last follow-up was evaluated as excellent in 7, as good in 11 and as fair in 2 in the PSIF group, giving an excellent and good rate of 90.0%, and as excellent in 9, as good in 13 and as fair in 4 in the APIF group, giving an excellent and good rate of 84.6%. According to the Majeed criteria, the pelvic function at the final follow-up was evaluated as excellent in 10, as good in 7, as fair in 2 and as poor in one in the PSIF group, giving an excellent and good rate of 85.0%, and as excellent in 13, as good in 10, and as fair in 3 in the APIF group, giving an excellent and good rate of 88.5%. There were no significant differences between the 2 groups in all the comparisons above (P>0.05). The incidence of femoral nerve parasthesia was 0(0/20) for the PSIF group, significantly lower than that for the APIF groups (3.8%, 1/26) (P<0.05). Conclusion As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture, either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive

Trends and predictors of mortality in unstable pelvic ring fracture: a 10-year experience with a multidisciplinary institutional protocol

BackgroundPelvic ring fracture is often combined with other injuries and such patients are considered at high risk of mortality and complications. There is controversy regarding the gold standard protocol for the initial treatment of pelvic fracture. The aim of this study was to assess which risk factors could affect the outcome and to analyze survival using our multidisciplinary institutional protocol for traumatic pelvic ring fracture.Material and methodsThis retrospective study reviewed patients who sustained an unstable pelvic ring fracture with Injury Severity Score (ISS) ≥ 5. All patients were admitted to the emergency department and registered in the Trauma Registry System of a level I trauma center from January 1, 2008, to December 31, 2017. The annular mortality rate after the application of our institutional protocol was analyzed. Patients with different systems of injury and treatments were compared, and regression analysis was performed to adjust for factors that could affect the rate of mortality and complications.ResultsDuring the 10-year study period, there were 825 unstable pelvic ring injuries, with a mean ISS higher than that of other non-pelvic trauma cases. The annual mortality rate declined from 7.8 to 2.4% and the mean length of stay was 18.1 days. A multivariable analysis showed that unstable initial vital signs, such as systolic blood pressure < 90 mmHg (odds ratio [OR] 2.53; confidence interval [CI] 1.11–5.73), Glasgow Coma Scale < 9 (OR 3.87; CI 1.57–9.58), 24 > ISS > 15 (OR 4.84; CI 0.85–27.65), pulse rate < 50 (OR 11.54; CI 1.21–109.6), and diabetes mellitus (OR 3.18; CI 1.10–9.21) were associated with higher mortality. No other specific system in the high Abbreviated Injury Scale increased the rates of mortality or complications.ConclusionPoor initial vital signs and Glasgow Coma Scale score, higher ISS score, and comorbidity of diabetes mellitus affect the mortality rate of patients with unstable pelvic ring fractures. No single system of injury was found to increase mortality in these patients. The mortality rate was reduced through institutional efforts toward the application of guidelines for the initial management of pelvic fracture.

Preliminary application of Starr reduction framecombined with O-arm navigation systemin the treatment ofcomplex pelvic fractures

Objective To investigate the feasibility and short term clinical efficacy of early minimally invasive treatment of complex pelvic trauma with Starr reduction frame combined with O-arm navigation system. Methods From June 2017 to December 2018, thirty two patients with Tile C complex pelvic fractures were prospectively divided into two groups according to the random number table. The open treatment group included 17 cases (open reduction and internal fixation group; 10 males and 7 females, age 24-60 years, average 37±6.5 years; according to Tile classification, 8 cases of C1 type, 8 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 9 cases in zone I, 6 cases in zone II and 2 cases in zone III). The combined treatment group included 15 cases (Starr reduction frame group combined with O-arm navigation system, 8 males and 7 females, age 32-57 years, average 40±5.2 years; according to Tile classification, 8 cases of C1 type, 6 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 8 cases in zone I, 5 cases in zone II and 2 cases in zone III). The ilioinguinal and Stoppa approaches were used in the open treatment group, and the anterior and posterior ring injuries were fixed with reconstruction plate screws and hollow screws, respectively. In the combined treatment group, starr frame was used to assist reduction, combined with O arm navigation technique, infix internal fixation frame, superior pubic branch screw, sacroilium screw were used to fix the anterior and posterior ring injury. The quality of pelvic fracture reduction was evaluated by the Matta scoring system, and the Majeed score was used to evaluate the clinical efficacy. Results All patients were followed up for 6 to 12 months. The hospitalization time (45±11 d), operation time (220.0±49.4 min) and fracture healing time (24.0±5.6 weeks) in the open treatment group were longer than those in the combined treatment group (21±9 d, 180.0±24.2 min, 16.1±3.8 weeks), and the intraoperative blood loss (820.0±140.4 ml) was significantly higher than that in the combined treatment group (24.0±10.4 ml)(t=6.651, 2.772, 6.128, 22.874; all P< 0.05). According to Matta scoring system, in the open treatment group, there are 8 excellent cases, 6 good cases, 2 fair cases, 1 poor case, thus the excellent and good rate was 82.4%(14/17). While 9 cases were excellent, 5 good, 1 fair, and the excellent and good rate was 93.3% (14/15) in the combined treatment group. At the latest follow-up, Majeed score was 51-85 points in the open treatment group, including excellent in 8 cases, good in 6 cases, fair in 2 cases, poor in 1 case, thus the excellent and good rate 82.4% (14/17), and the Majeed score was 75-95 points in the combined treatment group, including excellent in 9 cases, good in 5 cases, fair in 1 case, thus excellent and good rate 93.3% (14/15). There was a statistically significant difference between the two groups of Matta score and Majeed score (χ2=0.034, 0.040; P< 0.05). Surgical infection occurred in 4 cases in the open treatment group and healed after debridement and treatment with sensitive antibiotics. The incidence of complications was 23.5% (4/17). In the combined treatment group, 2 cases had anterolateral thigh skin sensory loss after operation, and the symptoms were relieved after mannitol, mecobalamine treatment and removal of internal fixations. One patient had hematoma of the gluteus maximus muscle after operation. The result of angiography showed that the INFIX screw was too long and perforated near the foramen of the ischium, resulting from the injury of the superior gluteal artery. After stopping the use of anticoagulant, intravenous infusion of tranexamic acid, blood transfusion, etc., the patient was cured and discharged from hospital. The incidence of complications was 20.0% (3/15). There was no significant difference in the incidence of complications between the two groups. Conclusion With the help of starr reduction frame, the early reduction and minimally invasive treatment of pelvic fracture can be realized, and the amount of intraoperative bleeding can be reduced. The combined application of o arm navigation can improve the accuracy and safety of sacroiliac screw and anterior column screw placement, reduce the radiation dose and frequency of operators and patients, shorten the operation time and improve the curative effect. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Surgery, computer-assisted

Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage

Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage

Minimally invasive posterior reconstructive plating by parallel Kirschner wires for unstable posterior pelvic fractures

Objective To explore the clinical efficacy of minimally invasive posterior reconstructive plating by parallel Kirschner wires in the treatment of unstable posterior pelvic fractures. Methods From January 2013 to December 2016, 29 patients with unstable posterior pelvic fracture were treated at Trauma Center, Liuzhou Workers＇ Hospital. They were 22 men and 7 women, aged from 19 to 65 years (mean, 44.2 years). By the Tile classification, 10 cases were classified as type B and 19 as type C. The delay from injury to surgery ranged from 4 to 14 days (mean, 8.7 days). All the patients received minimally invasive posterior fixation with a U-shaped reconstructive plate and parallel Kirschner wires. The length of incision, intraoperative bleeding, operation time, quality of fracture reduction, curative effects and complications at the last follow-up were recorded. Results The length of intraoperative unilateral incision ranged from 2.3 to 3.4 cm (average, 2.99 cm); the volume of intraoperative bleeding ranged from 47 to 88 mL (average, 69.9 mL); the average operation time ranged from 17 to 34 min (average, 25.2 min). One patient was lost to the follow-up. The other 28 patients were followed up for 14 to 26 months (average, 18.3 months). The fracture healing time ranged from 8 to 15 months (average, 10.1 months). According to the Matta criteria for fracture reduction, 17 cases were rated as excellent at the last follow-up, 9 as good, one as fair and one as poor, giving an excellent to good rate of 92.9%. According to the Pohlemann functional scoring, 14 cases were rated as excellent, 11 as good, 2 as fair and one as poor, giving an excellent to good rate of 89.3%. Conclusion In the treatment of unstable posterior pelvic fractures, minimally invasive posterior reconstructive plating by parallel Kirschner wires presents advantages of high security, limited surgical trauma, good curative effects and limited postoperative complications. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Bone plates; Kirschner wires

Percutaneous minimally invasive screwing assisted by 3D printing patient-specific external guide template for pelvic and acetabular fractures

Objective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures. Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics, Wuhan Union Hospital. The patients were divided into a template group and a freehand group. In the template group, there were 14 men and 7 women with an age of 46.3±18.2 years and 17 pelvic fractures and 4 acetabular fractures; in the freehand group, there were 12 men and 6 women with an age of 43.8±12.2 years and 14 pelvic fractures and 4 acetabular fractures. The 2 groups were compared in terms of operation time, fluoroscopic frequency, guide wire adjustments, fracture reduction, screw penetration rate, function evaluation and adverse events. Results All the 39 patients were followed up for 9 to 13 months (average, 11.6 months). A total of 42 screws were placed in the template group and 35 screws in the freehand group. The values of operation time (43.8±22.2 min), fluoroscopic frequency (29.6±10.7 times) and guide wire adjustments (1.8±1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8±22.6 min, 54.6±16.5 times and 9.8±2.8 times, respectively) (P 0.05). One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up. Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency, save operation time and improve accuracy of screw insertion, providing a new means for minimally invasive treatment of pelvis and acetabular fractures. Key words: Pelvis; Acetabulum; Fractures, bone; Surgical procedures, minimally invasive; 3D printing technology

Comparison of anterior internal fixator and external fixator for treatment of anterior pelvic ring fracture

Objective To compare the therapeutic effects between anterior internal fixator (INFIX) and external fixator (EXFIX) for anterior pelvic ring fracture. Methods A retrospective study was conducted on the 66 patients with anterior pelvic ring fracture who had been treated surgically from January 2016 to June 2017 at Department of Spinal Surgery, Hospital Affiliated to Southwest Medical University and at Department of Orthopedics, Union Hospital Affiliated to Tongji Medical College. They were divided into an observation group and a control group according to their fixation of the anterior pelvic ring. In the observation group of 33 cases fixated with INFIX, there were 20 males and 13 females, aged from 32 to 47 years (38.8±4.8 years). By the Tile’s classification, 15 of them belonged to type B and 18 to type C. In the control group of another 33 patients fixated with EXFIX, there were 19 males and 14 females, aged from 33 to 48 years (39.5±4.6 years). By the Tile's classification, 14 of them belonged to type B and 19 to type C. The 2 groups were compared in terms of postoperative fracture reduction, pelvic function and complications. Results The 66 patients were followed up for an average of 13.7 months(from 12 to 18 months). According to the Matta criteria for fracture reduction, 21 cases were excellent, 9 good, 2 fair and one poor in the observation group (excellent and good rate: 90.9%); 18 cases were excellent, 8 good, 5 fair and 2 poor in the control group (excellent and good rate: 78.8%). The difference was statistically significant between the 2 groups (P 0.05). The incidences of screw loosening and pin track infection were significantly lower in the observation group than in the control group[0 versus 24.2%(8/33) and 0 versus 18.2%(6/33), respectively] (both P<0.05). Conclusion Compared with EXFIX, INFIX can lead to better clinical outcomes and fewer operative complications in the treatment of anterior pelvic ring fractures. Key words: Pelvis; Fractures, bone; Fracture fixation; Internal fixator; External fixator

Progress in treatment of obsolete pelvic fracture

Severe pelvic fractures are often accompanied with injuries to abdominal and pelvic organs and nerves and vessels as well. Timely operations for pelvic fractures may be delayed due to urgent management of serious and life-threatening injuries, rendering the fractures obsolete. Patients with severe obsolete pelvic fracture often sustain severe pain, unstable pelvis, neurovascular injuries and organ dysfunction associated with pelvic malunion and malalignment which can only be treated by surgery. This paper reviews the literature and summarizes clinical manifestations of the fracture, indications for surgery, surgical treatment algorithms and difficulties encountered during operation, with an aim to provide useful information for management of obsolete pelvic fractures. Key words: Pelvis; Old fractures; Fracture, nonunion; Deformity

Percutaneous screw fixation assisted by an orthopedic robot for pelvic and acetabular fractures

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures. Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 10 men and 5 women, from 22 to 69 years of age (average, 65.2 years). There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures, 2 posterior column fractures and one transverse fracture). All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot. Fluoroscopic frequency, number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively. Postoperative CT was performed to eval-uate screw positions and incidence of adverse events. Functional recovery in the patients was evaluated in regular follow-ups. Results A total of 26 screws were implanted in the operation. The fluoroscopic fre-quency ranged from 12 to 49 times, with a mean value of 17.3 times per screw; the number of needle ad-justment ranged from 0 to 2 times(mean, 0.3 times); the deviation of the actual path from its initial plan-ning ranged from 0.82 to 1.42 mm (mean, 1.06 mm). No surgery-related neurovascular injury occurred in any patient. Postoperative CT examination revealed that no screws cut out of cortical bone, yielding a 100% rate of excellent and good screw positions. Two patients were lost to the follow-up, and the re-maining 13 patients were followed up for 12 to 14 months (mean, 12.6 months). Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points). No neurological symptoms were observed during follow-up. Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency, it will became a major minimally invasive surgical technique for pelvic and acetabular fractures. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Robot

Treatment of unstable pelvic fractures with sacroiliac screwing assisted by 3D printing technique in combination with front ring nail-rod system

Objective To explore the clinical efficacy of 3D printing technique in assisting sacroiliac screwing in combination with front ring nail-rod system for treatment of unstable pelvic fractures. Methods From July 2015 to June 2017, 3D printing technique was used to assist the sacroiliac screwing in combination with front ring nail-rod system for 16 patients with unstable pelvic fracture at Orthopaedic Center, The Fourth People's Hospital of Zigong. They were 9 males and 7 females, aged from 19 to 60 years (average, 39.8 years). By the Tile classification, 5 cases were type B1, 6 type B2, 3 type B3 and 2 type C. Their operation duration, bleeding, fluoroscopy frequency, incision length, postoperative fracture reduction, success rate of sacroiliac screwing, accuracy of sacroiliac screwing, perioperative complications, weight-bearing exercise time, fracture healing time and the Majeed scores at the last follow-up were documented. Results All the 3D models and navigation templates were successfully designed and printed. Surgery succeeded in all the patients. Follow-ups ranged from 6 to 18 months, averaging 13.3 months. The bleeding ranged from 100 to 250 mL, averaging 162.4 mL; the operation duration ranged from 60 to 120 min, averaging 73.2 min; the intra-operative fluoroscopy frequency ranged from 13 to 31 times, averaging 17.4 times; the incision length ranged from 16 to 32 cm, averaging 21.1 cm. All the incisions healed by the first intention and all the fractures obtained osseous union after 90 to 120 d (average, 102.3 d). No significant complications like neurovascular injury or pulmonary embolism happened. The weight-bearing exercise time ranged from 25 to 40 d, averaging 31.5 d. According to the Matta imaging scores, the reduction was rated as excellent in 12 cases and good in 4. Altogether 28 screws were inserted with a success rate of 100%. Compared with the preoperative simulated screwing, the actual screwing angle deviated postoperatively by 0.12°±0.32°, the X axis by 0.36±1.24 mm, the Y axis by 0.36±1.24 mm and the Z axis by 0.22±1.26 mm, showing no statistically significant difference between the actual 3D deviations and the test value of 0 (P>0.05). Conclusion In the treatment of unstable pelvic fractures, 3D printing technique can be used in preoperative preparation of the connecting rod in the front ring nail-rod system to assist the sacroiliac screwing, significantly shortening the operation duration, reducing bleeding, ensuring safe and accurate screwing, and facilitating functional recovery. Key words: Pelvis; Fracture fixation, internal; Bone nails; 3D printing technique

Complications Following Internal Fixator in the Treatment of Pelvic Fracture

The aim of this systematic review was to investigate the incidence of complications of the internal fixator in the treatment of anterior pelvic ring injury. The literature was comprehensively searched from 1980 to January 2017 to identify potential studies. Six studies involving 272 cases of anterior pelvic ring injury treated with the internal fixator were included in this meta-analysis. The rates of wound infection, heterotopic ossification, nerve paresthesia, pain, and fracture dislocation were 5.7%, 35.1%, 28.2%, 3.7%, and 3.0%, respectively. This new technique should be prudently used to treat pelvic fractures. [Orthopedics. 2019; 42(1):e7-e13.].

External pelvic reduction frame system combined with tunnel screw fixation for Tile C1 pelvic fracture

Objective To investigate the efficacy of external pelvic reduction frame system combined with tunnel screw fixation in the treatment of Tile C1 pelvic fracture. Methods A retrospective case series analysis of 15 patients with Tile C1 pelvic fractures from January 2014 to October 2016 was performed. Clinical data included seven males and eight females, aged 26-84 years (mean, 48.9 years). According to Tile classification, there were five cases of type C1.1, three cases of C1.2, and seven cases of type C1.3. The average time from injury to surgery was 9.5 days (range, 4-33 days). All patients received the treatment of external pelvic reduction frame system combined with tunnel screw fixation. The operation time, intraoperative blood loss, and complications were recorded. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function and neurological function were evaluated by the Majeed functional scoring system and the Gibbons sacral nerve injury grading, respectively. Results The patients were followed up for an average of 16 months (range, 12-24 months). The mean operation time was 139 minutes (range, 50-250 minutes), and the mean intraoperative blood loss was 90 ml (range, 20-260 ml). No complications such as wound infection, loose internal fixation, rupture or loss of reduction occurred in the patients. According to the Matta score, 14 patients obtained anatomical reduction, and one obtained satisfactory reduction. At the last follow-up, according to the Majeed functional scoring criteria, the results were excellent in all 15 patients, with an excellent and good rate of 100%. According to Gibbons sacral nerve injury grading, two out of the three patients with neurologic impairment before the operation recovered completely while the remaining one did not recover. Conclusion In the treatment of Tile C1 pelvic fractures, external pelvic frame reduction system combined with tunnel screw fixation can attain satisfactory fracture reduction, reliable fixation, and good functional recovery. Key words: Pelvis; Fracture fixation; Surgical procedures, minimally invasive

High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada

IntroductionAlthough fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period. MethodsA cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment. ResultsThe incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death. ConclusionsStable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population.

Chinese expert consensus on echelons treatment of pelvic fractures in modern war

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level I facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level II facilities. At Level III facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Effect of 3D printing technology on pelvic fractures:a Meta-analysis

To evaluate the effect of 3D printing technology applied in the surgical treatment of pelvic fractures through the published literatures by Meta-analysis. The PubMed database, EMCC database, CBM database, CNKI database, VIP database and Wanfang database were searched from the date of database foundation to August 2017 to collect the controlled clinical trials in wich 3D printing technology was applied in preoperative planning of pelvic fracture surgery. The retrieved literatures were screened according to predefined inclusion and exclusion criteria, and quality evaluation were performed. Then, the available data were extracted and analyzed with the RevMan5.3 software. Totally 9 controlled clinical trials including 638 cases were chosen. Among them, 279 cases were assigned to the 3D printing technology group and 359 cases to the conventional group. The Meta-analysis results showed that the operative time[SMD=-2.81, 95%CI(-3.76, -1.85)], intraoperative blood loss[SMD=-3.28, 95%CI(-4.72, -1.85)] and the rate of complication [OR=0.47, 95%CI(0.25, 0.87)] in the 3D printing technology were all lower than those in the conventional group;the excellent and good rate of pelvic fracture reduction[OR=2.09, 95%CI(1.32, 3.30)] and postoperative pelvic functional restoration [OR=1.94, 95%CI(1.15, 3.28) in the 3D printing technology were all superior to those in the conventional group. 3D printing technology applied in the surgical treatment of pelvic fractures has the advantage of shorter operative time, less intraoperative blood loss and lower rate of complication, and can improve the quality of pelvic fracture reduction and the recovery of postoperative pelvic function.

PMD101 - Health Care Resource Utilization and Direct Medical Costs Among Patients Receiving Treatment for Pelvic Fractures

To estimate the healthcare resource utilization and direct medical costs among patients receiving treatment for pelvic fractures in the United States. This retrospective longitudinal cohort study included Truven Health MarketScan Commercial Claims and Encounters and the Medicare Supplemental and Coordination of Benefits databases. Patients that received open or closed treatment (index event) for pelvic fractures from 2012 to 2016 were identified using Current Procedural Terminology (CPT) code series 272xx (15-18, 20, 22, 26-28) or 27130. Analyses were performed at the index and at 12-month follow up after the index. The outcome measures included length of stay and costs during the index hospitalization and readmission rates and all-cause direct medical costs for both inpatient and outpatient services during the 12-month follow-up period. A total of 4,994 patients in the commercial and 1,735 patients in Medicare databases were identified that underwent procedures for pelvic fractures from 2012-2016. A majority was male, 65.5% in commercial with age between 46-64 years and 54.4% in Medicare with age greater than equal to 65 years. The mean (SD) length of stay were 9.34 (±10.69) days and 5.16 (± 6.57) days and the mean costs for index hospitalization were $79,961(±123,887) and $22,099 (±57,737) for commercial and Medicare populations respectively. During the 12-month follow-up the rates of readmission were 39.3% and 40.2% and the mean (SD) total all-cause direct costs were $ 36,371 (±75,037) and $41,128 (±61,912) for commercial and Medicare populations respectively. The results show that patients receiving treatment for pelvic fractures not only have long length of stay and burdensome costs for index pelvic procedures but also have high 12-month readmission rates and post-index costs. Better cost efficient medical procedures are warranted to successfully treat patients and address the current economic burden.