Unstable Anterior Pelvic Ring Research Articles

Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study.

Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture. To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries. A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score. The results revealed a statistically significant difference between both groups (P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (P = 0.513). A lower surgical site infection rate was noticed in the INFIX group (P = 0.007). Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis

ObjectivesThis study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using the Tornetta and Matta grading system and finite element analyses (FEA).MethodsIn a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n = 30) or INFIX (n = 33). The main outcome measures were the Majeed score, incidence of complications, and adverse outcomes, and fixation stability as evaluated by finite element analysis.ResultsSixty-three patients were included in the study, with an average age of 34.4 and 36.2 in modified group and conventional group, respectively. Two groups did not differ in terms of the injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a rate of higher satisfactory results according to the Tornetta and Matta grading system than the conventional group (73.33% vs 63.63%) as well as a higher Majeed score (81.5 ± 10.4 vs 76.3 ± 11.2), and these differences were statistically significant at 6 months post-surgery. FEA showed that MPSRF was stiffer and more stable than INFIX and had a lower risk of implant failure.ConclusionsBoth MPSRF and INFIX provide acceptable biomechanical stability for the treatment of unstable anterior pelvic ring fractures. However, MPSRF provides better fixation stability and a lower risk of implant failure, and can thus lead to better clinical outcomes. Therefore, MPSRF should be more widely applied to anterior pelvic ring fractures

Comparison of effectiveness of anterior subcutaneous internal fixator and plate internal fixation for unstable anterior pelvic ring fractures

To compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures. The clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation. The patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group ( t=-11.965, P=0.000; t=-20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups ( P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group ( P>0.05), but there were significant differences in sitting and sexual intercourse scores ( t=-4.250, P=0.003; t=-6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group ( P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group ( P<0.05). Compared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.

Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture

The aim of this study was to compare the clinical outcomes in patients with unstable anterior pelvic ring fractures after treatment with anterior subcutaneous internal fixator (INFIX) or plate fixation. We performed a retrospective study from August 2015 to October 2017. A consecutive series of 74 patients who underwent surgical treatment of their anterior pelvic ring (35 treated with INFIX and 39 treated with plates) were studied. Data collected included patients’ demographic data, injury severity score (ISS), AO/OTA classification, injury mechanism, time to surgery, procedure time, and blood loss. The quality of postoperative reduction were assessed by postoperative radiographs using the Tornetta and Matta method. Functional outcome was evaluated using Majeed scoring system. In the INFIX group, ten patients developed LFCN paralysis, one patient suffered from superficial infection. Three screw loosening cases and two wound infection cases occurred in the plate group. INFIX is relatively minimally invasive and time-saving than the reconstruction plate in the treatment of anterior pelvic ring fracture. However, plate fixation increases the rate of anatomic reduction of the pelvic anterior ring fracture. Plates also provide a higher functional outcome compared with INFIX. INFIX is especially suitable in patients with urological injury, which can also decrease the wound infection rate.

Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study

BackgroundPelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique.MethodsThis retrospective study included six patients with unstable pelvic ring injuries who underwent MPSRF, with or without posterior fixation. Intraoperative parameters such as blood loss, operative time, complications, and quality of reduction (Matta criteria) were recorded and evaluated by a blinded reviewer.ResultsIn the present clinical series, the mean operative times and mean blood loss for unilateral versus bilateral anterior ring fixations were 176.0 min versus 295.6 min, and 153.3 mL versus 550.0 mL, respectively. No iatrogenic neuropraxia of the lateral femoral cutaneous nerve or femoral nerve palsy occurred. The reduction quality, graded by the Matta criteria, was excellent in five patients and good in one patient.ConclusionsThere were no infections, delayed unions, nonunions, or loss of reductions during the follow-up period. Only one patient suffered from a broken rod at 4 months postoperatively. The modified technique represents a novel, minimally invasive procedure for the treatment of anterior pelvic ring fractures and offers a reliable and effective alternative to currently available surgical techniques.

The Use of External Fixation for the Management of the Unstable Anterior Pelvic Ring.

The objective of this article was to highlight the indications and various methods of external fixation for management of the unstable anterior pelvic ring. Although most often used temporarily in the setting of significant hemorrhage from a pelvic ring fracture, external fixation remains an option for definitive stabilization of select pelvic ring injuries. Classically, the iliac crest frame has been used, although use of the supra-acetabular frame has gained favor due to its superior bone purchase and improved biomechanics. Common complications from external fixation include pin site infections, loss of reduction, and the "external fixator deformity."

The Pelvic Bridge: A Subcutaneous Approach for Anterior Pelvic Fixation.

An alternative method to external fixation for the treatment of unstable anterior pelvic ring injuries, termed the pelvic bridge technique, provides equivalent results with fewer complications and is performed using occipital cervical rods subcutaneously, with fixation into the iliac wings and parasymphyseal bone. For preoperative planning, review the appropriate imaging, including radiographs and computed tomography (CT) scans, to mesh the findings on imaging to the clinical picture of the patient and ensure that the patient meets operative criteria and that none of the contraindications are present. Position the patient to facilitate anterior and posterior fixation. Make the incisions necessary to expose the osseous contour where fixation will be utilized. Carefully contour the plate-rod construct, which is necessary to minimize postoperative complications. Use care when inserting the rod as doing so will help to avoid neurovascular complications. To recreate pelvic stability, the pelvic ring needs to heal in as close to anatomic position as possible and there are multiple methods that help to obtain an adequate reduction. Multiple constructs may be used to stabilize the anterior pelvic ring, but the fundamental principle is to attach the 2 hemipelves to achieve stability, and the location where fixation can be achieved depends on the fracture pattern. Ensure meticulous closure to reduce the chance of infection and achieve appropriate soft-tissue coverage over hardware. Early mobilization is a fundamental goal of this procedure, but the time to full weight-bearing is dependent on fracture characteristics and healing. Anterior pelvic internal fixation (APIF) using the pelvic bridge technique has been demonstrated to have significantly fewer complications than APEF2.

Modified pedicle screw\u2013rod fixation as a minimally invasive treatment for anterior pelvic ring injuries: an initial case series

BackgroundUnstable pelvic ring injuries often involve high mortality and morbidity. This study was aimed to evaluate the modified minimally invasive pedicle screw–rod fixation for anterior pelvic ring injuries, in the respects of its feasibility, merits, and limitations.MethodsTwenty-three patients with unstable pelvic ring injuries underwent the modified anterior pedicle screw–rod fixation, with or without posterior fixation. The clinical outcomes were assessed using Majeed scores, and the quality of reduction was evaluated according to the criteria of Matta.ResultsMajeed scores showed that the clinical outcomes at postoperatively 1 year were excellent in 14 patients, good in 7, and fair in 2. One woman complained of persistent pain at the pubic tubercle during sexual intercourse. Iatrogenic neuropraxia of the unilateral lateral femoral cutaneous nerve occurred in 3 patients. Unilateral femoral nerve palsy occurred in 1 patient. The reduction was found to be excellent in 12 patients, good in 8, and fair in 3. Heterotopic ossification occurred in 8 patients, all being asymptomatic.ConclusionsThe modified pedicle screw–rod fixation with the minimally invasive technique offered an effective alternative for unstable anterior pelvic ring injuries.

Therapeutic effect of minimally invasive percutaneous plate osteosynthesis in treatment of anterior pelvic ring fractures

Objective To discuss feasibility and clinical effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of unstable anterior pelvic ring fractures.Methods A retrospective study was carried out on data of eight patients with pelvic fractures,including five males and three females at age of 21-57 years (average 38 years).All fractures were identified as unstable type according to Tile classification.MIPPO was performed for all patients after closed reduction.Reduction effect was analyzed according to Matta radiological evaluation criterion.Results All patients were followed up for 3-5 months (average 4.1 months),which showed reduction of anterior pelvic ring in eight patients including satisfactory reduction in five patients and good reduction in three.Fractures in all patients obtained bony union without complications like vascular nerve injury,wound infection,intraoperative massive hemorrhage,deep venous thrombosis or postoperative long-term pain.Conclusion MIPPO has advantages of reduced bleeding,few soft tissue complications,low infection rate and easy removal in treatment of anterior pelvic ring fractures and thereby is a promising surgical method. Key words: Pelvis; Fracture fixation, internal; Retrospective studies

Internal Fixation of the Unstable Anterior Pelvic Ring: A Biomechanical Comparison of Standard Plating Techniques and the Retrograde Medullary Superior Pubic Ramus Screw

Summary: The purpose of this study was to evaluate pubic ramus fracture fixation. This biomechanical evaluation compared standard plating techniques with retrograde medullary screw fixation of a superior pubic ramus fracture in a pelvic fracture model. Six fresh-frozen, cadaveric pelvic specimens with a mean age of 79 years were harvested. These specimens were physiologically loaded according to the following modifications and instrumentations: (a) intact; (b) an APC-II unstable pelvic injury, specifically, unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac (SI) joint, sacrospinous, and sacrotuberous ligamentous disruptions, without fixation; (c) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws; (d) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws; (e) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long (medial to the hip joint); and (f) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint. The posterior disruptions of the pelvic ring were not fixed. The APC-II injury created in this study resulted in significant (p < 0.05) motion at the disrupted rami and the injured SI joint, compared with the intact pelvic specimen. When compared with the disrupted specimen without fixation, displacement at the superior ramus was significantly (p < 0.05) decreased by all forms of ramus fixation evaluated. Plate fixation decreased pubic ramus and sacroiliac deflections slightly better than retrograde screw fixation did, yet not significantly better. The number of screws in the plate did not significantly affect displacement measurements at either the disrupted ramus or the disrupted SI joint. Similarly, the length of the retrograde ramus screw did not significantly alter displacements at either the injured pubic ramus or the disrupted SI joint. Sacroiliac joint deflections were not significantly (p < 0.05) decreased by any of the forms of anterior pelvic fixation. Flexion at the disrupted SI joint was slightly, but not significantly (p < 0.05), decreased with all forms of fixation when compared with the disrupted specimen. The long retrograde screw and the plate with six screws decreased flexion slightly, but not significantly, better than the short retrograde screw and the plate with four screws.

Internal Fixation of the Unstable Anterior Pelvic Ring: A Biomechanical Comparison of Standard Plating Techniques and the Retrograde Medullary Superior Pubic Ramus Screw

The purpose of this study was to evaluate pubic ramus fracture fixation. This biomechanical evaluation compared standard plating techniques with retrograde medullary screw fixation of a superior pubic ramus fracture in a pelvic fracture model. Six fresh-frozen, cadaveric pelvic specimens with a mean age of 79 years were harvested. These specimens were physiologically loaded according to the following modifications and instrumentations: (a) intact; (b) an APC-II unstable pelvic injury, specifically, unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac (SI) joint, sacrospinous, and sacrotuberous ligamentous disruptions, without fixation; (c) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws; (d) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws; (e) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long (medial to the hip joint); and (f) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint. The posterior disruptions of the pelvic ring were not fixed. The APC-II injury created in this study resulted in significant (p < 0.05) motion at the disrupted rami and the injured SI joint, compared with the intact pelvic specimen.(ABSTRACT TRUNCATED AT 250 WORDS)