[Surgical treatment for Tile C type pelvis fracture through posterior approach].
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Abstract:
To study the clinical results of surgical treatment for Tile C type pelvis fractures with internal fixation by posterior approach.From January 2005 to June 2009, 12 patients with Tile C type pelvis fracture were treated by open reduction through posterior approach. There were 8 males and 4 females, with an average age of 39.5 years ranging from 25 to 58 years. The time from injury to operation was ranged from 7 to 10 days with an average of 9.5 days. All the patients were given X-ray, 3-D CT examinations before operation. The fracture were classified by Tile classification: Type C1 in 5 cases, Type C2 in 2 cases, Type C1 and Type C2 in 4 cases, Type C3 in 1 case. All the posterior rings were fixed by re-establishing steel board without anterior ring fixation after stabilization of body condition. All the patients were treated with skin traction for 3 weeks after operation.All 12 patients were followed up for 6 months to 24 months with an average of 12.6 months. All the incisions healed well, and the fractures got union. No pelvic malunion, low back pain or leg length discrepancy was found. According to Majeed criteria for the evaluation of therapeutic effect, 10 patients were excellent, and 2 were good.In the management of the Tile C type pelvis fractures, a stable pelvis can be reconstructed by fixing posterior ring simply through the posterior approach, so that further sequelae can be reduced.Keywords:
Malunion
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Objective
To evaluate the clinical treatment of unstable pelvic fractures by posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation.
Methods
From January 2010 to January 2016, 31 patients with unstable pelvic fracture were treated at our department. They were 20 males and 11 females, with an average age of 44.4 years (range, from 18 to 65 years). According to the Tile classification, 6 cases were type B2, 8 cases type B3, 12 cases type C1, and 5 cases type C2. The anterior pelvic ring was fixated in supine position first, and the posterior pelvic ring was fixated next using percutaneous minimally invasive pedicle screws. The operation time, intraoperative bleeding, and frequency of fluoroscopy needed for the posterior ring fixation were recorded. Reduction quality, complications like loss of reduction and pelvic function at the final follow-up were also assessed.
Results
For the posterior ring fixation in the 31 patients, the operation time ranged from 40 to 60 minutes (average, 50.7 minutes), blood loss from 30 to 80 mL (average, 42.9 mL), and fluoroscopic frequency from 7 to 12 times (average, 9.7 times). By the Tornetta evaluation, the reduction was rated postoperatively as excellent in 15 cases and as good in 16 ones, yielding an excellent and good rate of 100%. Twenty-nine patients obtained complete follow-up for 12 to 83 months (average, 34.7 months), and they achieved bone union after an average of 14.5 weeks (range, from 12 to 16 weeks). According to the Majeed criteria for pelvic function at the final follow-up, 10 cases were rated as excellent, 16 cases as good, and 3 cases as fair, giving an excellent and good rate of 89.7%. No reduction loss, incision infection, vascular or nerve injury, screw loosening or breakage, or fracture displacement was observed during follow-up.
Conclusion
In the treatment of unstable pelvic fractures, posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation can lead to less operation time, intraoperative bleeding and fluoroscopic radiation, and satisfactory fracture reduction and functional recovery of the pelvis as well.
Key words:
Pelvis; Fractures, bone; Fracture fixation, internal; Internal fixators; Surgical procedures, minimally invasive
Supine position
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Objective To evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template. Methods The clinical data of 10 patients who underwent surgical treatment for unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template between May 2015 and June 2016 were retrospectively analysed. There were 7 males and 3 females with an average age of 37.5 years (range, 20-58 years). The causes of injury included falling from height in 5 cases, crushing from heavy load in 1 case, and traffic accidents in 4 cases. The interval from injury to admission was 1-5 hours (mean, 3.1 hours). The fracture situation included 6 cases of sacral fracture, 1 case of right sacroiliac joint dislocation, and 3 cases of iliac bone fracture. There were 10 cases of superior and inferior pubic rami fracture, including 3 cases on the left side (2 cases of suprapubic fracture adjacent to symphysis pubis), 2 cases on the right side, and 5 cases on the bilateral. All fractures were classified according to the Tile system, there were 4 cases of type B2, 1 of type B3, 4 of type C1, and 1 of type C2. The radiological outcome was evaluated by Matta scale, and the positions of the iliosacral screw and superior pubic ramus screw were evaluated according to 3D reconstruction of CT postoperatively. The functional outcome was evaluated by Majeed function scale. Results The average time of each screw implantation was 30 minutes, and the average blood loss per screw incision was 50 mL. The time of implantation of each sacroiliac screw was 24-96 seconds (mean, 62 seconds), and the time of implantation of each suprapubic screw was 42-80 seconds (mean, 63.2 seconds). The hospitalization duration was 17-90 days (mean, 43.7 days). All incisions healed by first intention. All patients were followed up 12-22 months (mean, 15.6 months). The radiological outcome was excellent in 8 cases and good in 2 cases according to Matta scale; and 3D reconstruction of CT demonstrated that all the 9 iliosacral screws were placed as type Ⅰ, and all the 13 suprapubic ramus screws were placed as grade 0 on the first postoperative day. No complication such as neurovascular injury, screw back out or rupture, or secondary fracture displacement was observed during the follow-up. At 6 months after operation, the X-ray films showed good fracture healing in all the 10 patients. The functional outcome was excellent in 9 cases and good in 1 case according to Majeed scale at 1 year after operation. One patient sustained Tile C2 pelvic disruption complicated with L 5 nerve root injury achieved complete nervous functional recovery at last follow-up. Conclusion It has advantages of precise screw insertion and lower risk of neurovascular injury to treat unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template, which can be a good alternative for the treatment of unstable pelvic fractures.
Pelvic fracture
Pubic symphysis
Sacroiliac joint
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To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.
Pelvic fracture
Nerve Injury
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Citations (1)
Objective:To study the clinical results of surgical treatment for Tile C type pelvis fractures with internal fixation by posterior approach. Methods:From January 2005 to June 2009,12 patients with Tile C type pelvis fracture were treated by open reduction through posterior approach. There were 8 males and 4 females,with an average age of 39.5 years ranging from 25 to 58 years. The time from injury to operation was ranged from 7 to 10 days with an average of 9.5 days. All the patients were given X-ray,3-D CT examinations before operation. The fracture were classified by Tile classification:Type C1 in 5 cases,Type C2 in 2 cases,Type C1 and Type C2 in 4 cases,Type C3 in 1 case. All the posterior rings were fixed by re-establishing steel board without anterior ring fixation after stabilization of body condition. All the patients were treated with skin traction for 3 weeks after operation. Results:All 12 patients were followed up for 6 months to 24 months with an average of 12.6 months. All the incisions healed well,and the fractures got union. No pelvic malunion,low back pain or leg length discrepancy was found. According to Majeed criteria for the evaluation of therapeutic effect,10 patients were excellent,and 2 were good. Conclusion:In the management of the Tile C type pelvis fractures,a stable pelvis can be reconstructed by fixing posterior ring simply through the posterior approach,so that further sequelae can be reduced.
Malunion
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Objective To summarize the curative effect of staged treatment with combined internal and external fixation for type CⅠandⅡpelvic fracture. Methods From Mar. 2013 to Jul. 2011,there were 6 cases of type CⅠ,Ⅱpelvic fracture,including 4 males and 2 females( age ranged from 24 to 62 years,mean 55 years). There were 4 cases of traffic accident injury,and 2 cases of falling injury. The injury time ranged from 3 weeks to 2 months. All cases were complicated with other organ injuries. X-ray and CT examination showed 2 cases of pubic symphysis separation,with the separation distance 2. 5cm. There were 4 cases of type CⅠ( sacral fracture without sacroiliac joint dislocation) and 2 cases of CⅡ( sacral fracture with sacroiliac joint dislocation). In the first stage,external fixator was gradually pressurized to reset the anterior ring,correct the rotational instability,and simultaneously correct the vertical instability. In the second stage we used internal fixation for final treatment for both anterior and posterior pelvic ring.Results All incisions healed in the primary stage. Six cases were followed up,ranging from 5 to 26 months,with an average of 15. 5 months. The Matta score indicated excellent in 4 cases,good in 1 case,and fair in 1 case. The Majeed score for functional recovery indicated excellent in 4 cases,good in 1 case,and fair in 1 case. Conclusion The combined use of external and internal fixation for type CⅠ,Ⅱ pelvic fracture has advantages of minimal trauma,less bleeding,and fast postoperative recovery. It can obtain a good treatment effect.
Pelvic fracture
Sacroiliac joint
Pubic symphysis
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Objective
To evaluate the clinical efficacy of universal self-locking anatomical plate for acetabulum and pelvis (USAPAP) in the treatment of posterior acetabular fractures.
Methods
Data of 55 patients with posterior acetabular fractures who were treated with the USAPAP from January 2014 to January 2016 were retrospectively analyzed. There were 39 males and 16 females with an average age of 38.5 years old (range, 17-82 years). There were 35 fractures on the left side while the other 20 fractures were on the right side, including 52 fresh cases and 3 old cases. According to Letournel-Judet classification, there were 32 cases of posterior wall, 9 cases of transverse and posterior wall, 5 cases of anterior column and posterior wall, 2 cases of posterior column, 2 cases of transverse, 2 cases of two columns, 1 case of anterior column and posterior hemitransverse, 2 cases of Pipkin type IV. All patients were managed operatively by the USAPAP, which allows simultaneous fixation for two columns and quadrilateral surface fractures through a single Kocher-Langenback approach. The quality of reduction was assessed by Matta's score system. The mean follow-up period was 18.5 months (range, 12-24 months). Average operation time was 95 min, and average blood loss was 350 ml. Average operation time of plate and screws fixation was 19 min, and average fluoroscopy times in the surgery was 2 times. The mean time of bony union was 4.3 months. According to the criteria described by Matta, the excellent and good rate of radiological score was 92.7% (51/55), including 39 cases excellent, 12 cases good and 4 cases poor. The excellent and good rate of Merle d’Aubigne-Postel score was 87.3% (48/55), including 35 cases of excellent, 13 cases of good, 5 cases of fair, and 2 cases of poor. Heterotopic ossification occurred in 1 patient (Brooker type II) at three months postoperatively. One case with Pipkin type IV fracture underwent total hip arthroplasty due to femoral head necrosis at seven months postoperatively. Complications including wound infection, sciatic nerve injury, screw invade joint, redisplacement of the fracture, avascular necrosis of bone fragment, hardware failure, nonunion or malunion was not found in any case at the latest follow-up.
Conclusion
The USAPAP through the single posterior Kocher-Langenback approach provides strong and stable fixation for complex acetabular fractures associated with posterior region including posterior wall, both columns and quadrilateral surface. Satisfactory clinical results can be achieved by the use of this method.
Key words:
Acetabulum; Fractures, bone; Fracture fixation; Internal fixators
Posterior column
Acetabular fracture
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To investigate the feasibility and therapeutic effect of subcutaneous pedicle screw-rod system with modified placement in treatment of Tile B pelvic fractures.From June 2014 to August 2015, 14 patients with Tile B pelvic fractures were treated by subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle. There were 8 males and 6 females, aged from 23 to 65 years with an average of 42 years. Operative time, intraoperative blood loss, fracture healing and postoperative complication were observed and clinical effects were evaluated by Matta reduction standard and Majeed score.All patients were followed up from 8 to 15 months with an average of 10.5 months. Operative time was 25 to 45 min with an average of 32 min;intraoperative blood loss was 10 to 35 ml with an average of 18 ml. All fractures got primary healing and healed time was 9 to 14 weeks with an average of 12.5 weeks. No postoperative incision infection, internal fixation failure and ectopic ossification were found, 4 cases occurred unilateral lateral femoral cutaneous nerve injury and 1 case occurred unilateral femoral nerve paralysis, but all restored finally. According to Matta criteria, reduction was excellent in 7 cases, good in 5 cases, fair in 2 case. According to Majeed score system, the functional evaluation at last follow-up was excellent in 5 cases, good in 7 cases, fair in 2 cases with the average score of 81.50±8.05.Subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle have advantages of strong reduction, less trauma and complications, and is a promising surgical method in the treatment of Tile B pelvic fractures.
Fracture reduction
Femoral nerve
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Objective:To explore the clinic values of percutaneous screw combined with limited internal fixation in the treatment of pelvic fracture of Tile C type.Methods:Under the guide of CT,percutaneous screw combined with limited internal fixation was used to treat 15 cases of pelvic fracture of Tile C type(9 cases of C1 type,4 cases of C2,2 cases of C3).Results:The reduction was excellent in 14 cases,only one case was poor,with the lengthwise displace of 0.8 cm.The period of union of fracture ranged from 8 weeks to 5 months,averagely 3.4 months.Light infection appeared in the wound of pubic symphysis for one case,which was cured by changing dressings.All cases were followed up for 15 to 60 months,averagely 40 months.According to the Majeed score,9 cases were excellent,4 good and 2 fair,with the excellent and good rate of 86.7%.4 cases suffered from sacral plexus injury preoperatively recovered 3 months after operation.Two cases informed pain of lumbosacral area and pubic symphysis respectively.Conclusions:Percutaneous screw combined with limited internal fixation is a reasonable operation for treating pelvic fracture of Tile C type.
Pelvic fracture
Pubic symphysis
Lumbosacral joint
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Objective To appraise the surgical treatment for fractures of the posterior wall of acetabulum to decrease the incidence of post-traumatic osteoarthritis. Methods This series comprised of 83 cases of fractures of posterior wall of acetabulum that were treated with ORIF, among which 62 were males, 21 were females. The age ranged from 18 to 59 years. 61 cases of fractures were complicated with hip dislocation. The interval between injury and operation ranged from 1 to 90 days. The operating period lasted from 55 to 145 minutes, with blood loss of 150 to 420 ml. This series was composed with 49 typical posterior wall fractures, 9 postero-superior, 3 postero-inferior, 12 with transverse fractures, and 10 with posterior column fractures. Of the series, 49 cases were one-piece-facture, 26 cases were two-piece-fracture, and 8 cases were multi-piece-fracture. All cases were treated with the Kocher-Langenbeck approach, the ilioinguinal approach was supplemented in 3 cases with transverse fractures, 12 cases were fixed with plates and screws. Results Follow-up period ranged from 0.6 to 9.6 years. Transient paralysis occurred in 5 cases. By Matta's X-ray reduction criteria, there were 77 cases of anatomical reduction, 6 cases of satisfactory. By modified d'Aubigne clinical evaluation criteria, there were excellent result clinically in 65 cases, good in 11 cases and fair in 7 cases. Conclusion All fractures of posterior wall of acetabulum should be repaired surgically with exception of those with tiny fragments. Fixation with plate and screw provides good biomechanical stability and allows early functional practice without the aid of external fixation. There is a close relationship between the clinical result and surgical reduction, the number of fratured fragments and whether or not complicated with fracture of the femoral head.
Posterior column
Posterior wall
Acetabular fracture
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Objective To explore the clinical effect of lateral-rectus approach for the intemal fixation of acetabular fractures with concurrent ipsilateral pelvic fracture.Methods From March 2011 to March 2013,15 patients with acetabular fracture and ipsilateral type C pelvic fracture were surgically managed through the lateral-rectus approach.They were 10 males and 5 females,with an average age of 45.6 years (from 21 to 64 years).According to Judet-Letournel classification,there were 8 anterior column fractures,3 anterior column plus posterior hemitransverse fractures,and 4 double column fractures.All the cases had concurrent pelvic fractures.By Tile classification,there were 5 cases of type B2.1,7 ones of type C1.2,and 3 ones of type C1.3.The duration from injury to surgery ranged from 5 to 21 days,averaging 11 days.Eleven cases of merely anterior acetabular and pelvic fractures were treated with the lateral-rectus approach only,in the supine position.Four cases involving the posterior acetabular wall and posterior column were treated with combined lateral-rectus and posterior Kocher-Langenbeck approaches,in the floating position.The titanium reconstruction plates and cannulated screws were applied in these cases.Results The operation time averaged 105 minutes and the intraoperative blood loss 640 mL.Postoperative X-ray and CT exams showed excellent and good reduction.According to the Matta radiological evaluation postoperatively,reduction of acetabular fracture was rated as anatomic in 8 cases,satisfactory in 4 and unsatisfactory in 3.Injury to the sciatic nerve occurred in one case,and fat liquefaction at the abdominal incision in one case.All the patients were followed up for 10 to 20 months (average,16 months) and the fractures healed after 10 to 15 weeks (average,12 weeks).According to the modified Merle d'Aubigne and Postel scoring system,10 cases were excellent,4 good,and one fair 6 months after operation.Conclusions Surgical management of acetabular fractures through the lateral-rectus approach can provide adequate exposure for not only the treatment of acetabular fractures involving the anterior column and the quadrilateral surface,but also the simultaneous treatment of ipsilateral fractures involving the pubic superior ramus,iliac ala and sacroiliac joint,leading to fine outcomes.
Key words:
Acetabulum; Pelvis; Fractures, bone; Surgical approach
Acetabular fracture
Posterior column
Supine position
Pelvic fracture
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