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Treatment of pelvic fractures through a less invasive ilioinguinal approach combined with a minimally invasive posterior approach.

Zhu L, Wang L, Shen D, Ye TW, Zhao LY, Chen AM - BMC Musculoskelet Disord (2015)

Bottom Line: There are several treatment modalities available.One superficial wound infection and two deep vein thromboses occurred, all of which resolved with conservative treatment.The clinical outcome at one year was "excellent" in 29 patients and "good" in 8 patients (Majeed score).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Trauma Surgery, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd., Huangpu District, Shanghai, China. hailangzhulei@126.com.

ABSTRACT

Background: Unstable pelvic fractures usually result from high-energy trauma. There are several treatment modalities available. The purpose of this study was to evaluate the clinical application of a new less invasive ilioinguinal approach combined with a minimally invasive posterior approach technique in patients with unstable pelvic fractures. We also address the feasibility, validity, and limitations of the technique.

Methods: Thirty-seven patients with unstable pelvic fractures were treated with our minimally invasive technique. The anterior pelvic ring fractures were treated with a less invasive ilioinguinal approach, and the sacral fractures were treated with a minimally invasive posterior approach. The clinical outcome was measured using the Majeed scoring system, and the quality of fracture reduction was evaluated. The patients were followed up for 13 to 60 months (mean, 24 months).

Results: Anatomical or near to anatomical reduction was achieved in 26 (70.3 %) of the anterior pelvic ring fractures and a satisfactory result was obtained in another 11(29.7 %). For the posterior sacral fractures, excellent reduction was obtained in 33 (89.2 %) of the fractures, with a residual deformity in the other 4 patients. One superficial wound infection and two deep vein thromboses occurred, all of which resolved with conservative treatment. The clinical outcome at one year was "excellent" in 29 patients and "good" in 8 patients (Majeed score).

Conclusions: The satisfactory results showed that a reduction and fixation of unstable pelvic fractures is possible through a combination of a limited ilioinguinal approach and posterior pelvic ring fixation. We believe our method is a new and effective alternative in the management of pelvic fractures.

No MeSH data available.


Related in: MedlinePlus

Patient with closed unstable pelvic ring disruption. A 43-year-old woman had a type B (Tile classification) pelvic fracture caused by a traffic accident. a Preoperative pelvic radiographic image. b Preoperative computed tomographic image. c Postoperative pelvic radiographic image. d Pelvic model demonstrates two pedicle screws in each dorsal iliac crest
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Fig1: Patient with closed unstable pelvic ring disruption. A 43-year-old woman had a type B (Tile classification) pelvic fracture caused by a traffic accident. a Preoperative pelvic radiographic image. b Preoperative computed tomographic image. c Postoperative pelvic radiographic image. d Pelvic model demonstrates two pedicle screws in each dorsal iliac crest

Mentions: A total of 37 patients with closed, unstable pelvic ring disruptions were treated from January 2008 and September 2012 at our department. All patients were evaluated based on anteroposterior, inlet and outlet plain pelvic radiography (Fig. 1a) and computed tomography scans of the pelvis (Fig. 1b). Patients were excluded from the study if they (1) had pubic symphysis separation, (2) bilateral sacral fracture, (3) sacroiliac joint injuries, (4) sacral plexus injuries that required neurolysis or decompression, or (5) injuries of unclear date or a history of conservatively or surgically treated pelvic injuries. Specific sacral fractures such as comminuted fractures, sacral dimorphism, sacral fractures with inadequate intra-operative images, which are difficult to be treated by percutaneous screws, are the best indications for this technique. Based on the rotational and vertical instabilities of the patients’ injuries, their pelvic fractures were classified as Type B or Type C according to the Tile classification [11] . There were 9 B1 cases, 17 B2 cases, 9 C1 cases and 2 C2 cases (Table 1). All patients underwent reduction and internal fixation of a pelvic fracture using our less invasive anterior approach, combined with a minimally invasive pedicle screw system for a posterior pelvic ring fracture. Written informed consent for participation in the study was obtained from all patients. The research was in compliance with the Helsinki Declaration. The medical ethics committee of the Second Military Medical University gave ethical approval (reference number 2007–029).Fig. 1


Treatment of pelvic fractures through a less invasive ilioinguinal approach combined with a minimally invasive posterior approach.

Zhu L, Wang L, Shen D, Ye TW, Zhao LY, Chen AM - BMC Musculoskelet Disord (2015)

Patient with closed unstable pelvic ring disruption. A 43-year-old woman had a type B (Tile classification) pelvic fracture caused by a traffic accident. a Preoperative pelvic radiographic image. b Preoperative computed tomographic image. c Postoperative pelvic radiographic image. d Pelvic model demonstrates two pedicle screws in each dorsal iliac crest
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4513702&req=5

Fig1: Patient with closed unstable pelvic ring disruption. A 43-year-old woman had a type B (Tile classification) pelvic fracture caused by a traffic accident. a Preoperative pelvic radiographic image. b Preoperative computed tomographic image. c Postoperative pelvic radiographic image. d Pelvic model demonstrates two pedicle screws in each dorsal iliac crest
Mentions: A total of 37 patients with closed, unstable pelvic ring disruptions were treated from January 2008 and September 2012 at our department. All patients were evaluated based on anteroposterior, inlet and outlet plain pelvic radiography (Fig. 1a) and computed tomography scans of the pelvis (Fig. 1b). Patients were excluded from the study if they (1) had pubic symphysis separation, (2) bilateral sacral fracture, (3) sacroiliac joint injuries, (4) sacral plexus injuries that required neurolysis or decompression, or (5) injuries of unclear date or a history of conservatively or surgically treated pelvic injuries. Specific sacral fractures such as comminuted fractures, sacral dimorphism, sacral fractures with inadequate intra-operative images, which are difficult to be treated by percutaneous screws, are the best indications for this technique. Based on the rotational and vertical instabilities of the patients’ injuries, their pelvic fractures were classified as Type B or Type C according to the Tile classification [11] . There were 9 B1 cases, 17 B2 cases, 9 C1 cases and 2 C2 cases (Table 1). All patients underwent reduction and internal fixation of a pelvic fracture using our less invasive anterior approach, combined with a minimally invasive pedicle screw system for a posterior pelvic ring fracture. Written informed consent for participation in the study was obtained from all patients. The research was in compliance with the Helsinki Declaration. The medical ethics committee of the Second Military Medical University gave ethical approval (reference number 2007–029).Fig. 1

Bottom Line: There are several treatment modalities available.One superficial wound infection and two deep vein thromboses occurred, all of which resolved with conservative treatment.The clinical outcome at one year was "excellent" in 29 patients and "good" in 8 patients (Majeed score).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Trauma Surgery, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd., Huangpu District, Shanghai, China. hailangzhulei@126.com.

ABSTRACT

Background: Unstable pelvic fractures usually result from high-energy trauma. There are several treatment modalities available. The purpose of this study was to evaluate the clinical application of a new less invasive ilioinguinal approach combined with a minimally invasive posterior approach technique in patients with unstable pelvic fractures. We also address the feasibility, validity, and limitations of the technique.

Methods: Thirty-seven patients with unstable pelvic fractures were treated with our minimally invasive technique. The anterior pelvic ring fractures were treated with a less invasive ilioinguinal approach, and the sacral fractures were treated with a minimally invasive posterior approach. The clinical outcome was measured using the Majeed scoring system, and the quality of fracture reduction was evaluated. The patients were followed up for 13 to 60 months (mean, 24 months).

Results: Anatomical or near to anatomical reduction was achieved in 26 (70.3 %) of the anterior pelvic ring fractures and a satisfactory result was obtained in another 11(29.7 %). For the posterior sacral fractures, excellent reduction was obtained in 33 (89.2 %) of the fractures, with a residual deformity in the other 4 patients. One superficial wound infection and two deep vein thromboses occurred, all of which resolved with conservative treatment. The clinical outcome at one year was "excellent" in 29 patients and "good" in 8 patients (Majeed score).

Conclusions: The satisfactory results showed that a reduction and fixation of unstable pelvic fractures is possible through a combination of a limited ilioinguinal approach and posterior pelvic ring fixation. We believe our method is a new and effective alternative in the management of pelvic fractures.

No MeSH data available.


Related in: MedlinePlus