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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

Operative steps. a Marking for the incision for exposure through the lateral and medial window. b A preflexed reconstruction plate is manoeuvred from the lateral window to the medial window. c Marking for the posterosuperior iliac spine and iliac crest. d Tightening the screws with a wrench through a small incision 8 cm proximal to the midpoint between the bilateral posterosuperior iliac spines
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Fig2: Operative steps. a Marking for the incision for exposure through the lateral and medial window. b A preflexed reconstruction plate is manoeuvred from the lateral window to the medial window. c Marking for the posterosuperior iliac spine and iliac crest. d Tightening the screws with a wrench through a small incision 8 cm proximal to the midpoint between the bilateral posterosuperior iliac spines

Mentions: The incision for exposure through a lateral window extended along the anterior one-third of the iliac crest and ended at the anterosuperior iliac spine (Fig. 2a marked with a thick black line in the area of the anterosuperior iliac spine). Because the lateral femoral cutaneous nerve exits into the thigh over a distance approximately 2 cm medial to the anterosuperior iliac spine, the incision ensures that the lateral femoral cutaneous nerve is protected. The exposure progresses to the iliac crest using sharp dissection. The abdominal muscles and start of iliacus muscle are sharply incised from their origins. After subperiosteal elevation, the iliacus muscle is dissected from the internal iliac fossa to the anterior inferior iliac spine.Fig. 2


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)

Operative steps. a Marking for the incision for exposure through the lateral and medial window. b A preflexed reconstruction plate is manoeuvred from the lateral window to the medial window. c Marking for the posterosuperior iliac spine and iliac crest. d Tightening the screws with a wrench through a small incision 8 cm proximal to the midpoint between the bilateral posterosuperior iliac spines
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Operative steps. a Marking for the incision for exposure through the lateral and medial window. b A preflexed reconstruction plate is manoeuvred from the lateral window to the medial window. c Marking for the posterosuperior iliac spine and iliac crest. d Tightening the screws with a wrench through a small incision 8 cm proximal to the midpoint between the bilateral posterosuperior iliac spines
Mentions: The incision for exposure through a lateral window extended along the anterior one-third of the iliac crest and ended at the anterosuperior iliac spine (Fig. 2a marked with a thick black line in the area of the anterosuperior iliac spine). Because the lateral femoral cutaneous nerve exits into the thigh over a distance approximately 2 cm medial to the anterosuperior iliac spine, the incision ensures that the lateral femoral cutaneous nerve is protected. The exposure progresses to the iliac crest using sharp dissection. The abdominal muscles and start of iliacus muscle are sharply incised from their origins. After subperiosteal elevation, the iliacus muscle is dissected from the internal iliac fossa to the anterior inferior iliac spine.Fig. 2

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