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Surgical Correction of Pelvic Malunion and Nonunion.

Lee KJ, Min BW, Oh GM, Lee SW - Clin Orthop Surg (2015)

Bottom Line: Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis.However, there is not much information in the literature on the management of these late complications.The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

ABSTRACT
Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. However, there is not much information in the literature on the management of these late complications. Because they cause disabling symptoms and socioeconomic problems, some patients with malunion or nonunion of pelvic fractures need to undergo surgery. We report our experience with satisfactory results of surgery for pelvic malunion and nonunion in four patients. The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.

No MeSH data available.


Related in: MedlinePlus

Case 1. (A) Initial anteroposterior view. (B) The three-dimensional computed tomography image shows upward migration and internal rotation deformity of the left hemipelvis. (C) The radiograph obtained immediately after surgery shows correction of the deformity. (D) The radiograph obtained 4 years after surgery shows union and maintenance of the reduction.
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Figure 1: Case 1. (A) Initial anteroposterior view. (B) The three-dimensional computed tomography image shows upward migration and internal rotation deformity of the left hemipelvis. (C) The radiograph obtained immediately after surgery shows correction of the deformity. (D) The radiograph obtained 4 years after surgery shows union and maintenance of the reduction.

Mentions: A 27-year-old woman was injured when she fell from a height 9 months before presenting for treatment. The initial diagnosis was type C injury according to Tile's classification,5) and she was treated without surgery because of polytrauma and complete peroneal nerve palsy. When she revisited our hospital, she reported buttock pain, limping, and sitting intolerance. Radiographs obtained during this visit showed posterior translation of the left hemipelvis on the inlet view and a significant 5.5-cm superior migration of left hemipelvis on the outlet view. A two-dimensional (2D) computed tomography (CT) scan showed nonunion through the left sacrum and pubic ramus and 15° internal rotation deformity of the left hemipelvis, and a three-dimensional (3D) CT scan showed superior and posterior migration-along with internal rotation and flexion deformity-of the left hemipelvis. We performed a three-stage pelvic reconstruction. In the first stage, the patient was placed in the supine position, and we used an ilioinguinal approach to perform osteotomies of the superior and inferior pubic rami near the original fracture site. The wound was irrigated and closed. Then, the patient was placed prone for the second stage of the procedure. Through a posterior approach, we performed an osteotomy at the site of nonunion in the sacral foramen. In this stage, it is very important to cut the sacrospinous and sacrotuberous ligament attachments to the sacrum to reduce the superior migration of the hemipelvis. Correction of cranial displacement was carried out using a variety of bone clamps and reduction forceps. A transverse tension band plate, placed posterior to the sacral lamina, required a second smaller posterior approach on the right. The posterior wound was closed, and the patient was rolled into the supine position. The anterior wound was reopened and the superior ramus was fixed with a plate and screws. A bone graft was also added. Radiographs obtained immediately after surgery showed correction of superior migration and internal rotation deformity. Four years later, a follow-up radiograph showed union and maintenance of the reduction, and the patient had no clinical signs of pain, limping, or sitting intolerance. In addition, she showed complete recovery from peroneal nerve palsy (Fig. 1).


Surgical Correction of Pelvic Malunion and Nonunion.

Lee KJ, Min BW, Oh GM, Lee SW - Clin Orthop Surg (2015)

Case 1. (A) Initial anteroposterior view. (B) The three-dimensional computed tomography image shows upward migration and internal rotation deformity of the left hemipelvis. (C) The radiograph obtained immediately after surgery shows correction of the deformity. (D) The radiograph obtained 4 years after surgery shows union and maintenance of the reduction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553291&req=5

Figure 1: Case 1. (A) Initial anteroposterior view. (B) The three-dimensional computed tomography image shows upward migration and internal rotation deformity of the left hemipelvis. (C) The radiograph obtained immediately after surgery shows correction of the deformity. (D) The radiograph obtained 4 years after surgery shows union and maintenance of the reduction.
Mentions: A 27-year-old woman was injured when she fell from a height 9 months before presenting for treatment. The initial diagnosis was type C injury according to Tile's classification,5) and she was treated without surgery because of polytrauma and complete peroneal nerve palsy. When she revisited our hospital, she reported buttock pain, limping, and sitting intolerance. Radiographs obtained during this visit showed posterior translation of the left hemipelvis on the inlet view and a significant 5.5-cm superior migration of left hemipelvis on the outlet view. A two-dimensional (2D) computed tomography (CT) scan showed nonunion through the left sacrum and pubic ramus and 15° internal rotation deformity of the left hemipelvis, and a three-dimensional (3D) CT scan showed superior and posterior migration-along with internal rotation and flexion deformity-of the left hemipelvis. We performed a three-stage pelvic reconstruction. In the first stage, the patient was placed in the supine position, and we used an ilioinguinal approach to perform osteotomies of the superior and inferior pubic rami near the original fracture site. The wound was irrigated and closed. Then, the patient was placed prone for the second stage of the procedure. Through a posterior approach, we performed an osteotomy at the site of nonunion in the sacral foramen. In this stage, it is very important to cut the sacrospinous and sacrotuberous ligament attachments to the sacrum to reduce the superior migration of the hemipelvis. Correction of cranial displacement was carried out using a variety of bone clamps and reduction forceps. A transverse tension band plate, placed posterior to the sacral lamina, required a second smaller posterior approach on the right. The posterior wound was closed, and the patient was rolled into the supine position. The anterior wound was reopened and the superior ramus was fixed with a plate and screws. A bone graft was also added. Radiographs obtained immediately after surgery showed correction of superior migration and internal rotation deformity. Four years later, a follow-up radiograph showed union and maintenance of the reduction, and the patient had no clinical signs of pain, limping, or sitting intolerance. In addition, she showed complete recovery from peroneal nerve palsy (Fig. 1).

Bottom Line: Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis.However, there is not much information in the literature on the management of these late complications.The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

ABSTRACT
Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. However, there is not much information in the literature on the management of these late complications. Because they cause disabling symptoms and socioeconomic problems, some patients with malunion or nonunion of pelvic fractures need to undergo surgery. We report our experience with satisfactory results of surgery for pelvic malunion and nonunion in four patients. The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.

No MeSH data available.


Related in: MedlinePlus