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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 3. (A) The initial inlet view radiograph shows severe residual internal rotation deformity of the right hemipelvis. (B) The radiograph obtained immediately after surgery shows correction of the internal rotation. (C) The radiograph obtained 2 months after surgery shows loss of reduction, metal failure, and nonunion. (D) In revision surgery, the anterior lesion was reopened and fixed with a broad plate.
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Figure 3: Case 3. (A) The initial inlet view radiograph shows severe residual internal rotation deformity of the right hemipelvis. (B) The radiograph obtained immediately after surgery shows correction of the internal rotation. (C) The radiograph obtained 2 months after surgery shows loss of reduction, metal failure, and nonunion. (D) In revision surgery, the anterior lesion was reopened and fixed with a broad plate.

Mentions: A 25-year-old woman was referred to our hospital because of nonunion with severe residual deformity of the right hemipelvis. The initial diagnosis was vertical shear injury according to the Young-Burgess classification,6) and she underwent surgery at another hospital. When we saw her, she had severe buttock and pubic pain and moderate limping. Radiographs obtained at our hospital showed severe residual internal rotation deformity and 4-cm cranial displacement of the right hemipelvis. CT showed nonunion through the right iliac wing and the left pubic rami, along with upward migration, internal rotation, and adduction deformity. For surgery, the patient was placed in the supine position. The right posterior hemipelvis was osteotomized for mobilization through an iliac approach and then fixed with a plate and screws. With the patient still in the supine position, we used an ilioinguinal approach for the anterior pelvis, where we performed plating and placed a bone graft at the osteotomy site. Radiographs obtained immediately after surgery showed correction of the internal rotation and superior migration deformity. However, radiographs obtained at a follow-up examination 2 months later showed loss of reduction, metal failure, and nonunion, especially in the anterior pelvis. Therefore, we decided to operate again. The anterior lesion was reopened and fixed with a broad plate and fused at the symphysis. The posterior lesion was united and the plate was removed at the same time. A follow-up examination 6 years later showed a well-fused symphysis and posterior pelvis; the patient reported no bothersome symptoms (Fig. 3).


Surgical Correction of Pelvic Malunion and Nonunion.

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

Case 3. (A) The initial inlet view radiograph shows severe residual internal rotation deformity of the right hemipelvis. (B) The radiograph obtained immediately after surgery shows correction of the internal rotation. (C) The radiograph obtained 2 months after surgery shows loss of reduction, metal failure, and nonunion. (D) In revision surgery, the anterior lesion was reopened and fixed with a broad plate.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Case 3. (A) The initial inlet view radiograph shows severe residual internal rotation deformity of the right hemipelvis. (B) The radiograph obtained immediately after surgery shows correction of the internal rotation. (C) The radiograph obtained 2 months after surgery shows loss of reduction, metal failure, and nonunion. (D) In revision surgery, the anterior lesion was reopened and fixed with a broad plate.
Mentions: A 25-year-old woman was referred to our hospital because of nonunion with severe residual deformity of the right hemipelvis. The initial diagnosis was vertical shear injury according to the Young-Burgess classification,6) and she underwent surgery at another hospital. When we saw her, she had severe buttock and pubic pain and moderate limping. Radiographs obtained at our hospital showed severe residual internal rotation deformity and 4-cm cranial displacement of the right hemipelvis. CT showed nonunion through the right iliac wing and the left pubic rami, along with upward migration, internal rotation, and adduction deformity. For surgery, the patient was placed in the supine position. The right posterior hemipelvis was osteotomized for mobilization through an iliac approach and then fixed with a plate and screws. With the patient still in the supine position, we used an ilioinguinal approach for the anterior pelvis, where we performed plating and placed a bone graft at the osteotomy site. Radiographs obtained immediately after surgery showed correction of the internal rotation and superior migration deformity. However, radiographs obtained at a follow-up examination 2 months later showed loss of reduction, metal failure, and nonunion, especially in the anterior pelvis. Therefore, we decided to operate again. The anterior lesion was reopened and fixed with a broad plate and fused at the symphysis. The posterior lesion was united and the plate was removed at the same time. A follow-up examination 6 years later showed a well-fused symphysis and posterior pelvis; the patient reported no bothersome symptoms (Fig. 3).

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