Anterior approach to the sacroiliac joint for pelvic ring fractures: Technical note

OBJECTIVEThe authors evaluated the outcomes of sacroiliac joint (SIJ) arthrodesis via an original anterior approach to the upper anterior surface of the SIJ in patients with a minimum of 5 years’ follow-up.METHODSThe authors performed anterior SIJ arthrodesis in 45 patients between 2001 and 2015. Of these patients, 27 (11 men and 16 women; mean age at surgery 49 [24–86] years) were followed up for a minimum of 5 years (average 113 months, range 61–157 months). In the 14 patients in the earlier period of this study, the authors used an anterior approach to expose the SIJ by separating the iliac muscle from the iliac bone and performed internal fixation. In the 13 patients later in the study, the authors changed to a pararectal approach, which involved an incision along the lateral border of the rectus abdominal muscle. Then, extraperitoneally, the upper anterior surface of the SIJ was exposed between the psoas major muscle and the iliac muscle.RESULTSAmong the 27 patients, 21 had unilateral anterior arthrodesis alone, 4 required additional posterior arthrodesis, and 2 required pelvic ring arthrodesis because of later pain on the opposite side. In the 21 patients with a unilateral anterior arthrodesis, outcome according to the modified Macnab criteria was excellent in 7, good in 11, and fair in 3. Outcomes were excellent, good, fair, and poor in 1 patient each among the 4 with additional posterior fusion. Outcomes were good and poor for 1 patient each among those with pelvic ring arthrodesis. All 27 patients demonstrated bone union of the SIJ on CT. Lateral femoral cutaneous neuralgia developed in 7 of the 27 patients; 6 patients had undergone the initial anterior method and 1 the later method.CONCLUSIONSAnterior SIJ arthrodesis was effective in most patients with severe SIJ pain resistant to conservative therapy. This approach has the advantage of direct curettage and bone graft into the wide area of the SIJ, which result in good bone union. In particular, the authors’ current pararectal approach could decrease the potential risk of lateral cutaneous injury.

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An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing’s Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

Case Reports in Orthopedics ◽

10.1155/2016/9250938 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Andreas Höch ◽

Philipp Pieroh ◽

Faramarz Dehghani ◽

Christoph Josten ◽

Jörg Böhme

Keyword(s):

Cushing’S Disease ◽

Sacroiliac Joint ◽

Adrenocorticotropic Hormone ◽

Bone Structure ◽

Pelvic Ring ◽

Pelvic Girdle ◽

Cushing's Disease ◽

High Dose ◽

Pelvic Ring Fractures ◽

Pelvic Instability

Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

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J.W.R. Young and A.R. Burgess, Radiologic Management of Pelvic Ring Fractures, Systematic Radiographic Diagnosis, Urban & Schwarzenberg, Baltimore, Munich (1987) 94 pp., 82 figs.

Clinical Radiology ◽

10.1016/s0009-9260(88)80383-0 ◽

1988 ◽

Vol 39 (2) ◽

pp. 256-256

Author(s):

P RENTON

Keyword(s):

Pelvic Ring ◽

Radiographic Diagnosis ◽

Pelvic Ring Fractures

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Insufficiency Fractures vs. Low-Energy Pelvic Ring Fractures – Epidemiological, Diagnostic and Therapeutic Characteristics of Fragility Fractures of the Pelvic Ring

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1394-6502 ◽

2021 ◽

Author(s):

Manuel Sterneder ◽

Patricia Lang ◽

Hans-Joachim Riesner ◽

Carsten Hackenbroch ◽

Benedikt Friemert ◽

...

Keyword(s):

Pelvic Ring ◽

Diagnostic Testing ◽

Insufficiency Fracture ◽

Fragility Fractures ◽

Relative Increase ◽

Trauma Centre ◽

Low Energy ◽

Insufficiency Fractures ◽

Type Iv ◽

Pelvic Ring Fractures

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP.

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Low-Energy Pelvic Ring Fractures: A Care Conundrum

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320985406 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098540

Author(s):

Bailey R. Abernathy ◽

Lisa K. Schroder ◽

Deborah C. Bohn ◽

Julie A. Switzer

Keyword(s):

Acute Care ◽

Patient Population ◽

Pelvic Ring ◽

Fracture Prevention ◽

Low Energy ◽

Care Pathways ◽

Secondary Fracture ◽

Secondary Fracture Prevention ◽

Pelvic Ring Fractures ◽

Rehabilitative Care

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

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