Intraoperative Imaging in Pelvic Surgery

2018 ◽  
Vol 157 (04) ◽  
pp. 367-377 ◽  
Author(s):  
Holger Keil ◽  
Sara Aytac ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Intraoperative Imaging ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
Posterior Pelvic Ring ◽  
Data Set ◽  
Intraoperative 3D Imaging ◽  
Pelvic Injuries ◽  
Preoperative Ct

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

scholarly journals Surgical treatment of the unstable type C pelvic injury

2013 ◽  
Vol 60 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Jordan Saveski ◽  
Ivan Micic ◽  
Milan Mitkovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries ◽  
Ring Complex ◽  
Type C ◽  
Stable Internal Fixation

Rotationally and vertically unstable injuries to the pelvic ring (Type C) require stabilisation of the anterior and posterior pelvic ring complex. Inadequate treatment of these injuries leads to chronic instability of the pelvic ring, which can finally cause permanent disability. Open reduction and stable internal fixation of the anterior and posterior complex of unstable pelvic ring injuries are standard procedures in the treatment of hemodynamically stable patients with (Type C) pelvic injuries. Our aim is to show that this type of treatment achieves excellent and good results. All patients were operated on using the method of open reduction and anterior plate fixation of sacroiliac complex as well as fixation of the pubic symphisis. We present a retrospective study of the results concerning the treatment of 19 patients with (Type C ) unstable pelvic injuries. The average age of the patients was 43,21 years old. The final functional results, 2 years post-surgery according to the Majeed scoring system and the results were excellent in 11 (57.89%) and good in 8 (42.1%) patients. There were no bad results to report. Type C pelvic ring injuries are unstable and unless they are adequately treated, they can lead to permanent consequences. Surgical treatment that includes open reduction and stable internal fixation of the anterior and posterior pelvic ring complex leads to excellent and good results. The patients that were treated surgically by fixation of the anterior and posterior pelvic ring complex return to their everyday lives and work activities.

scholarly journals Use of Cannulated Screws in Pelvic Injury Surgery

2016 ◽  
pp. 25-34
Author(s):  
A. V. Bondarenko ◽  
I. V. Kruglykhin ◽  
A. N. Voitenko
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Surgical Techniques ◽  
Pelvic Injury ◽  
Acetabular Fractures ◽  
Treatment Technique ◽  
Cannulated Screws ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries ◽  
Osteosynthesis Techniques

Osteosynthesis with cannulated screws is one of low invasive osteosynthesis techniques that does not aggravate the condition of polytraumatized patients and can be used at the early stages of treatment. The purpose of the study was to determine the peculiarities of cannulated screws application in pelvic ring and acetabular injuries. Cannulated screws were used at surgical treatment of 368 patients, aged 14–77 years, with pelvic injuries. The overwhelming majority of patients were with severe polytrauma (17 and more points by ISS score). Pelvic ring injuries (61st segment) were diagnosed in 259 (70.4%) patients, acetabular fractures (62nd segment) — in 75 (20.4%), pelvic ring injuries associated with acetabular fractures (61st and 62nd segments) — 34 (9.2%) patients. The screws were mainly used as the basic treatment technique, rarely — in combination with internal plate osteosynthesis and more rarely — in combination with external fixation device. Analysis of the results and complications was performed. Treatment results by Majeed pelvic score at terms 1 to 3 years were studied in 207 patients. Poor results were observed in 15 (7.2%) cases. Pelvic fracture osteosynthesis with cannulated screws has a number of advantages and can be referred to as one of the basic surgical techniques for pelvic fractures.

scholarly journals Comparison of Biomechanical Performance of Five Different Treatment Approaches for Fixing Posterior Pelvic Ring Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yongtao Lu ◽  
Yiqian He ◽  
Weiteng Li ◽  
Zhuoyue Yang ◽  
Ruifei Peng ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Plate Fixation ◽  
Fixation Method ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Triangular Osteosynthesis ◽  
Pelvic Injuries ◽  
Posterior Pelvic Ring Injury

Background. A large number of pelvic injuries are seriously unstable, with mortality rates reaching 19%. Approximately 60% of pelvic injuries are related to the posterior pelvic ring. However, the selection of a fixation method for a posterior pelvic ring injury remains a challenging problem for orthopedic surgeons. The aim of the present study is to investigate the biomechanical performance of five different fixation approaches for posterior pelvic ring injury and thus provide guidance on the choice of treatment approach in a clinical setting. Methods. A finite element (FE) model, including the L3-L5 lumbar vertebrae, sacrum, and full pelvis, was created from CT images of a healthy adult. Tile B and Tile C types of pelvic fractures were created in the model. Five different fixation methods for fixing the posterior ring injury (PRI) were simulated: TA1 (conservative treatment), TA2 (S1 screw fixation), TA3 (S1 + S2 screw fixation), TA4 (plate fixation), and TA5 (modified triangular osteosynthesis). Based on the fixation status (fixed or nonfixed) of the anterior ring and the fixation method for PRI, 20 different FE models were created. An upright standing loading scenario was simulated, and the resultant displacements at the sacroiliac joint were compared between different models. Results. When TA5 was applied, the resultant displacements at the sacroiliac joint were the smallest (1.5 mm, 1.6 mm, 1.6 mm, and 1.7 mm) for all the injury cases. The displacements induced by TA3 and TA2 were similar to those induced by TA5. TA4 led to larger displacements at the sacroiliac joint (2.3 mm, 2.4 mm, 4.8 mm, and 4.9 mm), and TA1 was the worst case (3.1 mm, 3.2 mm, 6.3 mm, and 6.5 mm). Conclusions. The best internal fixation method for PRI is the triangular osteosynthesis approach (TA5), followed by S1 + S2 screw fixation (TA3), S1 screw fixation (TA2), and plate fixation (TA4).

scholarly journals Emergent Stabilization of Pelvic Bones Fractures in Polytrauma

2014 ◽  
pp. 19-25 ◽  
Author(s):  
E. A. Litvina
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Damage Control ◽  
Pelvic Injury ◽  
Treatment Concept ◽  
Concomitant Injuries ◽  
Surgical Interventions ◽  
Acute Period ◽  
Pelvic Injuries ◽  
Modern Treatment

Principle aspects of the management of patients with concomitant pelvic injury and injuries of other localization from the standpoint of modern treatment concept Damage control are discussed. Special attention are paid to the techniques for pelvic ring fixation, arrest of intrapelvic hemorrhage, sequence of surgical interventions depending on the pattern of concomitant injuries. The necessity of emergent pelvic injuries fixation with external devices as well as the fractures of other localization in the acute period until stabilization of patient’s general condition is substantiated

scholarly journals Preoperative CT Simulation of Iliosacral Screws for Treating Unstable Posterior Pelvic Ring Injury

2021 ◽  
Author(s):  
Peishuai Zhao ◽  
Xiaopan Wang ◽  
Xiaotian Chen ◽  
Jianzhong Guan ◽  
Min Wu
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Pelvic Ring ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Iliosacral Screws ◽  
Preoperative Ct ◽  
Ct Simulation ◽  
Posterior Pelvic Ring Injury

Abstract BackgroundPercutaneous iliosacral screw placement is an important surgical method for the treatment of pelvic unstable fractures, but either intraoperative X-ray screws or navigational screws may be misplaced. This study aimed to demonstrate a safe, effective, and rapid medthod for placing iliosacral screws for the treatment of unstable posterior pelvic ring injury according to preoperative computed tomography (CT) planning using simulated screws. MethodsAfter preoperative CT simulation of iliosacral screws planning screw insertion point and trajectory, intraoperative percutaneous iliosacral screws were used to treat unstable pelvic posterior ring injury.The mechanism of injury, Tile classification, number of screw implants, operative time of each screw implantation, radiation exposure time of each screw implantation screw position, complications, and postoperative follow-up time were collected.Screw position grading was evaluated by Smith grading. ResultsA total of 24 screws were implanted in 21 patients (9 men and 12 women;mean age 41.3 years:range 14-71 years). Tile classification included:Tile B:15 patients;Tile C:6 patients. The mean placement time of each screw was 19.5 minutes (range 14-32min); Radiation exposure time: 0.6 min (range 0.5-0.9min); Two screws were inserted in 3 patients; One screw was inserted in 18 patients; According to Smith grading standard, grade0:20 cases; and Grade1:1 case; Mean postoperative follow-up time was 17.1months (range12-25 months); None of the patients showed nonunion. ConclusionsPreoperative CT simulation of iliosacral screws for placement planning, screw trajectory, and intraoperative placement of screws is a safe method that can be used to reduce surgical time, radiation exposure, and accurate screw placement.

scholarly journals Emergent Stabilization of Pelvic Bones Fractures in Polytrauma

2014 ◽  
Vol 21 (1) ◽  
pp. 19-25
Author(s):  
E. A Litvina
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Damage Control ◽  
Pelvic Injury ◽  
Treatment Concept ◽  
Concomitant Injuries ◽  
Surgical Interventions ◽  
Acute Period ◽  
Pelvic Injuries ◽  
Modern Treatment

Principle aspects of the management of patients with concomitant pelvic injury and injuries of other localization from the standpoint of modern treatment concept Damage control are discussed. Special attention are paid to the techniques for pelvic ring fixation, arrest of intrapelvic hemorrhage, sequence of surgical interventions depending on the pattern of concomitant injuries. The necessity of emergent pelvic injuries fixation with external devices as well as the fractures of other localization in the acute period until stabilization of patient’s general condition is substantiated

scholarly journals A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 40
Author(s):  
Franz Müller ◽  
Bernd Füchtmeier
Keyword(s):  
Clinical Studies ◽  
Pelvic Ring ◽  
Randomized Study ◽  
Case Series ◽  
Operation Time ◽  
Fragility Fractures ◽  
Internal Fixator ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries

Objective: To summarize the literature on transiliac internal fixator (TIFI) indications and outcomes for treating posterior pelvic ring injuries. Methods: We searched databases for original publications in journals. Biomechanical and clinical studies using a TIFI for posterior pelvic ring injuries were considered for inclusion. The dates of publications that were included ranged from January 2000 until December 2020. Results: A total of 13 articles were reviewed, including eight clinical studies and five biomechanical tests. We found only case series and no multicenter or randomized study. The clinical studies contained data for a total of 186 cases, including indications, treatments, complications, and outcomes, with a minimum follow-up time of 12 months. All studies reported superior results according to operation time, blood loss, complication, dislocation, and union. One biomechanical test evaluated inferior results. Conclusions: The TIFI is a user-friendly and safe device to treat posterior pelvic injuries. It can also be used for acute, high-impact injuries, and fragility fractures. Nevertheless, there is no evidence concerning which types of pelvic fractures are most beneficial. Therefore, further biomechanical and clinical studies are necessary to resolve this question.

scholarly journals Computer and magnetic resonance imaging for pelvic fractures in children

2021 ◽  
Vol 25 (4) ◽  
pp. 122-133
Author(s):  
N. Yu. Serova ◽  
T. A. Akhadov ◽  
O. V. Karaseva ◽  
I. A. Mel'nikov ◽  
O. V. Bozhko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Road Traffic ◽  
Bone Fractures ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Acetabular Fractures ◽  
Bone Lesions ◽  
Posterior Pelvic Ring ◽  
Fractures In Children

Introduction. Fractures of pelvic bones in children are rare and make up from 0.3 to 4% of all childhood trauma, 20% of children with polytrauma have pelvic ring injuries. Comparative studies of diagnostic capabilities of MRI and CT in sacral and acetabular fractures showed that about 37% of CT were missed, therefore the authors recommended MRI as the best method in visualizing pelvic fractures.Aim of this study is to show the capabilities of CT and MRI to improve recognition of pelvic fractures.Material and methods. In the period 2010–2019, 790 children with pelvic fractures as part of polytrauma were studied. The age of children was from 8.5 to 17 years, average 10.14 ± 1.4. Computed tomography with three-phase contrast was performed in all 790 patients on Brilliance 16 scanners. MRI was performed (n = 63) on a 3 T tomograph with obtaining multiplanar STIR, T1-, T2- and PD weighted images (VI) with signal suppression factor of adipose tissue, as well as 3D isotropic images.Results. On the polytrauma severity scale (ISS), the assessment of the condition of 790 children ranged from 23.54 to 27.5 (mean 25.77) points. The main mechanism of pelvic injury was road traffic accidents (pedestrian + passenger – 63.54% (n = 502), catatrauma was in second place – 32.66% (n = 258), followed by compression – 2.15% (n = 17) , sports injury – 0.38% (n = 3), other injury – 3.43% (n = 27). 73.26% (n = 578) had multiple pelvic fractures, 20.5% (n = 162) – complicated, – 22.3% (n = 176) unstable In 63 patients with damage to the anterior pelvic ring, according to CT, MRI revealed fractures of the posterior pelvic ring in 79.36% (n = 50).Conclusion. Children with polytrauma must undergo computed tomography to exclude not only all non-muscular-skeletal injuries, but also combined pelvic fractures. We believe that for the detection and assessment of bone fractures and concomitant injuries of other tissues and organs of the pelvis, in most cases, multiphase CT with intravenous contrast is a sufficient method. MRI is important for evaluating pelvic soft tissue structures such as tendons, ligaments, nerves and fascia, as well as detecting hidden / fine bone lesions.

scholarly journals Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

2021 ◽  
Vol 28 ◽  
pp. 221049172110068
Author(s):  
Jeffrey M Henstenburg ◽  
Joseph A Larwa ◽  
Christine S Williams ◽  
Mitesh P Shah ◽  
Susan P Harding
Keyword(s):  
Risk Factors ◽  
Pelvic Ring ◽  
Smoking Status ◽  
Infection Risk ◽  
Acetabular Fractures ◽  
Ilioinguinal Approach ◽  
Pelvic Injuries ◽  
Urban Level ◽  
Operative Fixation ◽  
Level 1 Trauma Center

Background: Pelvic ring and acetabular fractures are some of the most morbid in orthopedic trauma. They commonly require large exposures for fixation and are associated with significant morbidity and mortality. This study attempts to identify risk factors for complications following operative fixation of pelvic injuries. Methods: 126 patients treated for pelvic injuries were reviewed retrospectively. Demographics, procedure characteristics, and outcomes were recorded. Variables associated with complications were analyzed using logistic regression analysis. Results: Complications occurred in 12 patients. Higher BMI, longer length of stay, and ilioinguinal approach were significantly associated with increased infection risk. Co-morbid heart disease and concurrent smoking status showed a trend for increased infection risk. Higher BMI and ilioinguinal approach were significantly associated with an increased likelihood of re-operation. Positive psychiatric history and Medicaid payer status showed a trend toward higher reoperation risk. Conclusion: Knowledge of these risk factors can help guide management and predict outcomes following pelvic fracture fixation.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

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