Improvement of External Fixator Performance in Type C Pelvic Ring Injuries by Plating of the Pubic Symphysis: An Experimental Study on 12 External Fixators

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.

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Width of pubic symphysis relating to age and sex in Koreans

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02561-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kun Hwang ◽

Xiajing Wu ◽

Chan Yong Park

Keyword(s):

Pelvic Ring ◽

Pubic Symphysis ◽

Posterior Border ◽

Anterior Border ◽

Pelvic Ring Injuries ◽

Axial Ct ◽

Few Data ◽

Pelvic Malunion ◽

Age And Sex

Abstract Introduction Diastasis of the pubic symphysis has been reported to occur in 13–16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans. Methods Width of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females). Results In supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003). Conclusion Pelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.

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Radiostereometric Analysis Allows Assessment of the Stability and Inducible Displacement of Pelvic Ring Disruptions during Healing: A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9113411 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3411

Author(s):

Andreas Ladurner ◽

Stuart A. Callary ◽

Aniruddha Mitra ◽

Mark Rickman ◽

Dominic Thewlis ◽

...

Keyword(s):

Pelvic Ring ◽

Weight Bearing ◽

Case Series ◽

External Fixators ◽

Radiostereometric Analysis ◽

Plain Radiographs ◽

Pelvic Ring Injuries ◽

The Stability ◽

Fracture Stability ◽

Over Time

There is currently no accurate data on fracture displacement during the rehabilitation of pelvic ring injuries. This study investigated the use of radiostereometric analysis (RSA) in assessing the stability of C1 pelvic ring injuries stabilised with a posterior plate and an anterior external fixator. Six patients, instructed to weight-bear as tolerated after surgery, were reviewed at 2, 4, 6, 12, 26, 52 and 104 weeks. The external fixators were removed at 6 weeks. Outcomes, including the Iowa Pelvic Score (IPS), and complications were recorded. Fracture stability was assessed using measurements on plain radiographs and RSA. All patients progressed to full weight-bearing without support within 6 weeks. At 104 weeks, the IPS was excellent in four patients, good in one patient and fair in one patient. Plain radiographs showed that all fractures were well reduced, and no loss of reduction occurred over time. By contrast, RSA measurements identified displacement in all cases. The maximum three-dimensional (3D) displacement at any time point in each patient ranged from 2 to 10 mm. Two patients with the largest displacement over time had the lowest IPS. RSA also demonstrated displacements above the currently defined normal threshold through the ‘un-injured’ sacroiliac joint in the same two patients, suggesting a subtle C2 injury, missed at initial assessment. This study demonstrates the limitations of plain radiographs in assessing pelvic fracture stability and displacement during healing, and the potential of RSA to monitor more accurately the effects of stabilisation and weight-bearing on fracture stability.

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Supplemental S1 fixation for type C pelvic ring injuries: biomechanical study of a long iliosacral versus a transsacral screw

Journal of Orthopaedics and Traumatology ◽

10.1007/s10195-015-0357-8 ◽

2015 ◽

Vol 16 (4) ◽

pp. 293-300 ◽

Cited By ~ 9

Author(s):

Pooria Salari ◽

Berton R. Moed ◽

J. Gary Bledsoe

Keyword(s):

Pelvic Ring ◽

Biomechanical Study ◽

Pelvic Ring Injuries ◽

Type C

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Surgical treatment of unstable pelvic ring injuries

Medicinski pregled ◽

10.2298/mpns16s1011h ◽

2016 ◽

Vol 69 (suppl. 1) ◽

pp. 11-14

Author(s):

Vladimir Harhaji ◽

Srdjan Ninkovic ◽

Predrag Rasovic ◽

Ivica Lalic ◽

Merhan Salabat ◽

...

Keyword(s):

Pelvic Ring ◽

Multiple Organ ◽

Common Mechanism ◽

Leg Length ◽

Pelvic Ring Injuries ◽

Fall From Height ◽

Type C ◽

Serious Injuries ◽

Unstable Pelvic Ring Injuries

Introduction. Unstable pelvic ring injuries are among the most serious injuries of skeletal system. As they are often associated with young age and multiple organ injuries they are difficult for management. Material and Methods. This study included 26 unstable pelvic ring injuries surgically treated at the Department of Orthopedic Surgery and Traumatology from August 2008 until August 2015. The average age of 22 males and 4 female patients was 45.4 years. The most common mechanism for injury was a traffic accident (19), fall from height (6), and one patient was buried under rubble. Out of 26 patients who were operated, 24 had type C injury and two had type B injury according to Tiles classification. The average follow-up time was 23 months (8 - 84 months). The functional outcome was assessed by means of Majeed and Iowa Pelvic Score. Results. Pelvic ring injuries were healed in all 26 patients. A leg length discrepancy was found in 13 patients and it was 9 mm on average. Four patients reported using walking stick, and 5 out of 26 had sexual dysfunction. Majeed score was 72.1 on average (23 to 100), and Iowa Pelvic Score was 76.5 (38 to 100). Conclusion. Unstable pelvic ring injuries are difficult to be surgically treated. When these injuries are treated adequately and timely, good results can be expected. Average scores achieved by our patients are very good for both scales.

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Mobilization versus displacement on lateral stress radiographs for determining operative fixation of minimally displaced lateral compression type I (LC1) pelvic ring injuries

International Orthopaedics ◽

10.1007/s00264-020-04912-3 ◽

2021 ◽

Author(s):

Joshua A. Parry ◽

Motasem Salameh ◽

August Funk ◽

Austin Heare ◽

Stephen C. Stacey ◽

...

Keyword(s):

Pelvic Ring ◽

Type I ◽

Lateral Stress ◽

Lateral Compression ◽

Stress Radiographs ◽

Pelvic Ring Injuries ◽

Operative Fixation ◽

Compression Type

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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

International Orthopaedics ◽

10.1007/s00264-021-05153-8 ◽

2021 ◽

Author(s):

Giuseppe Rovere ◽

Andrea Perna ◽

Luigi Meccariello ◽

Domenico De Mauro ◽

Alessandro Smimmo ◽

...

Keyword(s):

Sexual Dysfunction ◽

Sexual Function ◽

Pelvic Fracture ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Sexual Dysfunctions ◽

Fracture Type ◽

Ring Fracture ◽

Male And Female ◽

Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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