‘Within Ring’ Concept Treatment for Displaced H-Shaped Type IVb Fragility Fractures of the Pelvis

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

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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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Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable anterior pelvic ring fracture: a retrospective study and finite element analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02618-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhi-Hong Pan ◽

Fan-Cheng Chen ◽

Jun-Ming Huang ◽

Cheng-Yi Sun ◽

Sheng-Long Ding

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Pedicle Screw ◽

Lower Risk ◽

Pelvic Ring ◽

Grading System ◽

Element Analysis ◽

Pelvic Fixation ◽

Pelvic Ring Fractures ◽

Fixation Stability

Abstract Objectives This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures using the Tornetta and Matta grading system and finite element analyses (FEA). Methods In a retrospective review of a consecutive patient series, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n = 30) or INFIX (n = 33). The main outcome measures were the Majeed score, incidence of complications, and adverse outcomes, and fixation stability as evaluated by finite element analysis. Results Sixty-three patients were included in the study, with an average age of 34.4 and 36.2 in modified group and conventional group, respectively. Two groups did not differ in terms of the injury severity score, OTA classification, cause of injury, and time to pelvic surgery. However, the MPSRF group had a rate of higher satisfactory results according to the Tornetta and Matta grading system than the conventional group (73.33% vs 63.63%) as well as a higher Majeed score (81.5 ± 10.4 vs 76.3 ± 11.2), and these differences were statistically significant at 6 months post-surgery. FEA showed that MPSRF was stiffer and more stable than INFIX and had a lower risk of implant failure. Conclusions Both MPSRF and INFIX provide acceptable biomechanical stability for the treatment of unstable anterior pelvic ring fractures. However, MPSRF provides better fixation stability and a lower risk of implant failure, and can thus lead to better clinical outcomes. Therefore, MPSRF should be more widely applied to anterior pelvic ring fractures

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High energy pelvic ring fractures, an overview over the past decade

Revue de Chirurgie Orthopédique et Traumatologique ◽

10.1016/j.rcot.2016.08.057 ◽

2016 ◽

Vol 102 (7) ◽

pp. S97-S98

Author(s):

Sara Machado ◽

Luís Vieira ◽

Rui Pinto ◽

Isabel Pinto ◽

Paulo Ribeiro De Oliveira ◽

...

Keyword(s):

Pelvic Ring ◽

High Energy ◽

The Past ◽

Pelvic Ring Fractures

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Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1192-7583 ◽

2020 ◽

Author(s):

Patricia Lang ◽

Manuel Sterneder ◽

Hans-Joachim Riesner ◽

Carsten Hackenbroch ◽

Benedikt Friemert ◽

...

Keyword(s):

Pelvic Ring ◽

Fragility Fractures ◽

Diagnostic Procedures ◽

Fracture Morphology ◽

Therapy Regimen ◽

Therapeutic Consequences ◽

Pelvic Ring Fractures ◽

Clear Change ◽

Choice Of Therapy

Abstract Introduction The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options – sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) – has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. Materials and Methods We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. Results The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 – 2009: 5.3% vs. 2015 – 2017: 60.3%). Conclusion We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

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Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring

Journal of Clinical Medicine ◽

10.3390/jcm10112326 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2326

Author(s):

Moritz F. Lodde ◽

J. Christoph Katthagen ◽

Clemens O. Schopper ◽

Ivan Zderic ◽

Geoff Richards ◽

...

Keyword(s):

External Fixator ◽

Motion Tracking ◽

Pelvic Ring ◽

Plate Fixation ◽

Treatment Options ◽

Fragility Fractures ◽

Study Groups ◽

Axial Stiffness ◽

Pelvic Ring Fractures ◽

Fixation Techniques

Background: Incidence of pelvic ring fractures has increased over the past four decades, especially after low-impact trauma—classified as fragility fractures of the pelvis (FFP). To date, there is a lack of biomechanical evidence for the superiority of one existing fixation techniques over another. An FFP type IIc was simulated in 50 artificial pelvises, assigned to 5 study groups: Sacroiliac (SI) screw, SI screw plus supra-acetabular external fixator, SI screw plus plate, SI screw plus retrograde transpubic screw, or S1/S2 ala–ilium screws. The specimens were tested under progressively increasing cyclic loading. Axial stiffness and cycles to failure were analysed. Displacement at the fracture sites was evaluated, having been continuously captured via motion tracking. Results: Fixation with SI screw plus plate and SI screw plus retrograde transpubic screw led to higher stability than the other tested techniques. The S1/S2 ala–ilium screws were more stable than the SI screw or the SI screw plus external fixator. Conclusions: In cases with displaced fractures, open reduction and plate fixation provides the highest stability, whereas in cases where minimally invasive techniques are applicable, a retrograde transpubic screw or S1/S2 ala–ilium screws can be considered as successful alternative treatment options.

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Routine Postoperative CT scans following Posterior Pelvic Fixation of Pelvic Ring Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000002341 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

David M Thompson ◽

A Gianni Ricci ◽

John CP Floyd ◽

Achraf H Jardaly ◽

Bruce H Ziran ◽

...

Keyword(s):

Pelvic Ring ◽

Ct Scans ◽

Pelvic Fixation ◽

Pelvic Ring Fractures

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Modified pedicle screw-rod versus anterior subcutaneous internal pelvic fixation for unstable pelvic anterior ring fracture: A retrospective study and finite element analysis

10.21203/rs.3.rs-16488/v1 ◽

2020 ◽

Author(s):

Sheng-Long Ding ◽

Fan-Cheng Chen ◽

Jun-Ming Huang ◽

Guang-Ming Zhang ◽

Fu-Yong Wang ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Pedicle Screw ◽

Lower Risk ◽

Pelvic Ring ◽

Element Analysis ◽

Pelvic Fixation ◽

Pelvic Ring Fractures ◽

Fixation Stability ◽

Anterior Ring

Abstract Objectives: This study compared the stability and clinical outcomes of modified pedicle screw-rod fixation (MPSRF) and anterior subcutaneous internal pelvic fixation (INFIX) for the treatment of anterior pelvic ring fractures. Methods: In a retrospective review of a consecutive patient series conducted in a level 1 trauma university hospital, 63 patients with Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B or C pelvic ring fractures were treated by MPRSF (n=30) or INFIX (n=33). The mean follow-up was 20 months. The main outcome measure was the incidence of complications and adverse outcomes, and fixation stability was evaluated by finite element analysis (FEA). Results: The 2 groups did not differ in terms of injury severity score, OTA classification, cause of injury, and time to pelvic surgery (P>0.05). However, the MPSRF group had a higher satisfactory rate according to the Tornetta and Matta grading system than the INFIX group (73.33% vs 63.63%) as well as a higher Majeed score (81.5±10.4 vs 76.3±11.2), which was statistically significant at 6 months’ post-surgery (P<0.001). FEA showed that MPRSF was stiffer and more stable than INFIX and had a lower risk of implant failure. Conclusions: Both MPSRF and INFIX have acceptable biomechanical stability for the treatment of unstable pelvic anterior ring fractures. However, MPRSF has better fixation stability and lower risk of implant failure, which can lead to better clinical outcomes.

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A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04925-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Katharina Jäckle ◽

Marc-Pascal Meier ◽

Mark-Tilmann Seitz ◽

Sebastian Höller ◽

Christopher Spering ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Functional Outcome ◽

Pelvic Ring ◽

Fragility Fractures ◽

Well Being ◽

Posterior Pelvic Ring ◽

Pelvic Ring Fractures ◽

Sf 36

Abstract Background Fragility fractures without significant trauma of the pelvic ring in older patients were often treated conservatively. An alternative treatment is surgery involving percutaneous screw fixation to stabilize the posterior pelvic ring. This surgical treatment enables patients to be mobilized quickly and complications associated with bedrest and temporary immobility are reduced. However, the functional outcome following surgery and quality of life of the patients have not yet been investigated. Here, we present a comprehensive study addressing the long-term well-being and the quality of life of patients with fragility pelvic ring fractures after surgical treatment. Methods Between 2011–2019, 215 geriatric patients with pelvic ring fractures were surgically treated at the university hospital in Göttingen (Germany). Of these, 94 patients had fragility fractures for which complete sets of computer tomography (CT) and radiological images were available. Fractures were classified according to Tile and according to the FFP classification of Rommens and Hofmann. The functional outcome of surgical treatment was evaluated using the Majeed pelvic score and the Short Form Health Survey-36 (SF-36). Results Thirty five tile type C and 48 type B classified patients were included in the study. After surgery eighty-three patients scored in average 85.92 points (± 23.39) of a maximum of 100 points using the Majeed score questionnaire and a mean of 1.60 points on the numerical rating scale ranging between 0 and 10 points where 0 points refers to “no pain” and 10 means “strongest pain”. Also, the SF-36 survey shows that surgical treatment positively effects patients with respect to their general health status and by restoring vitality, reducing bodily pain and an increase of their general mental health. Conclusions Patients who received a percutaneous screw fixation of fragility fractures of the posterior pelvic ring reported an overall positive outcome concerning their long-term well-being. In particular, older patients appear to benefit from surgical treatment. Trial registration Functional outcome and quality of life after surgical treatment of fragility fractures of the posterior pelvic ring, DRKS00024768. Registered 8th March 2021 - Retrospectively registered. Trial registration number DRKS00024768.

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One sacroiliac screw for posterior ring fixation in unstable pelvic fractures

Acta Orthopaedica Belgica ◽

10.52628/87.3.04 ◽

2021 ◽

Vol 87 (3) ◽

pp. 411-418

Author(s):

Hossam Hosny ◽

Mohamed Ali Mohamed ◽

Moustafa Elsayed ◽

Ashraf Marzouk ◽

Wael Salama

Keyword(s):

Pelvic Ring ◽

High Energy ◽

High Rate ◽

Fixation Method ◽

Posterior Arch ◽

Consecutive Series ◽

Unstable Fracture ◽

Anterior Arch ◽

Sacroiliac Screw

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.

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Emergency and Trauma of the Pelvic Ring

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0037-1602409 ◽

2017 ◽

Vol 21 (03) ◽

pp. 210-217 ◽

Cited By ~ 3

Author(s):

Victor Cassar-Pullicino ◽

Miguel Pérez ◽

Giuseppe Guglielmi ◽

Antonio Leone

Keyword(s):

Pelvic Ring ◽

Three Dimensional ◽

High Energy ◽

High Rate ◽

Pelvic Ring Injuries ◽

Pelvic Ring Fractures ◽

Appropriate Treatment ◽

Initial Identification ◽

Vascular Structures ◽

Pelvic Viscera

Pelvic ring fractures are a common consequence of high-energy blunt trauma with a high rate of morbidity and mortality due to associated injuries, especially to the head, pelvic viscera, and vascular structures. The Young and Burgess classification system is the most widely utilized for categorizing pelvic ring injuries and assessing stability. The initial identification of these injuries often comes from an anteroposterior radiograph; however, computed tomography examination with three-dimensional volume-rendered reconstructions represents the reference standard and has essentially eliminated the requirement for inlet and outlet views. The appropriate treatment depends on a good knowledge of the anatomy and biomechanics of the pelvis. This review article underlines the importance of the integrity of ligaments to pelvic stability and describes the patterns of pelvic ring injuries and their associated mechanisms of injury.

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