Management of Complex Pelvic Fracture with Associated Both Column Acetabular Fracture Judet-Letournel Type and a Coccygeal Fracture in a Severe Polytrauma Patient

Comprehensive emergency managements and early stabilization are pivotal upon treating complex pelvic and acetabular fractures. A thorough operative strategy is required to determine the best operative approach based on the patient’s general condition, available facilities, and surgeon preferences in such complex fracture configuration. Advanced technique of the fixation is necessary during a skillful execution of surgery in order to achieve good treatment results. An 18-years-old female crushed by a bus upon crossing street, presented with hypovolemic shock with ISS polytrauma score 50 consisting of right acetabular associated both column fracture, bilateral pelvic fracture anteroposterior compression type 3, and coccygeal fracture with bilateral drop foot. She underwent emergency laparotomy, had her ovary, bladder, and intestine primarily sutured, and then we immobilized the pelvic using anterior frame external fixator, which was maintained for 6 days. Upon stable condition, we performed right ilioinguinal approach and modified Stoppa with lateral window for the left side, while Kocher-Langenbeck technique was used to approach the posterior acetabular column. Postoperative radiology showed an adequate internal fixation in both right acetabular columns, successful reconstruction of pelvic ring which was fixated the left ischium, left superior and inferior pubic rami, and full restoration of left sacroiliac joint disruption. Majeed pelvic outcome score was 54, while Hannover pelvic outcome score was good and the patient was able to sit without pain 2 months postoperative. Management of complex pelvic-acetabular-coccygeal fracture requires a holistic chain of treatment by emphasizing the prompt emergency management, accurate preoperative planning, and excellent execution of reconstructive surgical strategy to achieve satisfactory outcome.

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Results of Modified Ilioinguinal Approach in Management of Acetabular and Pelvic Fractures (A Systematic Review and meta-analysis of Literature)

QJM ◽

10.1093/qjmed/hcaa059.004 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H A Fahmy ◽

A M Sallam ◽

M M A Abdelsamad

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Clinical Outcome ◽

Outcome Assessment ◽

Pelvic Ring ◽

Meta Analysis ◽

Acetabular Fractures ◽

Ilioinguinal Approach ◽

Pelvic Ring Fractures ◽

Satisfactory Outcome

Abstract Background Modified ilioinguinal approach was introduced to manage anterior acetabular fractures to reduce the morbidity & complications of the classic ilioinguinal approach, a less invasive anterior approach consisting of a medial window combined with the lateral window of the ilioinguinal approach. Aim of the Work a systematic review to determine whether the modified ilioinguinal approach is better the classic ilioinguinal approach in managing traumatic acetabular fractures by comparing the results in each study. Materials and Methods 5 studies(from 2010-2017) were included & reviewed the results of 147 patients operated by modified ilioinguinal approach in terms of: operative details, intraoperative & postoperative complications, postoperative reduction quality & final clinical outcome assessment, & results was analyzed & pooled together to reach a satisfactory outcome. Results Modified ilioinguinal approach showed operative time (123.2±6.83 minute), relatively small amount of blood loss (200-1000 ml) & better quality of reduction (84.8% had anatomical reduction, 10.9% had fair reduction, and 4.3% had poor reduction). However there were no significant differences in terms of postoperative complications & final clinical outcome assessment between different studies. Conclusion It was concluded that the modified ilioinguinal approach allowed reduction of anterior column and pelvic ring fractures without requiring dissection through the inguinal neurovascular structures. Results showed that its possible with this approach to reach safe reduction and stable fixation.

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Management of anteromedially displaced acetabular fractures using a collinear reduction clamp through modified ilioinguinal approach

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2018.10.004 ◽

2019 ◽

Vol 105 (5) ◽

pp. 889-893 ◽

Cited By ~ 2

Author(s):

Chul-Young Jang ◽

Dae-Kyung Kwak ◽

Hyung-Min Lee ◽

Ji-Hyo Hwang ◽

Je-Hyun Yoo

Keyword(s):

Acetabular Fractures ◽

Ilioinguinal Approach

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Operative Treatment of Acetabular Fractures Through the Ilioinguinal Approach

Journal of Orthopaedic Trauma ◽

10.1097/01.bot.0000202389.40246.c0 ◽

2006 ◽

Vol 20 (1) ◽

pp. S20-S29 ◽

Cited By ~ 10

Author(s):

Joel M Matta

Keyword(s):

Operative Treatment ◽

Acetabular Fractures ◽

Ilioinguinal Approach

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88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital

Age and Ageing ◽

10.1093/ageing/afz193.03 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i28-i29

Author(s):

D van Berkel ◽

O Herschkovich ◽

R Taylor ◽

T Ong ◽

O Sahota

Keyword(s):

Older People ◽

Pelvic Fracture ◽

Plain Radiograph ◽

Fragility Fractures ◽

University Teaching ◽

Acetabular Fractures ◽

Sacral Fractures ◽

Pubic Rami ◽

Number Of Patients ◽

Pelvic Imaging

Abstract Introduction Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures. Methods Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018. Results 103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification. Conclusions Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.

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The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

Computational and Mathematical Methods in Medicine ◽

10.1155/2015/790575 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Jianyin Lei ◽

Yue Zhang ◽

Guiying Wu ◽

Zhihua Wang ◽

Xianhua Cai

Keyword(s):

Pelvic Fracture ◽

Pelvic Ring ◽

Stable Condition ◽

Pubic Symphysis ◽

Pelvic Bone ◽

Anterior Plate ◽

Fe Method ◽

Pubic Ramus ◽

Complex Fracture ◽

The Stability

This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.

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