scholarly journals Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
Ismail H. Dilogo ◽  
Jessica Fiolin
Keyword(s):  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Sacral Fracture ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Unstable Pelvic Fracture ◽  
Percutaneous Screws

Unstable pelvic ring fractures raise treatment challenges in severely injured patients. Beside patient survival, demanding surgical technique also required. Classic technique of internal fixation requires extensive surgical exposure that leads to most complications of the pelvic fractures fixation. Therefore less invasive technique is a reasonable alternative especially in unstable pelvic fracture with soft tissue injury or potential infection. Unfortunately in sacral dysmorphism pelvic injury or in complete vertical sacral fracture, we need S3 level insertion to improve stability of iliosacral (IS) screw in S1 or S2. Purpose of this study was to show feasibility technically inserting IS screw in S3 level. Methods: We reported 2 cases of unstable pelvic injury. First case was an 11 years old boy with Torode and Zieg IV or Marvin Tile C1 pelvic fracture with right sacroiliac joint disruption and soft tissue injuries of skin avulsion on the left hip and Morel-Lavallée lesion on the right hip. He was managed with early anatomic reduction and fixation with percutaneous screws on both pubic rami and IS screw (sacroiliac lag screw type) on S1 and S3. Second case was a 30 years old male with open pelvic fracture Faringer zone III type, Marvin Tile B2 or YoungBurgess LC I and also with vertical sacral fracture Denis zone 1. This polytrauma case had associated injuries includes Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence, and immunocompromised. The same minimal invasive management of pelvic fracture was performed in this case by inserting percutaneous screws on pubic rami and IS (sacral screw type) on S1 and S3. Functional outcome was evaluated using Majeed and Hannover pelvic scoring system. Results: All patients survived and considered to have good reduction, with no residual displacement on the sacroiliac joint. The former case, at 21-month follow up, present with excellent outcome (80 out of 80) by Majeed score and very good outcome (4 out of 4) by Hannover score; while the latter case, at 18-month follow up, present with poor outcome (50 out of 100) by Majeed score and fair outcome (2 out of 4) by Hannover score. Conclusion: Percutaneous screw fixation for pelvic ring injury is a less invasive alternative that can be used for early stabilization of unstable anterior and posterior pelvic fractures and provide stable internal fixation. IS screw is feasible to be inserted in S3 level either sacroiliac joint type or sacral screw type.

scholarly journals A STUDY ON SKELETALLY IMMATURE UNSTABLE PELVIC FRACTURES IN CHILDREN

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rakesh Kumar Gupta ◽  
Dr. Mohkam Singh
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Fractures In Children ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial traumas were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

The ‘nightstick’ ischial fracture: a unique oddity of the pelvic injury family

2021 ◽  
Vol 14 (2) ◽  
pp. e240874
Author(s):  
Matthew John Gillespie ◽  
Navnit S Makaram ◽  
Tim O White ◽  
Samuel G Molyneux
Keyword(s):  
Surgical Management ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Weight Bearing ◽  
Pelvic Injury ◽  
Fracture Classification ◽  
Posterior Compartment ◽  
Radiographic Outcomes ◽  
Displaced Fracture

We present an unusual ischial fracture unreported in the literature. We discuss the mechanism and describe the appropriate investigations and surgical management of this fracture. A 36-year-old man sustained a direct blow to his right buttock following a fall from a dirt bike. Examination revealed a firm haematoma, with severe pain on any stretch involving the posterior compartment of the thigh. Radiographs revealed a displaced fracture of the ischial body. CT confirmed integrity of the pelvic ring. The patient underwent open reduction and internal fixation with a partially threaded cannulated screw via a ‘modified longitudinal’ posterior approach to the ischium. The patient was managed partially weight-bearing for 6 weeks; 6-month follow-up confirmed satisfactory clinical and radiographic outcomes. Clinicians should be aware of this novel pelvic fracture and its unusual presentation, currently not included in any pelvic fracture classification system. We report a novel operative technique for appropriate surgical management of such injuries.

scholarly journals Loss of Ambulatory Independence Following Low-Energy Pelvic Ring Fractures

2019 ◽  
Vol 10 ◽  
pp. 215145931987810
Author(s):  
David N. Kugelman ◽  
Nina Fisher ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Assistive Devices ◽  
Low Energy ◽  
Pelvic Ring Fractures ◽  
Long Term Follow Up

Introduction: Lateral compression type 1 (LC1) pelvic ring fractures make up 63% of all pelvic ring injuries. This fracture pattern is typically seen in older patients. The purpose of this study is to assess the ambulatory status of individuals sustaining LC1 fractures at long-term follow-up and what specific characteristics, if any, effect this status or functional outcomes. Methods: Over a 2-year period, all pelvic ring injury at 2 hospitals within one academic institution was queried. One hundred sixty-one low-energy LC1 pelvic fractures were identified. Results: Fifty patients were available for long-term outcomes (mean: 36 months). Long-term functional outcomes (mean follow-up: 36 months) as measured by SMFA subgroup scores were demonstrated to be 3 times higher in patients currently using assistive devices for walking ( P = .012). Increased age ( P = .050) was associated with the continued use of assistive walking devices. Of the patients who did not use an ambulatory device prior to LC1 injury, 5 (11.6%) sustained a fall or medical complication within 30 days of the index pelvic fracture; this was associated with the current use of an assistive ambulatory device ( P = .010). Forty-three (86%) patients didn’t use an assistive ambulatory device prior to sustaining the LC1 fracture. Seven (14%) patients utilized assistive devices both before and after the LC1 injury. Thirteen (26%) patients, who did not utilize assistive ambulatory devices prior to their injury, necessitated them at long-term follow-up. Discussion: Surgeons should be aware of these associations, as they can implement early interventions aimed at patients at risk, for assistive device use, following LC1 pelvic fractures. Conclusion: More than a quarter of the patients sustaining an LC1 pelvic fracture continue to use an aid for ambulation at long-term follow-up. Older age, complications, and falls within 30 days of this injury are associated with the utilization of an assistive ambulatory device.

scholarly journals STUDY OF CLINICOPATHOLOGIC PROFILES OF PATIENTS WITH BENIGN BREAST DISEASE

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rameshwar Dayal Goyal ◽  
Dr. Akhlesh Kumar Srivastava
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Motor Vehicle ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial trauma were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

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

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.

scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Posterior Pelvic Ring ◽  
Sf 36 ◽  
One Year ◽  
Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

scholarly journals Non-Traumatic Tile Type B3 Pelvic Fracture Combined With Garden Type III Femoral Neck Fracture Caused By Hypocalcaemia-Induced Convulsions

2021 ◽  
Author(s):  
Minghan Dou ◽  
Guangkai Ren ◽  
Baoming Yuan ◽  
Chuangang Peng ◽  
Dankai Wu
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Pelvic Fracture ◽  
Pelvic Fractures ◽  
Maintenance Hemodialysis ◽  
Tile Type ◽  
Conventional Radiograph ◽  
Type Iii ◽  
Neck Fracture

Abstract BACKGROUND Non-traumatic fractures caused by convulsions are relatively rare and are often overlooked due to the lack of obvious evidence of injury. Non-traumatic fractures due to convulsions are diverse, but the concomitant of pelvic and femoral fractures has not been reported previously. CASE SUMMARY A 47-year-old woman with a no significant medical history, was taken to the nearest hospital after one episode of generalized tonic-clonic seizure that had occurred during sleep. After the postictal phase, the patient regained consciousness and experienced diffuse pain in the inguinal regions bilaterally with inability to stand or walk. The entire attack was witnessed by the family members who confirmed that there was not external trauma. Blood investigations revealed high creatinine and uric acid levels, along with a low calcium level. Conventional radiograph of the pelvis was performed to detect the cause of pain. The patient was noted to have a pelvic fracture and unilateral fracture of the neck of the femur. She was then transferred to our hospital for further management. The patient was diagnosed as having Tile type B3 pelvic fractures combined with a Garden type III femoral neck fracture on three-dimensional computed tomography (3D-CT). In view of her blood results, nephrology consultation was sought. The patient was identified as having a stage 5 chronic kidney disease (CKD), hypocalcemia, and hyperphosphatemia. However, neurological examination showed no abnormalities. No surgical intervention was adopted for her pelvic fractures. In addition to complete bed rest, closed reduction and percutaneous cannulated screw fixation was performed for the treatment of the right femoral neck fracture. An arteriovenous fistula was created for maintenance hemodialysis on the tenth postoperative day. At follow-up, twelve months follow-up after the operation, the patient had a normally gait and was satisfied with the outcome. CONCLUSION Patients who present with convulsive seizures especially patients with ion metabolism disorder should be examined thoroughly to ensure that no injury is missed.

scholarly journals Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

2019 ◽  
Author(s):  
Pengyu Li ◽  
Dongsheng Zhou ◽  
Baisheng Fu ◽  
Wenhao Song ◽  
Jinlei Dong
Keyword(s):  
Retrospective Study ◽  
Pelvic Fracture ◽  
Influence Factor ◽  
Pelvic Ring ◽  
Delayed Diagnosis ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Pelvic Ring Fractures ◽  
Vaginal Injury

Abstract Backgound: Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury. Methods: We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10-36 months. Results: All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function. Conclusion: VS type pelvic fractures and compromised pubic symphysis are related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury. Key words: Pelvic fracture, Vaginal injury, Clinical outcome

scholarly journals Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

2018 ◽  
Vol 24 (4) ◽  
pp. 111-120 ◽  
Author(s):  
P. A. Ivanov ◽  
N. N. Zadneprovsky ◽  
A. V. Nevedrov ◽  
V. O. Kalensky
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
High Speed ◽  
Pelvic Ring ◽  
Skin Incision ◽  
Pelvic Fractures ◽  
Stable Fixation ◽  
Pubic Rami ◽  
Number Of Patients

Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy. 

Fractures of the transverse processes of the fourth and fifth lumbar vertebrae in patients with pelvic ring injuries

2018 ◽  
Vol 100-B (9) ◽  
pp. 1214-1219 ◽  
Author(s):  
M. Winkelmann ◽  
M. Lopez Izquierdo ◽  
J-D. Clausen ◽  
E. Liodakis ◽  
P. Mommsen ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Lumbar Vertebrae ◽  
Transverse Process ◽  
Trauma Centre ◽  
Pelvic Injury ◽  
Matched Pair ◽  
Haemodynamic Instability ◽  
Pelvic Ring Injury ◽  
Pelvic Ring Injuries

Aims This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent. Patients and Methods The study is a retrospective matched-pair analysis of patients with a pelvic fracture according to the modified Tile AO Müller and the Young and Burgess classification who presented to a level 1 trauma centre between January 2005 and December 2014. Results A total of 728 patients with pelvic ring injuries were included, of whom 183 (25.1%) had a biomechanically unstable pelvic fracture. Of these patients, 84 (45.9%) had a fracture of a TP of L4 and/or L5. A total of 73 patients (13.4%) with a stable pelvic ring injury (p < 0.001) had a fracture of a TP. Patients with a fracture of a TP of L4 and/or L5 had a 5.5-fold risk (odds ratio (OR)) of having a biomechanically unstable pelvic injury. TP fractures (OR 1.6, p = 0.2) could not be confirmed as an independent predictor of haemodynamic instability. Conclusion This is the first study that has demonstrated a positive correlation between a TP fracture of L4 and/or L5 and a biomechanically unstable pelvic ring injury. The presence of transverse process fractures of L4 and/or L5 indicates increased severity of pelvic injury and therefore can help in the planning of emergency treatment. Cite this article: Bone Joint J 2018;100-B:1214–19.

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