Overlapping Dislocation of the Pubic Symphysis with an Open Reduction and Anterior and Posterior Pelvic Ring Fixation

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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Instability of the posterior pelvic ring associated with disruption of the pubic symphysis

Orthopedic Clinics of North America ◽

10.1016/j.ocl.2004.06.004 ◽

2004 ◽

Vol 35 (4) ◽

pp. 445-449 ◽

Cited By ~ 13

Author(s):

Laura S. Phieffer ◽

William P. Lundberg ◽

David C. Templeman

Keyword(s):

Pelvic Ring ◽

Pubic Symphysis ◽

Posterior Pelvic Ring

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Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.12.002 ◽

2017 ◽

Vol 103 (2) ◽

pp. 223-227 ◽

Cited By ~ 17

Author(s):

M.M. Elzohairy ◽

A.M. Salama

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Screw Fixation ◽

Pelvic Ring ◽

Open Reduction Internal Fixation ◽

Iliosacral Screw ◽

Posterior Pelvic Ring ◽

Iliosacral Screw Fixation

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Surgical treatment of the unstable type C pelvic injury

Acta chirurgica iugoslavica ◽

10.2298/aci1302053m ◽

2013 ◽

Vol 60 (2) ◽

pp. 53-58 ◽

Cited By ~ 2

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.

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Trans-obturator cable fixation of open book pelvic injuries

Scientific Reports ◽

10.1038/s41598-021-92755-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Martin C. Jordan ◽

Veronika Jäckle ◽

Sebastian Scheidt ◽

Fabian Gilbert ◽

Stefanie Hölscher-Doht ◽

...

Keyword(s):

Pelvic Ring ◽

Testing Machine ◽

Biomechanical Testing ◽

Pubic Symphysis ◽

Cadaver Study ◽

Steel Cable ◽

Reliable Technique ◽

Peak Displacement ◽

Total Displacement ◽

Cable Fixation

AbstractOperative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

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Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

Journal of Clinical Medicine ◽

10.3390/jcm10020184 ◽

2021 ◽

Vol 10 (2) ◽

pp. 184

Author(s):

Maximilian Kerschbaum ◽

Siegmund Lang ◽

Florian Baumann ◽

Volker Alt ◽

Michael Worlicek

Keyword(s):

Pelvic Ring ◽

Three Dimensional ◽

Fusion Method ◽

Two Dimensional ◽

Posterior Pelvic Ring ◽

Simple Method ◽

Sacroiliac Screw ◽

Screw Insertion ◽

Multiplanar Reconstructions ◽

Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

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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 ◽

10.3390/medicina57030204 ◽

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.

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