scholarly journals Preoperative CT Simulation of Iliosacral Screws for Treating Unstable Posterior Pelvic Ring Injury

2021 ◽  
Author(s):  
Peishuai Zhao ◽  
Xiaopan Wang ◽  
Xiaotian Chen ◽  
Jianzhong Guan ◽  
Min Wu
Keyword(s):  
Radiation Exposure ◽  
Exposure Time ◽  
Pelvic Ring ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Iliosacral Screws ◽  
Preoperative Ct ◽  
Ct Simulation ◽  
Posterior Pelvic Ring Injury

Abstract BackgroundPercutaneous iliosacral screw placement is an important surgical method for the treatment of pelvic unstable fractures, but either intraoperative X-ray screws or navigational screws may be misplaced. This study aimed to demonstrate a safe, effective, and rapid medthod for placing iliosacral screws for the treatment of unstable posterior pelvic ring injury according to preoperative computed tomography (CT) planning using simulated screws. MethodsAfter preoperative CT simulation of iliosacral screws planning screw insertion point and trajectory, intraoperative percutaneous iliosacral screws were used to treat unstable pelvic posterior ring injury.The mechanism of injury, Tile classification, number of screw implants, operative time of each screw implantation, radiation exposure time of each screw implantation screw position, complications, and postoperative follow-up time were collected.Screw position grading was evaluated by Smith grading. ResultsA total of 24 screws were implanted in 21 patients (9 men and 12 women;mean age 41.3 years:range 14-71 years). Tile classification included:Tile B:15 patients;Tile C:6 patients. The mean placement time of each screw was 19.5 minutes (range 14-32min); Radiation exposure time: 0.6 min (range 0.5-0.9min); Two screws were inserted in 3 patients; One screw was inserted in 18 patients; According to Smith grading standard, grade0:20 cases; and Grade1:1 case; Mean postoperative follow-up time was 17.1months (range12-25 months); None of the patients showed nonunion. ConclusionsPreoperative CT simulation of iliosacral screws for placement planning, screw trajectory, and intraoperative placement of screws is a safe method that can be used to reduce surgical time, radiation exposure, and accurate screw placement.

Robot-assisted S2 screw fixation for posterior pelvic ring injury

Injury ◽  
2020 ◽  
Author(s):  
Junqiang Wang ◽  
Teng Zhang ◽  
Wei Han ◽  
KeHan Hua ◽  
Xinbao Wu
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Pelvic Ring Injury ◽  
Robot Assisted ◽  
Posterior Pelvic Ring ◽  
Posterior Pelvic Ring Injury

scholarly journals Posterior pelvic ring injury of straddle fractures: Incidence, fixation methods, and clinical outcomes

2021 ◽  
Vol 44 (1) ◽  
pp. 59-65
Author(s):  
Yong-Cheol Yoon ◽  
Dae Sung Ma ◽  
Seung Kwan Lee ◽  
Jong-Keon Oh ◽  
Hyung Keun Song
Keyword(s):  
Clinical Outcomes ◽  
Pelvic Ring ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Fixation Methods ◽  
Posterior Pelvic Ring Injury

scholarly journals Comparison of Biomechanical Performance of Five Different Treatment Approaches for Fixing Posterior Pelvic Ring Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yongtao Lu ◽  
Yiqian He ◽  
Weiteng Li ◽  
Zhuoyue Yang ◽  
Ruifei Peng ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Plate Fixation ◽  
Fixation Method ◽  
Pelvic Ring Injury ◽  
Posterior Pelvic Ring ◽  
Triangular Osteosynthesis ◽  
Pelvic Injuries ◽  
Posterior Pelvic Ring Injury

Background. A large number of pelvic injuries are seriously unstable, with mortality rates reaching 19%. Approximately 60% of pelvic injuries are related to the posterior pelvic ring. However, the selection of a fixation method for a posterior pelvic ring injury remains a challenging problem for orthopedic surgeons. The aim of the present study is to investigate the biomechanical performance of five different fixation approaches for posterior pelvic ring injury and thus provide guidance on the choice of treatment approach in a clinical setting. Methods. A finite element (FE) model, including the L3-L5 lumbar vertebrae, sacrum, and full pelvis, was created from CT images of a healthy adult. Tile B and Tile C types of pelvic fractures were created in the model. Five different fixation methods for fixing the posterior ring injury (PRI) were simulated: TA1 (conservative treatment), TA2 (S1 screw fixation), TA3 (S1 + S2 screw fixation), TA4 (plate fixation), and TA5 (modified triangular osteosynthesis). Based on the fixation status (fixed or nonfixed) of the anterior ring and the fixation method for PRI, 20 different FE models were created. An upright standing loading scenario was simulated, and the resultant displacements at the sacroiliac joint were compared between different models. Results. When TA5 was applied, the resultant displacements at the sacroiliac joint were the smallest (1.5 mm, 1.6 mm, 1.6 mm, and 1.7 mm) for all the injury cases. The displacements induced by TA3 and TA2 were similar to those induced by TA5. TA4 led to larger displacements at the sacroiliac joint (2.3 mm, 2.4 mm, 4.8 mm, and 4.9 mm), and TA1 was the worst case (3.1 mm, 3.2 mm, 6.3 mm, and 6.5 mm). Conclusions. The best internal fixation method for PRI is the triangular osteosynthesis approach (TA5), followed by S1 + S2 screw fixation (TA3), S1 screw fixation (TA2), and plate fixation (TA4).

Intraoperative Imaging in Pelvic Surgery

2018 ◽  
Vol 157 (04) ◽  
pp. 367-377 ◽  
Author(s):  
Holger Keil ◽  
Sara Aytac ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Intraoperative Imaging ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
Posterior Pelvic Ring ◽  
Data Set ◽  
Intraoperative 3D Imaging ◽  
Pelvic Injuries ◽  
Preoperative Ct

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

scholarly journals Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Daniel Howard Wiznia ◽  
Mike Wang ◽  
Chang Yeon-Kim ◽  
Paul Tomaszewski ◽  
Michael P. Leslie
Keyword(s):  
Pelvic Ring ◽  
Pelvic Ring Injury ◽  
Lateral Compression ◽  
Pfannenstiel Incision ◽  
Acetabulum Fracture ◽  
Stoppa Approach ◽  
Acetabulum Fractures ◽  
Testicular Dislocation ◽  
Compression Type

We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3) and left T-shaped acetabulum fracture (OTA classification 62-B2) in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries.

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