Outcome of percutaneous screw fixation of posterior pelvic ring injuries (original) (raw)
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Isolated pelvic ring injuries: functional outcomes following percutaneous, posterior fixation
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2015
To characterize pelvic-specific functional outcomes in patients with isolated, partially unstable (AO/OTA 61-B), pelvic ring injuries treated with posterior only percutaneous screw fixation of the pelvic ring. Between September 2007 and October 2011, 16 subjects (mean age 42.4 years; range 18-90 years) with isolated, partially unstable pelvic ring injuries (AO/OTA 61-B) were treated with percutaneous, posterior pelvic ring fixation. Subjects underwent an evaluation of pelvic ring function with a modification of Majeed's pelvic functional outcome assessment tool. Subjects were excluded if they sustained a concomitant long-bone fracture, visceral injury requiring surgery, spinal cord injury, and an injury to the anterior pelvic ring or acetabulum requiring additional fixation. Mean follow-up was 30.8 (range 14-55) months. Eleven subjects sustained unilateral posterior ring injuries, and five subjects sustained bilateral posterior ring injuries. All fractures healed uneventfully, a...
Percutaneous Ilio-sacral Screw Fixation for Unstable Pelvic Ring Injuries
JPMA. The Journal of the Pakistan Medical Association, 2016
This prospective interventional study was planned to determine the clinical and radiological outcome of percutaneous iliosacral screw fixation for unstable pelvic ring injuries. It was conducted from March 2008 to June 2014 at the Department of Orthopaedic Surgery Combined Military Hospital (CMH) at Lahore, Multan, Rawalpindi and Muzaffarabad. It comprised 50 patients with unstable pelvic ring injuries. Visual analogue scale (VAS), Majeed pelvic score and Lindahl criteria were used for functional and radiological outcomes assessment. The mean age of the patients was 47.82±8.94 years. Moreover, 33(66%) participants were males and 17(34%) were females. The mean pre-operative Majeed and VAS scores were 38.98±6.28 and 9.04±0.67, respectively. Operating time and blood loss were reduced significantly. VAS score for post-operative pain was 3.82±1.26 at 1 month and decreased further to 2.68±1.30 at 12 months post-operatively (p<0.001). Radiological outcome and the post-operative Majeed s...
International journal of Orthopaedics Science, 2019
Abstract: Objective: To evaluate functional outcome of single percutaneous iliosacral screw fixation in posterior pelvic ring injuries. Materials and Methods: 20 adult patients of either sex with partially or completely unstable posterior pelvic ring injuries with or without anterior ring injuries admitted between October 2016 to November 2018 were treated with single percutaneous iliosacral screw fixation. The patients were followed clinically and radiologically at four, ten, sixteen and twenty four weeks and assessed with Majeed Pelvic Score. Results: There were 15 male and 5 female with mean average age of 38.1 with 60% being Tiles Type C and 40% being Tiles type B injuries. Out of 20 patients 17 patients (85%) were found to have excellent functional outcome 2 patients (10%) had Good and 1 patient (5%) had fair functional outcome based on clinical grade of Majeed Pelvic score. 1 patient had screw breakage. No patient had Neurological deficit. No case of infection was reported. Conclusion: The results obtained in our study compare well with other studies undertaken in the past and shows that single percutaneous iliosacral screw fixation is safe and efficacious procedure for fixation of sacral fracture and sacroiliac disruption.
2013
P elvic injuries with posterior ring instability, including sacroiliac (SI) diastasis, fracture-dislocation of the SI joint, and sacral fractures, have been challenging to pelvic surgeons, and their treatment remains controversial. [1-3] Several studies have indicated that conservative treatment for these injuries may achieve acceptable results without disabling late sequelae. [1-3] Other studies have indicated that patients with unstable posterior ring injury who are treated conservatively have poor long-term outcomes, including prolonged immobility, late back pain, and a high rate of Original Article At a Glance Commentary Scientific background of the subject Pelvis ring injuries without adequate treatment may lead to poor prognosis. Several treatment strategies have been proved effective. Placement of iliosacral screws was shown to provide excellent biomechanical stability and satisfactory results in outcome, and the percutaneous means have even less complications. What this study adds to the field This study provided a comparison of radiographic and functional outcomes of percutaneous iliosacral screw fixation and conservative treatment. Percutaneous placement of iliosacral screws can result in less residual displacement, better pain relief, and better functional outcomes. Background: Unstable posterior ring injuries of the pelvis are a challenge to pelvic surgeons, and their treatment has been controversial. The functional outcomes of such injuries following either percutaneous iliosacral screw fixation or conservative treatment remain to be elucidated. Methods: We conducted a retrospective analysis of 32 consecutive patients with unstable pelvic ring injuries who were treated with percutaneous placement of iliosacral screws (group 1) or conservative means (group 2) from January 2002 to September 2009. Radiographic, clinical, and functional outcomes were compared between the two treatment groups. Results: Patients who underwent percutaneous iliosacral screw fixation after pelvic trauma had better functional results than those treated conservatively, as per the Majeed grading system. In addition, patients in group 1 demonstrated better results for general health and mental health on the 36 item Short Form Health Status Survey. Patients in group 1 also demonstrated less residual displacement on radiography at 1 year follow up than those in group 2. Finally, patients in group 1 had better pain relief at 1 month and 1 year follow ups than those in group 2. Conclusions: Percutaneous iliosacral screw fixation for unstable posterior pelvic ring injuries results in less residual displacement at medium term follow up, and better pain relief at short and medium term follow up, than does conservative treatment. Better functional outcomes were observed at 1 year follow up as compared with conservative treatment.
Our results of posterior percutaneous transiliac plate fixation in posterior pelvic ring injuries
Muğla Sıtkı Koçman üniversitesi tıp dergisi, 2022
Sakrum kırıklarının teşhisi ve tedavisi günümüzde halen zorlayıcı olabilmektedir. Literatürde sakral kırıkların tedavisi için çeşitli cerrahi yöntemler bildirilmiştir. Çalışmamızın amacı kliniğimizde posterior perkütan transiliak plak ile tedavi edilen hastaların fonksiyonel sonuçlarını incelemektir. Haziran 2013 ile Eylül 2020 tarihleri arasında posterior pelvik halka yaralanması nedeniyle cerrahi tedavi uygulanan ve en az 6 aylık takip süresi olan 56 hasta retrospektif olarak incelendi. Postoperatif 6. ayda demografik veriler, radyolojik görüntüler, Pelvik Sonuç Skorları (POS) ve Kısa Form-36 (SF-36) sonuçları analiz edildi. Hastaların 6. ay muayenesinde saptanan POS verileri incelendiğinde ortalama pelvik sonuç skoru 32 (26-37) ve SF-36 sonuçları 80 (48-90) olarak bulundu. Ortalama cerrahi işlem süresi 32,2 dakika ve ameliyat sırasında alınan ortanca floroskopi çekim sayısı 2 (1-6) idi. Posterior perkütan transiliak plak tespiti yapılan hastaların 6. ay muayenelerinde fonksiyonel sonuçları tatmin ediciydi. Bu teknik ile ameliyat süresinin kısa ve floroskopi maruziyetlerinin düşük olduğu görüldü. Kısa bir öğrenme eğrisine sahip olan bu tekniğin sakrum cerrahisinde güvenle kullanılabileceğine inanıyoruz. Bu nedenle pelvik cerrahi konusunda tecrübesi olmayan cerrahlar için bu yöntem daha kolay ve daha uygun bir yöntem gibi görünmektedir. The diagnose and treatment of sacrum fractures are still difficult to manage. Various surgical methods have been reported for the treatment of sacral fractures in the literature. The aim of our study is to examine the functional results of patients treated with posterior percutaneous transiliac plate in our clinic. 56 patients who underwent surgical treatment for posterior pelvic ring injury between June 2013 and September 2020 and who had a minimum 6-month follow-up were retrospectively analyzed. Demographic data, radiological images, Pelvic Outcome Scores (POS) and Short Form-36 (SF-36) results in the 6th postoperative month were analyzed. When the POS data detected at the 6th month examination were examined, the mean pelvic outcome score was found to be 32 (26-37) and the SF-36 results as 80 (48-90). The mean duration of the surgical procedure was 32.2 minutes, and the median number of fluoroscopy shots taken during surgery was 2 (1-6). The functional results of the patients who underwent posterior percutaneous transiliac plate fixation were good at the6th month examinations. With this technique, it was observed that the operation time was short and fluoroscopy exposures were low. We believe that this technique, which has a short learning curve, can be used safely in sacrum surgery. For that reason, this method seems to be an easier and more convenient method for surgeons who are not experienced in pelvic surgery.
Iliosacral Screw Fixation of the Unstable Pelvic Ring Injuries
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
PURPOSE OF THE STUDY To report on the early results and possible complications of iliosacral screw fixation in the management of unstable pelvic ring injuries. MATERIAL AND METHODS One hundred and two unstable pelvic ring injuries were treated using iliosacral screw fixation for posterior pelvic ring disruptions. Closed manipulative reductions of the posterior lesion were attempted for all patients. Open reductions were used in the minority of patients with unsatisfactory closed reductions as assessed fluoroscopically at the time of surgery. Anterior fixations were by means of open reduction in 62 patients and by external fixation in 14 patients, and by screws in 7 patients. Twenty patients had no anterior fixation. Plain anteroposterior, inlet and outlet radiographs of the pelvis were obtained postoperatively at six weeks, three months, six months and one year. A pelvic computed tomography scan was performed postoperatively in those patients where residual displacement or screw misplacement was suspected. Complications were recorded. RESULTS One patient died 31 days after the trauma due to pneumonia and one died 9 months after the surgery after a fall from a height in a second suicidal attempt. There were two posterior pelvic infections and one anterior pelvic infection. Screw misplacement occurred in seven cases. In six cases a misplaced screw produced transient L5 neuroapraxia. There was no fixation failure requiring revision surgery. There was one case of injury to the superior gluteal artery. DISCUSION Unstable pelvic ring disruptions are severe injuries, associated with a high rate of morbidity and mortality. Pelvic fractures can be treated by variety of methods. Treatment with traction and pelvic slings does not offer accurate reduction and confines the patient to prolong bed rest with all potential complications. Several authors documented lower morbidity and mortality rates and shorter hospital stay in patients treated by early operative stabilization of pelvic injuries. The timing of the surgery is still controversial. Some authors in large trauma centres believe that ideally the initial treatment should be the final treatment. The advantage of urgent fixation is the use of this usually minimally invasive technique in the initial stabilisation of a hemodynamically unstable patient. The disadvantage is performance of the surgery under increased stress and time limit, which may lead to the acceptance of sub-optimal reduction. Very good team work of the orthopaedic surgeon, anaesthetist and other involved specialists (general surgeon, urologist) is necessary. CONCLUSIONS Iliosacral screw fixation is a useful method of stabilizing unstable pelvic ring injuries. It is a difficult technique, with a steep learning curve. The surgeon must understand the complex and variable sacral anatomy. High quality fluoroscopic imaging is a must. Especially in vertically unstable injuries the sacroiliac screws need to be augmented by sound anterior fixation. Low rates of infection, wound healing problems and minimal blood loss are advantages of this method.
Surgical treatment of unstable pelvic ring injuries
Medicinski pregled, 2016
Introduction. Unstable pelvic ring injuries are among the most serious injuries of skeletal system. As they are often associated with young age and multiple organ injuries they are difficult for management. Material and Methods. This study included 26 unstable pelvic ring injuries surgically treated at the Department of Orthopedic Surgery and Traumatology from August 2008 until August 2015. The average age of 22 males and 4 female patients was 45.4 years. The most common mechanism for injury was a traffic accident (19), fall from height (6), and one patient was buried under rubble. Out of 26 patients who were operated, 24 had type C injury and two had type B injury according to Tiles classification. The average follow-up time was 23 months (8 - 84 months). The functional outcome was assessed by means of Majeed and Iowa Pelvic Score. Results. Pelvic ring injuries were healed in all 26 patients. A leg length discrepancy was found in 13 patients and it was 9 mm on average. Four patient...
The long-term clinical outcome after pelvic ring injuries
The bone & joint journal, 2013
We report the functional and socioeconomic long-term outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre between 1973 and 1990 with multiple blunt orthopaedic injuries including an injury to the pelvic ring, with an Injury Severity Score (ISS) of ≥ 16. These patients were invited for clinical review at a minimum of ten years after the initial injury, at which point functional results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior (group P) and 43 combined anterior/posterior pelvic ring injuries (group A/P) were included. The mean age of the patients at injury was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42), being significantly worse compare...
Standard practice in the treatment of unstable pelvic ring injuries: an international survey
International Orthopaedics
Purpose Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. Methods A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were...