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Journal of Orthopaedic Trauma Aug 2016Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing... (Review)
Review
Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case. A cannulated pig sticker (drill guide) used with long drill tip guide wires provide improved manual control to both finding a good start site and directing the trajectory. For patient safety, sacral anatomy and safe zones are discussed as well. Using these technical points will help make this a successful procedure.
Topics: Bone Screws; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Sacroiliac Joint; Treatment Outcome
PubMed: 27441927
DOI: 10.1097/BOT.0000000000000606 -
Der Unfallchirurg Dec 2017Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported. (Review)
Review
BACKGROUND
Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported.
OBJECTIVES
The purpose of this article is to outline the imaging, indication, planning, equipment, surgical technique and complications of these methods.
METHODS
A review of the literature is provided and the techniques for anterior and posterior pelvic stabilisation are discussed.
RESULTS
High-quality preoperative CT scans are essential in planning for this technique. The anterior internal fixator ("InFix") is an effective method for stabilising the anterior ring and should be usually used in conjunction with posterior fixation. Good technique avoids neurovascular injury, which can be a devastating complication. The retrograde anterior column screw (RACS) is a technique that can be used in most patients, although in smaller patients smaller screw diameters may be needed. The entry point for the screw is more lateral in women than men. Iliosacral screws (ISS) are an effective method of posterior stabilisation and can be placed using 2D or 3D fluoroscopy, computer navigation or CT navigation.
CONCLUSION
Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.
Topics: Fracture Fixation, Internal; Humans; Minimally Invasive Surgical Procedures; Pelvic Bones; Postoperative Complications; Surgical Equipment
PubMed: 27659309
DOI: 10.1007/s00113-016-0225-x -
The Orthopedic Clinics of North America Jul 2020Percutaneous reduction and fixation of pelvic ring fractures is now widely accepted as a safe and effective treatment method. The only exception remains reduction and... (Review)
Review
Percutaneous reduction and fixation of pelvic ring fractures is now widely accepted as a safe and effective treatment method. The only exception remains reduction and fixation of pubic symphyseal injuries. Several units from China and one from Spain have published clinical and biomechanical studies supporting percutaneous reduction and fixation of the pubic symphysis with various screw configurations. The initial clinical results are promising. Biomechanical data show there is little difference between plate and screw fixation. We review the current literature and also present a case performed by ourselves using this novel technique.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Minimally Invasive Surgical Procedures; Pelvic Bones; Pubic Symphysis
PubMed: 32498950
DOI: 10.1016/j.ocl.2020.02.010 -
Injury Jul 2020Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
BACKGROUND
Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
METHODS
We retrospectively reviewed 197 patients with closed pelvic fracture who presented to our institution from January 2012 to December 2018. Pelvic fractures were diagnosed by plain radiography and computed tomography (CT). First, we investigated the prevalence and clinical findings of VP in pelvic fractures. Second, we compared the clinical findings between pelvic fracture with and without VP. Finally, VP in pelvic fracture was evaluated clinically and radiologically.
RESULTS
VP in pelvic fractures was detected by CT in 9 (3.6%) of the 197 patients with pelvic fractures. Patients with VP had a significantly greater proportion of fracture progression than those without VP (42.9% vs. 11.3%, P = 0.02). Patients with VP had a greater proportion of fragility fractures of the pelvis (FFP), and a lesser proportion of bone union than those without VP, although the differences were not significant. In nine pelvic fractures with VP, all sacral fractures were classified as type 1 according to the Denis classification, and all pubic fractures were classified as type 1 according to the Nakatani classification. Two (22.2%) nonunion in nine pelvic fractures with VP occurred at the pubic fracture site alone.
CONCLUSIONS
Orthopedic clinicians should be aware of the potential of CT for detecting VP in pelvic fractures, especially in the course of FFP progression.
Topics: Aged; Aged, 80 and over; Female; Fractures, Bone; Gases; Hospitals, General; Humans; Japan; Male; Middle Aged; Pelvic Bones; Pubic Bone; Radiography; Retrospective Studies; Sacrum; Tomography, X-Ray Computed; Vacuum
PubMed: 32386839
DOI: 10.1016/j.injury.2020.03.051 -
European Radiology Sep 2022Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of...
OBJECTIVES
Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of reinforced cementoplasty (RC) in painful and unstable lesions involving the pelvic bone in terms of pain relief and functional recovery.
METHODS
All patients with neoplastic lesion or pelvic fracture for whom a pelvic bone RC was carried out between November 2013 and October 2017 were included in our study. All patients who failed the medical management, patients unsuitable for surgery, and patients with unstable osteolytic lesions were eligible to RC. Clinical outcome was evaluated with a 1-month and 6-month post-procedure follow-up. The primary endpoint was local pain relief measured by the visual analogue scale (VAS).
RESULTS
Twenty-two patients (18 females, 4 males; mean age of 65.4 ± 13.3 years [range 38-80]) presenting with painful and unstable pelvic lesions were treated by RC during the study period. Among the 22 patients, 8 patients presented with unstable pelvic fractures (3 patients with iliac crest fracture, 3 with sacral fractures, and the remaining 2 with peri-acetabular fractures). No procedure-related complications were recorded. All patients had significant pain relief and functional improvement at 1 month. One patient (4.5%) had suffered a secondary fracture due to local tumour progression.
CONCLUSIONS
Reinforced cementoplasty is an original minimally invasive technique that may help in providing pain relief and effective bone stability for neoplastic and traumatic lesions involving the pelvic bone.
KEY POINTS
• Reinforced cementoplasty is feasible in both traumatic fractures and tumoural bone lesions of the pelvis. • Reinforced cementoplasty for pelvic bone lesions provides pain relief and functional recovery. • Recurrence of pelvic bone fracture was observed in 4.5% of the cases in our series.
Topics: Adult; Aged; Aged, 80 and over; Cementoplasty; Female; Fractures, Bone; Humans; Male; Middle Aged; Pain; Pelvic Bones; Pelvic Neoplasms; Spinal Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 35362749
DOI: 10.1007/s00330-022-08742-2 -
Seminars in Musculoskeletal Radiology Apr 2019Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical... (Review)
Review
Good outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.
Topics: Acetabulum; Femoral Fractures; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Joint Dislocations; Pelvic Bones; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 30925631
DOI: 10.1055/s-0039-1681048 -
Medicina (Kaunas, Lithuania) Aug 2022: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles... (Review)
Review
: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. : An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were "malunion" AND "pelvic" OR "pelvis". Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. : Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.
Topics: Fractures, Bone; Fractures, Malunited; Humans; Pelvic Bones
PubMed: 36013565
DOI: 10.3390/medicina58081098 -
International Orthopaedics Nov 2018Vertical shear pelvic ring fractures are rare and account for less than 1% of all fractures. Unlike severely displaced antero-posterior compression and lateral... (Review)
Review
Vertical shear pelvic ring fractures are rare and account for less than 1% of all fractures. Unlike severely displaced antero-posterior compression and lateral compression pelvic fractures, patients' mortality is lower. Nevertheless, patients must be managed acutely using well-defined ATLS protocols and institution-specific protocols for haemodynamically unstable pelvic ring fractures. The definitive treatment of vertical shear pelvic fractures is however more controversial with a paucity of literature to recommend the ideal reduction and fixation strategy. While the majority of injuries can be reduced and fixed in a closed manner, orthopaedic traumatologists should be familiar with the contraindications to those techniques as well as options such as tension band plating and lumbo pelvic fixation. Our paper reviews the acute management, associated injuries and definitive reduction and fixation strategies of vertical shear pelvic fractures. In addition, we propose a treatment algorithm for the selection of the most appropriate fixation technique.
Topics: Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators; Male; Open Fracture Reduction; Pelvic Bones
PubMed: 29582114
DOI: 10.1007/s00264-018-3883-1 -
Skeletal Radiology Jul 2020Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to... (Review)
Review
Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to be large and located in close proximity to pelvic viscera as well as vital neurovascular structures. Operative management of pelvic bone tumors is indicated for a variety of orthopedic oncologic conditions. In general, limb-sparing pelvic resection rather than hemipelvectomy with amputation of the ipsilateral limb is considered when a functional limb can be preserved without compromising the surgical margins. There are various options for pelvic resection and reconstruction, and the selection depends on tumor histology, anatomic location, and extent. The decision regarding choice of surgical procedure and reconstruction method for a pelvic bone tumor requires a thorough knowledge of the pelvic anatomy, and careful inspection of the anatomic extent. The surgical plan must strike a balance between acceptable functional outcome and acceptable morbidity. In this review, we describe the different types of pelvic resection techniques, and the vital role preoperative imaging plays in defining the anatomic extent of a pelvic bone tumor and subsequent surgical planning.
Topics: Bone Neoplasms; Contrast Media; Humans; Imaging, Three-Dimensional; Margins of Excision; Pelvic Bones; Salvage Therapy
PubMed: 32072185
DOI: 10.1007/s00256-020-03395-y -
Der Radiologe Mar 2020Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy... (Review)
Review
EPIDEMIOLOGY
Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy impact, a distinction is made between anteroposterior compression, lateral compression, and vertical shear (Young and Burgess classification), while the stability-related classification according to Tile distinguishes between type A (stable), type B (rotationally unstable) and type C (completely unstable). A comprehensive modern classification is given by the AO/OTA.
RADIOLOGICAL FRACTURE DIAGNOSIS
Plain pelvis x‑rays lack sufficient sensitivity but are still used to detect highly unstable pelvic fractures. CT has superior sensitivity and specificity. In addition to fracture classification, CT allows reliable assessment of associated vascular and bladder/urethral injuries and large soft tissue hemorrhage. MRI is unparalleled in showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage. MRI may also prove to be a valuable diagnostic tool for pelvic ring injuries in children, adolescents and young women, provided they are hemodynamically stable. Angiography, ultrasonography and bone scintigraphy are additional important diagnostic and therapeutic options.
PRACTICAL RECOMMENDATIONS
Knowledge of basic pelvic trauma mechanisms is important to understand the potential severity of traumatic pelvic fractures and to classify them correctly in terms of stability. Being familiar with typical concomitant injuries in pelvic ring fractures allows reliable diagnosis and their communication with the clinician. CT remains the "diagnostic workhorse". In fragile pelvic fractures, the often prolonged course with fracture progression must be taken into account, which is why MRI is of particular importance herein.
Topics: Abdominal Injuries; Adolescent; Child; Female; Fractures, Bone; Humans; Magnetic Resonance Imaging; Pelvic Bones; Pelvis; Tomography, X-Ray Computed
PubMed: 32108247
DOI: 10.1007/s00117-020-00656-8