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Asian Journal of Surgery Jan 2021Straddle fracture, a superior and inferior ramus fracture of both sides, is generally treated conservatively. However, posterior pelvic ring injury is often associated... (Review)
Review
Straddle fracture, a superior and inferior ramus fracture of both sides, is generally treated conservatively. However, posterior pelvic ring injury is often associated with straddle fracture, leading to unstable pelvic bone fracture that requires surgical treatment. The present study reports the clinical and radiological outcomes of straddle fracture with posterior pelvic ring injury. This study included 73 patients (41 men, 32 women) with a straddle fracture injury. The injury mechanism, injury severity score (ISS), accompanying injuries, presence of posterior pelvic ring injury, and fixation methods for the pelvic fracture were analyzed, and outcomes were evaluated functionally and radiologically. Of the 73 patients, 56 (77%) had a posterior pelvic ring injury and 7 died. In 43 patients, the posterior pelvic ring injuries constituted unstable pelvic injury and were treated surgically. The fixation method was determined based on the severity of the posterior pelvic injury. The patients' mean ISS was 24.7 points. Radiological evaluation of surgical outcomes in 43 patients revealed the outcomes as anatomic in 20, nearly anatomic in 14, moderate in 5, and poor in 4, whereas functional evaluation revealed the outcomes as excellent in 21, good in 9, fair in 7, and poor in 6. Posterior pelvic ring fracture can accompany straddle fractures, which may lead to pelvic injury instability. Thus, special attention is required for patients with a straddle fracture.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Pelvis; Radiography; Trauma Severity Indices; Treatment Outcome; Young Adult
PubMed: 32376214
DOI: 10.1016/j.asjsur.2020.03.021 -
Injury Aug 2023Pelvic ring injuries comprise a spectrum of bony, ligamentous and muscular injuries, described by several common classification systems. However, the majority of... (Review)
Review
Pelvic ring injuries comprise a spectrum of bony, ligamentous and muscular injuries, described by several common classification systems. However, the majority of injuries lie in areas of intermediate severity, where complexity and variable nature make it extremely hard to define in detail. This fact and associated injuries make it extremely difficult to conduct randomised control trials, with purpose to direct treatment guidelines. Thus, special interest and expertise are required by pelvic trauma surgeons, while surgical indications and fixation methods rely on their experience, at least in part. Namely, a significant grey zone of indication exists. As fixation methods evolve, specifically percutaneous fixation using osseous fixation pathways, some injuries in which morbidity bound with surgical fixation was considered too high relative to its benefits, may be considered eligible for surgical treatment nowadays. Moreover, due to significant progress in the treatment of the acute polytrauma casualties, the survival rate increased over the years, emphasizing the effect of long-term morbidity and functional outcome of pelvic ring injuries. The purpose of this manuscript is to describe the equivocal areas of controversies, hence "the grey zone", and to provide the readership with up-to-date published data. We aimed to collect and detail clinical and radiological clues in the diagnosis of intermediate unstable anterior-posterior compression and lateral compression injuries, and for the selection of treatment methods and sequence. Recent publications have provided some insights into specific injury features that are correlated with increased chance of instability, pain and delay in ambulation. Specific focus is given to the utility of examination under anaesthesia in selected cases. Other publications surveyed the shared experience of pelvic trauma surgeons as for the classification, indication and treatment sequence of pelvic ring injuries. Although the data hasn't matured yet to a comprehensive treatment algorithm, it may serve clinicians well when making treatment decisions in the grey zone of pelvic ring injuries, and serve as a basis for future prospective studies.
Topics: Humans; Fractures, Bone; Pelvic Bones; Prospective Studies; Fracture Fixation; Radiography; Fracture Fixation, Internal; Retrospective Studies
PubMed: 37453290
DOI: 10.1016/j.injury.2023.110887 -
Journal of Orthopaedic Research :... Mar 2021Unstable pelvic ring fractures are severe and complex injuries, and surgical fixation is challenging and can be complicated by early failure due in part to difficulties...
Unstable pelvic ring fractures are severe and complex injuries, and surgical fixation is challenging and can be complicated by early failure due in part to difficulties with securely fixing screws in low-density bone. There is limited information in the literature about how the density distribution across the pelvic bones changes with age and sex. In this study, we used 60 sets of calibrated bone density measurements obtained opportunistically from clinical computed tomography scans of the pelvis. Three-dimensional models of the innominate bone were produced and the effects of age and sex on cortical bone density modeled. Overall trends and regions where these factors had a significant effect were identified, and the results visualized. Across the entire innominate bone, the mean loss of density was found to be 1.6 mg/cc per year, with several specific areas (pubic body, iliac fossa, posterior ilium, and anterior inferior iliac spine for example) showing significant rates of loss up to three times greater than the rest of the bone. Areas significantly affected by sex included the posterior pubic root, anterior aspect of the pubic body, and iliac crest. Despite overall trends of attenuation, there remains significant variability between individuals. This supports the need to further explore subject-specific planning tools for pelvic fracture repair. Statement of clinical significance: Bone density changes across the innominate bone due to age and sex tend to vary between individuals, although consistent effects were seen at specific regions. This information may help in surgical planning of unstable fracture repairs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Bone Density; Cortical Bone; Female; Humans; Male; Middle Aged; Pelvic Bones; Retrospective Studies; Sex Characteristics; Tomography, X-Ray Computed; Young Adult
PubMed: 32617998
DOI: 10.1002/jor.24792 -
Zeitschrift Fur Orthopadie Und... Apr 2023The "floating hip" is a rare and complex fracture involving the pelvis and the ipsilateral femur and is therefore difficult to treat. Data and studies on this topic are...
INTRODUCTION
The "floating hip" is a rare and complex fracture involving the pelvis and the ipsilateral femur and is therefore difficult to treat. Data and studies on this topic are still scarce. The optimal strategy for surgical treatment and thus the resulting quality of treatment are still being debated; a femur-first strategy is often the preferred treatment.
METHODS
Retrospectively, patients with a pelvic fracture treated at the Level I Trauma Centre of the University of Tübingen between 2003 and 2017 were identified. Patients with an additional ipsilateral femur fracture were identified in this collective. We compared the quality of treatment of pelvic fractures between floating and non-floating hip injuries.
RESULTS
Proximal femur fractures were more common with pelvic ring fractures (n = 16) than with acetabular fractures (n = 1). Floating hip injuries occur more frequently in younger polytraumatised male patients. Pelvic fractures in floating hip injuries are operated more frequently (62.8% vs. 39.1%; p = 0.003) and the clinical course is significantly longer (27.8 ± 19.3 vs. 19.9 ± 23.1 days; p < 0.001). However, the quality of treatment of pelvic fracture, exemplified by morbidity (18.6% vs. 14.6%; p = 0.610) and mortality (7.0% vs. 2.6%; p = 0.108), shows no differences.
CONCLUSION
Injury severity and complexity of pelvic fracture is significantly higher in floating hip injuries, but without affecting the resulting quality of treatment. A "femur first" treatment strategy is preferable. Algorithms for emergency treatment and definitive care are proposed in a flowchart.
Topics: Humans; Male; Retrospective Studies; Fractures, Bone; Femoral Fractures; Hip Fractures; Pelvic Bones; Hip Injuries; Acetabulum
PubMed: 36195111
DOI: 10.1055/a-1918-2243 -
Journal of Orthopaedics and... May 2020Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates...
BACKGROUND
Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates where iliosacral screws may be placed when stabilizing pelvic ring injuries. In dysmorphic sacra, the safe osseous corridor of the upper sacral segment (S1) is smaller and lacks a transsacral corridor, increasing the need for fixation in the second sacral segment (S2). Previous evidence suggests that S2 is less dense than S1. The aim of this cross-sectional study is to further evaluate bone mineral density (BMD) of the S1 and S2 iliosacral osseous pathways through morphology stratification into normal and dysmorphic sacra.
MATERIALS AND METHODS
Pelvic computed tomography scans of 50 consecutive trauma patients, aged 18 to 50 years, from a level 1 trauma center were analyzed prospectively. Five radiographic features (upper sacral segment not recessed in the pelvis, mammillary bodies, acute alar slope, residual S1 disk, and misshapen sacral foramen) were used to identify dysmorphic characteristics, and sacra with four or five features were classified as dysmorphic. Hounsfield unit values were used to estimate the regional BMD of S1 and S2. Student's t-test was utilized to compare the mean values at each segment, with statistical significance being set at p < 0.05. No change in clinical management occurred as a result of inclusion in this study.
RESULTS
A statistical difference in BMD was appreciated between S1 and S2 in both normal and dysmorphic sacra (p < 0.0001), with 28.4% lower density in S2 than S1. Further, S1 in dysmorphic sacra tended to be 4% less dense than S1 in normal sacra (p = 0.047). No difference in density was appreciated at S2 based on morphology.
CONCLUSIONS
Our results would indicate that, based on BMD alone, fixation should be maximized in S1 prior to fixation in S2. In cases where S2 fixation is required, we recommend that transsacral fixation should be strongly considered if possible to bypass the S2 body and achieve fixation in the cortical bone of the ilium and sacrum.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Adult; Bone Density; Bone Screws; Cross-Sectional Studies; Female; Humans; Ilium; Male; Middle Aged; Orthopedic Procedures; Pelvic Bones; Sacrum; Tomography, X-Ray Computed; Young Adult
PubMed: 32451838
DOI: 10.1186/s10195-020-00545-9 -
The Bone & Joint Journal Nov 2014A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed... (Review)
Review
A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Bone Resorption; Hip Joint; Hip Prosthesis; Humans; Pelvic Bones; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 25381413
DOI: 10.1302/0301-620X.96B11.34316 -
Clinical Radiology Aug 2019In this review, we discuss the imaging classification of pelvic ring fractures in the context of our experience of reporting trauma computed tomography (CT) in a major... (Review)
Review
In this review, we discuss the imaging classification of pelvic ring fractures in the context of our experience of reporting trauma computed tomography (CT) in a major trauma centre. Pelvic ring fractures are potentially significant injuries with risk of significant haemorrhage and morbidity. This review details the use of classification systems in determining the mechanism and severity of injury, with discussion of the features of the Young and Burgess classification system. We demonstrate the different types of pelvic ring fracture with examples from trauma CT, and with reference to the distribution and frequency of these injuries in trauma patients. This review will allow the reader to assess trauma CT for significant pelvic ring injury and identify features of instability.
Topics: England; Fractures, Bone; Humans; Pelvic Bones; Tomography, X-Ray Computed; Trauma Centers
PubMed: 31153596
DOI: 10.1016/j.crad.2019.04.020 -
The Journal of the American Academy of... Sep 2023Pelvic ring injuries and acetabular fractures are complex injuries and are often challenging to treat for a number of reasons. Orthopaedic trauma surgeons critically...
Pelvic ring injuries and acetabular fractures are complex injuries and are often challenging to treat for a number of reasons. Orthopaedic trauma surgeons critically evaluate pelvic radiographs and CT images to generate an appropriate detailed injury and patient-specific preoperative plan. There are numerous crucial osseous details that surgeons should be aware of. Often, some of the most important factors that affect patients in treatment timing decisions, assessing reduction strategies, and deciding and inserting fixation constructs may be subtle on preoperative imaging. The radiographic and CT imaging findings covered subsequently should be sought out and appreciated preoperatively. Combining all the available osseous information helps the surgeon predict potential pitfalls and adjust surgical plans before incision. Ensuring a methodical and meticulous imaging review allows for the development of a detailed preoperative plan and helps avoid intraoperative missteps. This process will inherently streamline the surgical procedure and optimize the patient's surgical care. Maximizing the accuracy of the preoperative planning process can streamline the treatment algorithm and ultimately contribute to the best possible clinical outcome.
Topics: Humans; Fractures, Bone; Pelvic Bones; Acetabulum; Hip Fractures; Fracture Fixation, Internal; Pelvis; Retrospective Studies
PubMed: 37476846
DOI: 10.5435/JAAOS-D-23-00112 -
ANZ Journal of Surgery Sep 2016Multiple scoring systems are used in the assessment of post-injury outcomes in pelvic fracture patients. Although commonly used, there is scarce evidence as to their... (Review)
Review
BACKGROUND
Multiple scoring systems are used in the assessment of post-injury outcomes in pelvic fracture patients. Although commonly used, there is scarce evidence as to their validity.
METHODS
We performed a systematic review of the current literature to compare a well validated generic outcome tool (Short Form-36 (SF-36)) and three commonly used pelvic-specific outcome tools, the Iowa Pelvic Score, Majeed Pelvic Score and Orlando Pelvic Score.
RESULTS
Eleven papers were found that used both the SF-36 and one or more of the pelvic-specific outcome tools. The data demonstrate great variability in both the method of application and form of reporting.
CONCLUSION
The pelvic-specific tools produce similar results to the SF-36 and are potentially more sensitive in examining specific areas related to pelvic injuries and easier to perform and calculate than the SF-36.
Topics: Fractures, Bone; Humans; Pelvic Bones; Radiography; Surveys and Questionnaires; Trauma Severity Indices
PubMed: 27283794
DOI: 10.1111/ans.13651 -
Injury Nov 2014This survey was conducted during the 38(th) Brazilian Congress of Orthopaedics and Traumatology to identify the opinion of Brazilian orthopaedic surgeons on the standard... (Review)
Review
INTRODUCTION
This survey was conducted during the 38(th) Brazilian Congress of Orthopaedics and Traumatology to identify the opinion of Brazilian orthopaedic surgeons on the standard treatment of pelvic fractures.
MATERIALS AND METHODS
Participants were randomly selected and invited to voluntarily answer a questionnaire of 10 multiple choice questions addressing the main aspects of the treatment of pelvic fractures: classification, fixation methods in unstable patients, optimal surgical timing in stable patients, and fixation methods in different types of anterior and posterior pelvic injuries.
RESULTS/CONCLUSION
Three hundred and fifty-two questionnaires were completed, and the following main observations were made: most orthopaedists prefer to use an external fixator in the iliac crest for the emergency stabilisation of pelvic injuries in haemodynamically unstable patients (79.5%); they consider a period of up to one week as optimal for fixation in stable patients (55.1%); they use a plate for the fixation of fractures of the iliopubic rami through a Pfannenstiel or ilio-inguinal approach (53.9%); and they use reconstruction plates for the fixation of fractures of the iliac wing (63.1%). Regarding other studied aspects, there was no predominance of more than 50% of the choices among respondents.
Topics: Brazil; Fractures, Bone; Health Care Surveys; Humans; Orthopedic Procedures; Pelvic Bones; Practice Patterns, Physicians'; Surveys and Questionnaires
PubMed: 25528625
DOI: 10.1016/S0020-1383(14)70021-X