Biomechanical analysis of anterior ring fixation of the ramus in type C pelvis fractures

McLachlin, Stewart D.; Lesieur, M.; Stephen, David; Whyne, Cari

doi:10.1007/s00068-017-0788-4

Cited by 22 publications

(19 citation statements)

References 24 publications

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“…Firstly, the insertion of a cannulated screw in this area is difficult and dangerous. McLachlin et al [ 4 ] declared that the diameter of a cannulated screw must be no <4.5 mm and penetrate the bilateral cortexes of the pubis to obtain the same stability as a reconstruction plate in the treatment of pubic fractures. These requirements are attainable in the treatment of superior pubic ramus fractures, which are medial to the obturator, because the screw length can be short and the operation can performed under direct vision to ensure the correct location of the screw and avoid damage to important nerve and vessels.…”

Section: Discussionmentioning

confidence: 99%

“…However, a growing number of studies have shown that ignorance of instability or excessive displacement of anterior ring fractures could increase the chance of nonunion, lead to long-term pain with limited mobility and result in severe complications, such as deep vein thrombosis, decubitus, or muscle dystrophy. [ 4 – 6 ] Some mechanical tests have demonstrated that fixation of both anterior and posterior ring can bring greater stability of the pelvis and had better prognosis than simple posterior ring fixation in Tile C pelvic fractures. [ 2 , 4 ] Therefore, anterior ring injury in Tile C fracture is now an absolute indication for surgical management.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 – 6 ] Some mechanical tests have demonstrated that fixation of both anterior and posterior ring can bring greater stability of the pelvis and had better prognosis than simple posterior ring fixation in Tile C pelvic fractures. [ 2 , 4 ] Therefore, anterior ring injury in Tile C fracture is now an absolute indication for surgical management.…”

Section: Introductionmentioning

confidence: 99%

“…The mechanical strength of the external fixator is too weak to stabilize the fracture and the rate of pin site infection is as high as 50%. [ 4 , 7 ] On the contrary, open reduction internal fixation can cause extensive soft-tissue damage, wound infection, and iatrogenic injury of the nerve and vessels. [ 8 , 9 ] Recently, minimally invasive internal fixation has become the focus of research because it avoid the limitations of these traditional methods.…”

Section: Introductionmentioning

confidence: 99%

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Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Sun

Yan

Wang³

et al. 2020

Medicine

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The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation. We retrospectively reviewed 18 patients (aged 25–62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed. The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation. Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Sun

Yan

Wang³

et al. 2020

Medicine

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“…The higher postoperative stability is an important advantage: it protects against implant loosening or failure and secondary fracture displacement. McLachlin et al tested four different anterior pelvic fixation methods in a vertically unstable pelvic fracture without posterior fixation [5]. The bicortical, fully threaded 6.5 mm retrograde transpubic screw provided the highest stability with the smallest displacement in the anterior and posterior pelvic ring.…”

mentioning

confidence: 99%

Focus on high energy pelvic trauma

Rommens¹

2018

Eur J Trauma Emerg Surg

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Management of high energy pelvic trauma is an interdisciplinary task. The early clinical picture of patients with pelvic trauma is a combination of haemodynamic and osteoligamentar instability. Despite an efficient emergency management, patients with a pelvic fracture will have a different course during their hospital stay when compared with patients with an equally high ISS without pelvic fracture. Almahmoud et al. showed that there was a longer length of stay in the intensive care unit and a longer total length of stay in the hospital. Inflammatory biomarkers and clinical parameters were significantly different as well [1]. As in all severely injured patients, resuscitation is focused on the preservation of airways, breathing and circulation. In case of pelvic ring disruption with haemodynamic instability, provisional stabilization of the pelvic ring is used in a great majority of patients using pelvic binders, pelvic clamp and external fixation. When logistical requirements are met, operative fixation of the disrupted posterior pelvic ring with iliosacral screws can be performed. Acker et al. present a series of 108 unstable pelvic injuries, of which 50 were treated with primary screw fixation [2]. No differences were found between the primary and delayed treatment groups for what concerns technical outcome measures and complication rate. Immediate screw fixation seems to be a valid alternative of delayed fixation. An unsolved question remains which type of pelvic fractures need operative fixation and which can be treated non-operatively. Höch et al. contributes to the discussion with a retrospective study on 71 patients, who suffered a lateral compression injury [3]. Thirty-five patients were treated non-operatively, 36 operatively. The amount of anterior fracture dislocation was higher in the operatively treated group. There was a significantly higher complication rate in the group, which was treated operatively. After at least 1-year follow-up, there was no difference regarding pain or quality of life. The results of this study underline the need of a critical analysis and precise decision-making in lateral compression injuries. Perhaps, isolated lateral compression pelvic injuries with a limited anterior fracture displacement do not need surgical therapy. The fourth and fifth manuscript of this focus on concern stabilization techniques of the anterior pelvic ring. Godinsky et al. compare stability of locked versus non-locked symphysial plating of unstable pelvic ring fractures [4]. They used an unstable pelvic ring model with a iliosacral dislocation and symphysis pubis disruption. The iliosacral dislocation was fixed with an iliosacral screw. Antero-posterior displacement at the pubic symphysis was larger in the non-locked symphysial plating than in locked symphysial plating. Medio-lateral gap and superior-inferior displacement were not significantly different. The higher postoperative stability is an important advantage: it protects against implant loosening or failure and secondary fracture displacemen...

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Biomechanical analysis of anterior pelvic ring fractures with intact peripelvic soft tissues: a cadaveric study

Fensky

Weiser

Sellenschloh

et al. 2019

Eur J Trauma Emerg Surg

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Biomechanical analysis of anterior ring fixation of the ramus in type C pelvis fractures

Abstract: The bicortical, fully threaded 6.5-mm pubic ramus screw was the only anterior fixation construct tested that controlled motion at both the anterior and posterior pelvic rings in the absence of posterior fixation.

Cited by 22 publications

References 24 publications

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture

Focus on high energy pelvic trauma

Biomechanical analysis of anterior pelvic ring fractures with intact peripelvic soft tissues: a cadaveric study

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