Biplanar Posterior Pelvic Fixator for Unstable Sacral Fractures: A New Fixation Technique

Abo-Elsoud, M.; Eldeeb, Said; Gobba, Mohamed; Sadek, Fouad

doi:10.1097/bot.0000000000001101

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…LPF To evaluate the clinical outcomes of traumatic spino‐pelvic dissociation (TSD) treated with modified bilateral triangular fixation rca n = 18 14m/4f Falling: 16 mva: 2 all sacral fractures had associated injuries U‐shaped fractures: 10 H‐shaped fractures: 6 Y‐shaped fractures: 2 Roy–Camille classification: type II: 12 type III: 6 sacral plexus decompression: 6 cases n/a Futamura et al (2018)/ International Orthoaedics 38 mod. LPF To describe the procedure and outcomes of a new approach, which we refer to as “within ring”-based sacroiliac rod fixation (SIRF) rca n = 15 10m/5f Fall:7 mva: 5 Compression by a heavy item:3 AO/OTA class: 61-B2.3: 1 C1.3: 4 C2.3: 7 C3.3: 1 H-type spinopelvic dissociation: 2 16.9 (9–30) Chou et al (2018)/Journal of the American Academy of Orthopaedic Surgeons 39 MIS-LPF To present a series of spinopelvic dissociation cases from a level I trauma center rca n = 18 n/a None of the patients underwent open spinal surgical decompression n/a Abo-Elsoud et al (2018)/Journal of Orhtopaedic Trauma 40 mod.LPF To preset a modified biplanar posterior pelvic fixation technique in patients with unstable sacral fractures rca n = 16 9m/7f Patients with unilateral vertical sacral fractures showing fracture comminution, gaps, vertical instability, and/or disruption of the L5/S1 facet joint n/a Shah et al (2019)/Cureus 41 MIS-LPF To analyze the outcome and complications of patients who underwent minimally invasive lumbopelvic fixation to treat unstable U-type sacral fractures rca n = 10 n/a Adult patients with U-type or vertical shear fra...…”

Section: Resultsmentioning

confidence: 99%

Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Yılmaz

Hoffmann

Glinski

et al. 2020

Sci Rep

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The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

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Section: Resultsmentioning

confidence: 99%

Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Yılmaz

Hoffmann

Glinski

et al. 2020

Sci Rep

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“…Lumbopelvic fixation and iliosacral screws are currently popular fixation methods. However, both have their limitations and deficiencies 19–24 . Lumbopelvic fixation cannot fix the sacral fracture directly, which leads to a relatively high rate of non‐union because of the excessive motion of the sacrum and malunion caused by re‐displacement of the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…However, both have their limitations and deficiencies. 19 , 20 , 21 , 22 , 23 , 24 Lumbopelvic fixation cannot fix the sacral fracture directly, which leads to a relatively high rate of non‐union because of the excessive motion of the sacrum and malunion caused by re‐displacement of the fracture. Meanwhile, iliosacral screws cannot simultaneously ensure reduction and fixation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Unstable Sacral Fractures with Robotically‐aided Minimally Invasive Triangular Fixation

Tian,

Jia,

Zheng

et al. 2023

Orthopaedic Surgery

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ObjectiveThe treatment of unstable sacral fractures is huge challenge to surgeons. Robotically‐aided minimally invasive triangular fixation (RoboTFX) is the most advanced technique up to now. This study is to evaluate the clinical outcomes of unstable sacral fractures treated with RoboTFX.MethodsFrom March 2017 to October 2021, 48 consecutive patients with unstable sacral fractures were included in the study. All patients received surgical treatment with triangular fixation (TFX). Patients were divided into four groups according to the number of fractures (uni‐ or bilateral) and surgical method employed (RoboTFX or traditional open TFX). Between these four groups, clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, infection rate, fracture healing rates, insertion accuracy, Majeed pelvic outcome score, Mears' criterion, and Gibbons score were compared. Quantitative data were expressed as mean ± standard deviation and compared using Student's t‐test. Categorical variable were compared using the Pearson's χ2 test.ResultsComparing unilateral RoboTFX versus open TFX, neither fracture healing rate, infection rate, Majeed pelvic outcome score, Mears' radiological evaluation criterion, nor Gibbons score of the two groups were statistically significantly different (p > 0.05). However, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and insertion accuracy in the RoboTFX group were all significantly better than those of the traditional open group (p < 0.05). Likewise, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and accuracy of fixation insertion of the bilateral RoboTFX group were significantly better than those of the bilateral open group (p < 0.05). Meanwhile infection rate, fracture healing rate, Majeed score, Mears' criterion, and Gibbons score of two groups were not significantly different (p > 0.05).ConclusionRoboTFX has the advantages of less operation time, less intraoperative bleeding and fluoroscopy, more accurate fixation insertion, and a higher healing rate compared to traditional open methods in the treatment of unstable sacral fractures. However, RoboTFX requires a few critical considerations, and the indications of its operation should be strictly evaluated.

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“…Sacral fractures with vertical displacement are one of the type C pelvic fractures, which are often caused by high-energy injuries and are frequently associated with multiple injuries [ 1 ]. In the early stage, the treatment of life-threatening bleeding and associated injuries is predominant, and the reduction of pelvic fractures is absent.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the above reasons, we used sacral osteotomy combined with triangular osteosynthesis to treated nine patients with pelvic malunion and nonunion originating from sacral fractures from April 2015 to January 2020. In this study, we retrospectively reviewed these data to (1) present the surgical technique of sacral osteotomy and (2) analyze the clinical effect of this treatment from the clinical and radiological aspects.…”

Section: Introductionmentioning

confidence: 99%

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures

Luo

et al. 2022

J Orthop Surg Res

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Background Malunion and nonunion of vertically displaced pelvic fractures result in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery for these old pelvic fractures. We present a surgical technique of sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results. Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and triangular osteosynthesis from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral hemipelvis was 3.0–4.5 cm (average, 3.80 cm). According to AO/OTA classification at the initial fracture, there are eight cases in type C1.3 and one case in type C3.3. Sacral osteotomy and triangular osteosynthesis were used in all nine patients. The degree of unilateral hemipelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. Majeed score and pain visual analog scale (VAS) were used to assess the therapeutic effect of the patients during follow-up. Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7–3.9 cm (average, 3.20 cm). All the patients were followed up for 6–36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30–84 points) preoperatively to 87.0 points (72–94 points), and the VAS score for pain decreased from an average of 6.0 points (4–8 points) preoperatively to 1.2 points (0–3 points). None had complications like infection, implant broken, screw loosening, iatrogenic nerve, and blood vessel injury. Conclusion Sacral osteotomy combined with triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fractures can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, achieving good clinical results.

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Biplanar Posterior Pelvic Fixator for Unstable Sacral Fractures: A New Fixation Technique

Cited by 5 publications

References 21 publications

Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Treatment of Unstable Sacral Fractures with Robotically‐aided Minimally Invasive Triangular Fixation

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures

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