Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial

Moussa, Islam Sayed; Sallam, Ahmed Mohammed; Mahmoud, Amr; Elzaher, Elzaher Hassan; Nagy, Amr Mohammed

doi:10.1016/j.cjtee.2022.06.003

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…However, based on various studies, sacroiliac joint screw fixation alone for Tile B2 and C pelvic ring lesions met the same therapeutic objectives with positive outcomes, particularly for vertically unstable pelvic ring injuries. Operative time, haemorrhage, and infection risk were all reduced as compared to open reduction internal fixation treatment [16]. The risk of screw implant deviation is relatively high while doing traditional manual percutaneous pedicle screw implant surgery because it is challenging to properly control the angle of screw insertion.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of “TiRobot”orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint

Zhu²,

Xiao³

et al. 2022

International Orthopaedics (SICOT)

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Purpose This study is to compare the precision and safety of the orthopaedic robot with conventional fluoroscopy for assisted percutaneous sacroiliac joint screw implantation. Methods Retrospective analysis was performed on the clinical data of 57 patients with unstable posterior pelvic ring injuries who were admitted and met the criteria between January 2017 and January 2022. All of these patients underwent percutaneous sacroiliac joint screw implantation, and their clinical data were split into two groups based on the surgical technique: a RA group (robot-assisted implantation, 30 patients, 54 screws) and a CF group (conventional fluoroscopic freehand implantation, 27 patients, 42 screws). There were 96 screws placed in total. The durations of the two groups’ operations, fluoroscopy examinations, fluoroscopy doses, total number of fluoroscopies, and intra-operative guide pin applications were noted and compared. On post-operative CT scans, the placement of each screw was assessed using the Gertzbein-Robbins classification. Finally, imaging Matta criteria were used to assess the sacroiliac joint fracture reduction. The Majeed functional score was used to assess clinical function. Results Both groups successfully completed 57 procedures in total. In both groups, there were no consequences from vascular injury, wound infection, or urinary tract infection. Additionally, there were no complications from robotic-induced nerve injury, operating time, fluoroscopic dose, and the frequency of fluoroscopic; the number of percutaneous punctures in the RA group was lower than that of the CF group.There were statistically significant differences between the aforementioned data (P < 0.05). The modified Matta evaluated the effectiveness of fracture reduction. In the RA group, there was no statistically significant difference between the CF group (P > 0.05). According to the modified Gertzbein-Robbins classification criteria, the 54 screws implanted in the RA group were classified as follows: class A (45), class B (5), class C (4), and class D (0); the accuracy rate of the implants was 92.59%. Forty-two screws implanted in the CF group, 30 screws were defined class A, class B (3), class C (7), and class D (2). The accuracy rate of the implants was 78.57%(χ2 = 3.967, P < 0.05). There was a statistically significant difference between the two groups. The Majeed score 30 patients in RA group, one month post-operation, 16 considered exceptional, eight decent, six moderate, and zero bad. Post-operation more than six months,25 recorded exceptional, five decent. By the time,27 patients in CF group,12 exceptional grade, eight decent, six moderate, and one bad,one month post-operation. Post-operation more than six months,22 recorded exceptional, five decent.Both group (P > 0.05). Conclusion “TiRobot” robot-assisted screw implant treatment for unstable posterior pelvic ring injury has a greater success rate than traditional surgery as compared to conventional percutaneous screw implant. It is a precise, secure, and minimally invasive surgical technique that can also be applied to severe pelvic injuries even congenital sacral deformities.

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Section: Discussionmentioning

confidence: 99%

The efficacy of “TiRobot”orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint

Zhu²,

Xiao³

et al. 2022

International Orthopaedics (SICOT)

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“…There is no consensus on the long-term outcomes of adding anterior stabilisation to posterior fixation in pelvic fractures. Therefore, it may be encouraging to many surgeons to opt for posterior fixation using the ilioilial fixator alone if the achieved reduction is accepted, rather than changing the position and starting from the first for anterior stabilisation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Ilioilial Fixator Versus Percutaneous Iliosacral Screw in Managing Unstable Sacral Fractures: A Prospective Randomised Controlled Study

Shaalan,

El Zaher,

Farag

et al. 2024

Cureus

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Introduction: Unstable sacral fractures with pelvic fractures are challenging to both surgeons and patients, particularly in the immediate post-injury phase and later when definitive fixation is undertaken. Percutaneous iliosacral screw fixation is widely regarded as the gold standard treatment for unstable sacral fractures without spinopelvic dissociation. Closed reduction and percutaneous fixation using iliosacral screws for sacral fractures provide early stabilisation without the need for extensive surgical exposure, thereby mitigating major complications associated with open surgical procedures. A new technique for stabilising unstable sacral fractures is the minimally invasive ilioilial fixator, also called a transiliac internal fixator (TIIF), which has gained more attention for its ability to address challenges associated with sacroiliac screw fixation. The objective of this study is to compare the functional, radiological, and surgical outcomes between the percutaneous iliosacral screw and the ilioilial fixator. Methods: A total of 51 patients with sacral fracture injuries sustained between August 2019 and November 2021 were included in this study, with 25 patients in Group A and 26 patients in Group B. Patient randomization was done using computer-generated randomization facilitated by Random Allocation Software (Mahmood Saghaei, Isfahan, Iran). All patients underwent the chosen intervention within 10 days of the trauma. Patients had follow-up at two weeks, six weeks, and 12 months post-treatment. The results of fixation were evaluated radiologically based on the Matta and Tornetta grading system and clinically using the Majeed pelvic scoring system. Complications were detected in both groups during follow-up visits. Results: The study found no statistically significant differences between the two patient groups in terms of final clinical assessment (p=0.79), radiological assessment (p=0.78), or the need for another operation (p=1.0). Moreover, there were no statistically significant differences between the groups with respect to complication rates (p=0.63) or the time of union (p=0.14). No differences were noted in terms of intraoperative blood loss (p=0.93) or operative time (p=0.34) but for longer incision length in the ilioilial fixator group (p<0.001) and an increased risk of intraoperative radiation exposure in the iliosacral screw group (p<00.1). Discussion: Although the iliosacral screw is considered a gold standard for unstable sacral fracture, a TIIF is a good alternative with a very satisfactory outcome. Conclusion: Although the iliosacral screw still remains the gold standard for the management of sacral fractures, the ilioilial fixator emerges as a good alternative with comparable functional and radiological outcomes.

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Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?

Aggarwal,

Patel,

Mehta

et al. 2024

Chinese Journal of Traumatology

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Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial

Cited by 3 publications

References 21 publications

The efficacy of “TiRobot”orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint

The efficacy of “TiRobot”orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint

Percutaneous Ilioilial Fixator Versus Percutaneous Iliosacral Screw in Managing Unstable Sacral Fractures: A Prospective Randomised Controlled Study

Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?

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