Fixation of Crescent Pelvic Fracture in a Tertiary Care Hospital: A Steep Learning Curve

Abstract

BackgroundCrescent fracture-dislocation of sacroiliac joint is a type of lateral compression pelvic injury associated with instability. These fractures comprise 12% of lateral compression fractures.ObjectiveThe objective of this study is to share the experience and to assess the functional outcome of fixation in crescent fracture-dislocation.MethodsWe analyzed a descriptive case series with clinical data of 15 patients at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2016 to August 2018. The patients were treated by closed and open fracture reduction and fixed with percutaneous screws and reconstruction plates.ResultsA total of 15 patients were included in this study with age ranging from 20 to 60 years (11 men [73%]; four women [27%]). According to the mechanism of injury, five (33%) had motorcycle accidents; four (27%) had collision while sitting in a car; three (20%) were pedestrians hit by a vehicle; four (27%) were injured while sitting in van; two (13%) had bus-related injury, and one (6.5%) presented with a history of wall collapse.Five (33%) patients had type I fractures, seven (47%) had type II fractures, and three (20%) had type III fractures Associated injuries were midshaft femur fracture in two patients, contralateral superior and inferior rami fracture in three patients, and open tibia fracture in one patient. All fractures were fixed with reconstruction plates and screws. Patients were kept as non-weight-bearing on the injured joint for three weeks, mobilized non-weight-bearing on the contralateral leg after three weeks, and partial weight-bearing was started at eight weeks; full weight-bearing was started after three months. Nine patients (60%) had excellent outcomes, three (20%) had a good outcome, and three (20%) had a poor outcome.ConclusionCrescent fracture-dislocations are unstable injuries. These fractures should have proper reduction and fixation that will reduce pain, malunion, and shortening.

Intelligent robot-assisted fracture reduction system for the treatment of unstable pelvic fractures

“…Open reduction, freehand closed reduction, and frame-assisted reduction are all overly dependent on the surgeon’s experience and technique. Open reduction is associated with elevated levels of damage, higher blood loss, extended recovery time, lower satisfaction with reduction outcomes, and elevated rates of complications and disability [ 20 , 21 ]. Conventional fluoroscopy-guided freehand closed reduction is only applicable to fractures with minimal displacement and relatively simple fractures.…”

Intelligent robot-assisted fracture reduction system for the treatment of unstable pelvic fractures

“…This approach is associated with elevated levels of damage, increased complexity, higher blood loss, extended recovery times, lower satisfaction with reduction outcomes, and elevated rates of complications and disability. Moreover, it excessively relies on the surgeon's experience [20,21]. In contrast, closed reduction can optimize the operation time, mitigate the risk of infection, and minimize blood loss as well as vascular and nerve damage [22,23].…”