Is Closed Reduction and Percutaneous Fixation of Unstable Posterior Ring Injuries as Accurate as Open Reduction and Internal Fixation?

Lindsay, Adam; Tornetta, Paul; Diwan, Amna; Templeman, David C.

doi:10.1097/bot.0000000000000418

Cited by 45 publications

(35 citation statements)

References 15 publications

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“…Complex pelvic fractures with polytrauma are associated with a very high mortality rate, approximately 18%, and should thus be treated with damage control [9]. The efficacy of the Starr Frame for pelvic closed reduction and percutaneous fixation has been clinically verified [10]. However, fracture reduction using this device still has limitations.…”

Section: Discussionmentioning

confidence: 99%

Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Zhang

et al. 2019

J Orthop Surg Res

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BackgroundSacral fracture and sacral nerve injury remain problems in orthopedics, especially in a sacral fracture combined with an anterior sacral nerve injury. Treating a sacral nerve injury with open reduction neurolysis or more conservative treatment cannot meet the clinical needs. Open reduction sacral nerve neurolysis will increase the number of severe, life-threatening injuries, regardless of whether the anterior or posterior approach is used. In recent years, computer- and robot-assisted orthopedic surgery has emerged as part of many clinical treatments.MethodsFor an unstable pelvic fracture with an anterior sacral nerve injury, we established a comprehensive and integrated solution. To achieve closed reduction, minimally invasive fixation, and minimally invasive anterior sacral nerve neurolysis, the Starr Frame, navigation robot, and Da Vinci robot were jointly applied.ResultsThe Starr Frame is very helpful for closed reduction percutaneous fixation in complex pelvic fractures. In this study, a minimally invasive fixation technique for the navigation robot in the pelvic fracture was explored. Although the patient had delayed anterior sacral nerve compression pain after surgery, we developed an approach and surgical method using the Da Vinci robot to explore the sacral nerve by celiac decompression. The patient was relieved of nerve pressure and pain.ConclusionsThis treatment method could be an alternative treatment for pelvic fractures and sacral nerve injury. The application of this treatment is a safe and feasible option that can be employed to manage early and late nerve repair with sacral fractures when open surgery or conservative treatment is unsuitable.

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Section: Discussionmentioning

confidence: 99%

Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Zhang

et al. 2019

J Orthop Surg Res

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“…As a consequence, percutaneous and minimal-invasive techniques have become popular and have been reported to result in low complication rates and good clinical outcomes [5][6][7].…”

Section: Ormentioning

confidence: 99%

“…Six weeks postoperatively, she was without pain and could ambulate on two sticks, her Timed Up & Go took 10 seconds without aids. At five months (Figure 6), she still had no pain and could ambulate without aids and without limitations (Timed Up & Go: 9 seconds without aids).DiscussionPercutaneous screw fixation of iliac wing fractures (Young & Burgess LC2) has become an established technique and good results have been described by several authors[2,7,9]. In conventional surgical treatment of lateral compression fractures radiographic imaging in several positions has to be done prior to the operation to plan the exact positioning of the screws.…”

mentioning

confidence: 93%

Guide wire insertion for percutaneous LC2 screws in acetabular and pelvic ring fixation using a transpedicular working cannula

Scherer¹,

Guy

Lefaivre

et al. 2017

Injury

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Closed reduction and percutaneous screw fixation (CRIF) of iliac crescent fractures and fractures of the anterior column of the acetabulum has become an established method in the treatment of these injuries. After reduction, safe insertion of a guide wire is a key step during this procedure. We present a technique that can facilitate introducing the guide wire under fluoroscopic guidance and allow for decreased radiation exposure.

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“…However, successful closed reduction of a three-dimensional (3D) multidirectional pelvic deformity is difficult to achieve [12,13]. Additionally, inadequate reduction may lead to residual displacement, which can cause adverse long-term outcomes [14,15]. McLaren et al [16] and Lindahl et al [17] reported that a residual deformity greater than 10 mm was a sign of poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Radiological measurement of pelvic fractures using a pelvic deformity measurement software program

Zhang

et al. 2020

J Orthop Surg Res

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Background: It is difficult for the surgeon to measure pelvic displacement in the closed reduction operation for unstable pelvic fracture. We therefore developed a pelvic deformity measurement software program based on standardized radiographs. The objectives of the present study were to evaluate the inter-observer reliability of the program for measuring specific fracture types on preoperative pelvic films and to assess the validity of the measurement software program by comparing it with a gold standard. Methods: Twenty-five patients diagnosed with AO/OTA type B or C pelvic fractures with the unilateral pelvis fractured and dislocated were included in this study. Four separate observers repeatedly determined the translational and rotational patterns and outcomes using the software program and hand measurement, and calculated the displacement using computed tomography (CT) coupled with a three-dimensional (3D) CT model. The validity of the measurement software was calculated by assessing the consistency between the software measurements and the gold standard. Additionally, inter-observer reliability was assessed for the software. The software was also applied in preliminary clinical practice for closed reduction procedures. Results: The overall inter-observer reliabilities of the software program, CT coupled with 3D reconstruction, and hand measurements were high, with kappa values of 0.956, 0.958, and 0.853, respectively. The software showed validity similar to that of CT coupled with 3D reconstruction (0.939 vs. 0.969), and better than that of hand measurement (0.939 vs. 0.858). A preliminary clinical application demonstrated that the software is effective for guiding closed reduction of pelvic fractures. Conclusions: Our newly established pelvic deformity measurement program is a reliable and accurate tool for analyzing pelvic displacement patterns and can be used for guidance of closed reduction and planning of the reduction pathway.

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Is Closed Reduction and Percutaneous Fixation of Unstable Posterior Ring Injuries as Accurate as Open Reduction and Internal Fixation?

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 45 publications

References 15 publications

Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

Guide wire insertion for percutaneous LC2 screws in acetabular and pelvic ring fixation using a transpedicular working cannula

Radiological measurement of pelvic fractures using a pelvic deformity measurement software program

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