Lateral Compression Type 2 Pelvic Fractures—A Clinical Study of Fracture Displacement Measurement and Closed Reduction

ObjectiveClosed reduction of pelvic injuries is a prerequisite and critical step in minimally invasive treatment. Achieving non‐invasive closed reduction of pelvic injuries is a challenging clinical problem. This study demonstrated a non‐invasive traction technique for closed reduction called countertraction closed reduction technique (CCRT) and evaluated its effectiveness for type C pelvic ring injuries.MethodThe data of patients with unstable pelvic fractures treated with CCRT and minimally invasive fixation were retrospectively reviewed from January 2017 to February 2022. Sacroiliac screws were placed to fix the posterior pelvic ring, and internal or external fixation was used to fix the anterior pelvic ring. Operation time, intraoperative blood loss, duration of hospital stay, fracture union and postoperative complications were recorded. Fracture reduction quality was evaluated using the Matta scoring criteria. Functional recovery and general quality of life were evaluated using the Majeed functional scoring criteria.ResultsThirteen patients (nine males and four females), with an average age of 49.6 years were treated with CCRT and followed up for a mean of 18.5 months. The average operation time was 137.2 minutes (range 92–195 minutes), the average intraoperative blood loss was 31.2 mL (range 10–120 mL) and the average duration of hospital stay was 14.3 days (range 4–32 days). All patients achieved bony union with an average union time of 11.9 weeks (range 10–16 weeks). According to the Matta radiographic criteria, the quality of fracture reduction was excellent in eight patients, good in four, and fair in one. The average Majeed functional score was 89.7 (range 78–100). The functional evaluation revealed that the outcomes were excellent in nine patients, and good in four patients. Complications included incision fat liquefaction in one patient, and heterotopic ossification in another patient. There were no surgical complications as a result of CCRT.ConclusionCCRT is a non‐invasive closed reduction method for minimally invasive fixation of fresh Tile C1 and C2 pelvic fractures. The advantages of CCRT combined with minimally invasive treatment include a small surgical incision, reduced intraoperative bleeding, satisfactory fracture reduction, bone healing and functional recovery.

Section: Discussionmentioning

confidence: 53%

A Countertraction Closed Reduction Technique in Minimally Invasive Fixation of Recent Type C Pelvic Ring Injuries

Liu,

Zhao,

Cheng

et al. 2024

“…Femoral transcondylar traction was applied using a rigid traction system. A pelvic UCRT frame was connected to the operating table, and a connecting rod was used to stabilize the spatial reduction construct for each pelvic fracture 20,24,25 …”

Section: Methodsmentioning

confidence: 99%

“…A pelvic UCRT frame was connected to the operating table, and a connecting rod was used to stabilize the spatial reduction construct for each pelvic fracture. 20,24,25 Notice 1. When installing the connecting rods of a pelvic UCRT frame, whether the connecting rods will prevent the C-arm from obtaining images of the outlet and inlet views of the pelvis should be considered.…”

Section: Installation Of Pelvic Unlocking Closed Reduction Technique ...mentioning

confidence: 99%

A New Technology Using Mixed Reality Surgical Navigation with the Unlocking Closed Reduction Technique Frame to Assist Pelvic Fracture Reduction and Fixation: Technical Note

Li,

Qi,

Liu

et al. 2023

Self Cite

BackgroundPelvic ring disruption (PRD) is a serious trauma associated with high mortality and disability rates. Poor reduction can lead to complications such as pelvic deformity and delayed fracture healing. Here, we introduce a new technology using mixed reality surgical navigation (MRSN) with an unlocking closed reduction technique (UCRT) frame to assist pelvic fracture reduction and fixation.MethodsThirty patients with PRD were enrolled in this study. All of the patients underwent preoperative CT scans, with the pelvis and tracker segmented into three‐dimensional models. Under MRSN guidance, auxiliary reduction screws were inserted to grasp the pelvic bone. An ideal trajectory for closed reduction was planned, and suitable CS screws were used for stable fixation after good reduction. Operation time, fluoroscopy frequency, and both Matta and Majeed scores were analyzed.ResultsThe mean follow‐up period was 10.8 months (7.5, 12.25 months) (range 6–24 months). The average duration of operation was 212.5 min (187.5, 272.8 min) (range 133–562 min), and the average reduction time was 23.0 min (15.0, 42.5 min) (range 10–70). The average fluoroscopy frequency was 34.0 times (31.5, 52.5 times) (range 23–68 times). One hundred and fifty screws were successfully inserted on the first attempt. All the fractures healed well with no complications. Excellent reduction quality (Matta score ≤4 mm) was achieved in 29/30 cases, and good reduction quality (Matta score between 4 and 10 mm) was achieved in 1/30 cases. All patients achieved bone healing after an average of 4.0 months (3.5, 5.9 months) (range 3–6), as well as good function recovery with an average Majeed score of 91.0 (87.8, 95.0) (range 71–100).ConclusionThe MRSN technique described improved reduction accuracy and radiation exposure without considerable extension of operation time.

“…This involves stabilization of the intact hemipelvis and application of lateral traction, flexion/extension, and rotation through Schanz pins inserted into the ilium and connected to the frame. In addition, their team 2 divided lateral compression type 2 Pelvic Fractures into two different kinds of fracture displacement: internal displacement only and a combination of internal, cephalic, and dorsal dislocation through the sacroiliac joint. Two different closed reduction strategies were suggested: the former one was first longitudinal traction and then transverse traction; the latter was first transverse traction then longitudinal and LC2 traction.…”

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confidence: 99%

“…Since 2014, they have led a national multi-center UCRT study of pelvic fracture in China, which has treated 454 patients and achieved good results. [1][2][3][4] Tang and Chen are the pioneers in China, who have pushed the minimally invasive techniques of pelvic fracture forward in China. Much of the recent world literature on this topic has come from China.…”

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confidence: 99%

Pelvic Reduction Frame Facilitating Percutaneous Fixation to Pelvic Fractures

Anglen

2023

This article is a retrospective report of the outcome of 43 unilateral unstable, vertically displaced pelvic ring injuries using a reduction frame which is attached to the OR table, along with special instruments allowing “unlocking” of the fracture to facilitate reduction. The frame utilized by the authors is a modification of the Starr Frame® (Starr Frame, LLC, Richardson), which has been refined to be lower profile, more accessible, and more versatile in pin placement. They have also reported a new attachment for the frame to apply lateral traction to the fractured hemipelvis. The authors provide a detailed description of the techniques involved in securing the patient to the frame and table, and then the stepwise application of multiplanar tractions to the fractured hemipelvis. Their technique of unlocking closed reduction (UCRT) involved controlled application of lateral distraction to disimpact the compressed or overlapping fractured bone surfaces, followed by distal and anterior traction through a femoral supracondylar pin, and direct manipulation of the hemipelvis through a supracetabular “LC‐2” half pin. Reduction is followed by percutaneous fixation using 7.3‐mm cannulated screws across the posterior ring and either external fixation or subcutaneous supra‐acetabular pedicle screw internal fixation device (INFIX) anteriorly.