Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

Abstract

Purpose Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic-ring injuries; however, this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. This study evaluates whether minimally invasive transiliac locked compression plate stabilisation may be an alternative to sacroiliac screw fixation in unstable posterior pelvic-ring injuries. Methods We performed a retrospective analysis of patients with unstable pelvic-ring injuries treated with a transiliac locked compression plate at a level I trauma centre. Outcome evaluation was assessed using the Pelvic Outcome Score and analysis of complications, intraoperative fluoroscopic time, and duration of the surgical procedure. Results Twenty-one patients were available for follow-up after an average of 30 months. The main findings were as follows: Overall outcome for the Pelvic Outcome Score was excellent in 47.6% (ten patients), good in 19% (four patients), fair in 28.6% (six patients), and poor in 4.8% (one patient). Average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 s. No iatrogenic neurovascular injuries were observed. Conclusion Minimally invasive transiliac locked compression plate stabilisation may be a good alternative to sacral screw fixation because it is quick, safe and associated with a good functional outcome.

The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results

“…As expected, the clinical data of the thorough follow-up of 31 patients (after a mean period of 4.5 years post surgery), including the German pelvic outcome score and SF-12 questionnaire, showed restrictions in quality of life but equivalent or better results when compared to other external and internal osteosynthesis techniques [7,10,20,24]. Nevertheless, these data have less clinical importance, due to the heterogeneity of the study population, the use of different clinical outcome scores and the retrospective analysis.…”

“…At first, it should be noted that our descriptive data (such as age, gender, accident cause, initial GCS and ISS scores) do not show essential differences when compared to other study populations in which the outcome after pelvic fractures has been evaluated [7,8,10,21]. With regard to the technique and application, we would like to refer to our original paper published in 2009 [15], even though we have slightly modified the procedure over the last few years in such a way that the screws are now placed in the supra-acetabular position (Fig.…”

“…In cases of emergency and haemodynamic instability, the pelvic clamp can provide temporary stabilisation [3,4], while there are different options for the definitive repair of the posterior pelvic ring (depending on fracture morphology), such as lumbopelvic and iliolumbar support using a system of rods and screws [5], a sacroiliac screw connection [6] or sacral screw and plates osteosyntheses in various configurations [7,8]. Furthermore, the transiliacal internal fixator (TIFI) represents another stable and minimally invasive option [9,10].…”

Evaluation and Clinical Application of Sacral S1 Vestibule Measurements in Chinese Adults

“…Many fixation methods are currently used to treat posterior pelvic ring injuries clinically (Sagi et al, 2004;Schildhauer et al, 2002Schildhauer et al, , 2003Yinger et al, 2003;Ziran et al, 2003;Vanderschot et al, 2001;Kobbe et al, 2012), and the iliosacral screw (ISS) technique (Ponsen et al, 2006) has been widely used (Cole et al, 1996;Shuler et al, 1995;Sciulli et al, 2007;Gardner & Chip Routt, 2010;Gardner et al, 2009;Zwingmann et al, 2010;Kim et al, 2012;Oh et al, 2008) because of its reliable fixation strength, small wound, decreased bleeding, and low infection rate. Mears & Velyvis (2003) described the pelvis as a "three-column structure."…”

Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury

“…Although this method could also reduce secondary damage to the blood vessels and nerves, it causes the patient discomfort because the steel plate is placed directly under the skin and is palpable (although in the report, they did not receive such complaints from patients); therefore, the authors also believed that the steel plate should be removed after a relatively short period. Moreover, in this fixation method, the steel plate is not tightly attached to the fracture, and the force arm is large; therefore, the fixation is unstable, and there is the possibility of micro-movement in the fracture, which affects fracture healing [17][18][19][20][21]. We treated the 15 patients with pubic ramus MIPO fixation, and with one exception, all of the patients denied discomfort and lived a normal life.…”