Outcome After Fixation of Unstable Posterior Pelvic Ring Injuries

Cole, James; Blum, David; Ansel, L. J.

doi:10.1097/00003086-199608000-00020

Cited by 189 publications

(142 citation statements)

References 18 publications

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“…This is in line with the functional outcome reported after SI screw fixation. Lindahl and Hirvensalo reported 83% of patients having excellent or good results following SI screw fixation [13], and Cole et al reported 70.6% of patients with none or only minor functional deficits [5]. As reported by Lindahl and Hirvensalo, post-traumatic pain appeared to be the main driver for the majority of fair results, which accords with our patient population [13].…”

Section: Discussionsupporting

confidence: 88%

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

Kobbe

Hockertz

Sellei³

et al. 2011

International Orthopaedics (SICOT)

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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.

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Section: Discussionsupporting

confidence: 88%

“…Internal fixation is the method of choice for the definitive treatment of unstable posterior pelvic-ring injuries [5,10,12,24]. Currently, percutaneous screw fixation of the sacroiliac (SI) joint seems to be the most promising method [4,14,15,27].…”

Section: Introductionmentioning

confidence: 99%

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

Kobbe

Hockertz

Sellei³

et al. 2011

International Orthopaedics (SICOT)

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“…According to Tornetta and Matta [40], reduction is graded as excellent if it is 4 mm or less and good if between 4 mm and 10 mm remaining displacement is achieved. Their suggestion is supported by a study of 64 patients with dorsal pelvic ring injuries in which displacement of 4 mm or greater was linked to increased probability for severe pain and decreased function [5]. Lindahl and Hirvensalo suggested a patient could have a maximum of 5 mm displacement with high functional scores [22].…”

Section: Discussionmentioning

confidence: 97%

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Dienstknecht

Berner

Lenich

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Open reduction and stabilization of dorsal pelvic ring injuries is accompanied by a high rate of soft tissue complications. Minimally invasive techniques have the potential to decrease soft tissue trauma, but the risk of iatrogenic nerve and vessel damage through the reduced surgical exposure should be considered. We treated these injuries using a transiliac internal fixator (TIFI) in a minimally invasive technique characterized by implantation of a pedicle screw and rod system, bridging the sacroiliac joints and the sacral area. Questions/purposes We asked whether (1) we could achieve anatomic restoration with the device, (2) specific complications were associated with this minimally invasive approach (particularly enhanced intraoperative blood loss, soft tissue complications, and iatrogenic neurovascular damage), and (3) function 3 years after trauma was comparable to that of established methods. Methods We retrospectively reviewed 67 patients with dorsal pelvic injuries during a 7-year period. We evaluated the (1) reduction by grading the maximal displacement measured with three radiographic views, (2) the complications during the observation period, and (3) the function with a validated questionnaire (Pelvic Outcome Score) in all but five patients at least 3 years after trauma (mean, 37 months; range, 36-42 months). Results At last followup we observed a secondary fracture displacement greater than 5 mm in one patient. The intraoperative blood loss was less than 50 mL in all patients. No neurovascular lesions occurred owing to implantation. Four patients had wound infections, one had loosening of a single pedicle screw, and one had an iatrogenic screw malpositioning. Thirty-five of the 62 patients achieved Pelvic Outcome Scores of either a maximum score or 6 of 7 points. Conclusion Our observations suggest TIFI is a reasonable alternative to other established fixation devices for injuries of the dorsal pelvic ring with minor risks of major blood loss or iatrogenic neurovascular damage.

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“…Cole and Bolhofner (1994) have used a limited Stoppa intrapelvic approach in the treatment of acetabular fractures, and later, Cole et al (1996) used it for treatment of pelvic fractures-as it provides a similar intrapelvic view. With the current technique, there was no need for dissection or separation of the inguinal neurovascular structures as is the case in the ilioinguinal approach (Letournel and Judet 1993).…”

Section: Discussionmentioning

confidence: 99%

Outcome of operatively treated type-C injuries of the pelvic ring

2005

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Background Internal fixation has become the preferred treatment for type-C pelvic ring injuries, but controversies persist regarding surgical approach and surgical technique.Patients We evaluated 101 consecutive patients with type C1-C3 pelvic ring injuries who had been treated with standardized reduction and internal fixation techniques.Results Our findings suggest a correlation between excellent reduction followed by sufficient fixation of the pelvic ring and functional outcome. Unsatisfactory reduction (displacement > 5 mm), failure of fixation, loss of reduction and a permanent lumbosacral plexus injury were the commonest reasons for an unsatisfactory functional result. All 40 patients with an associated lumbosacral plexus injury showed at least some evidence of neurological recovery. 14 underwent complete neurologic recovery. 8 had only sensory deficits and the remaining 18 also had motor deficits at the final followup. Complications were rare, but some of them were severe: loss of reduction in 8%, malunion in 10%, deep wound infection in 2%, and a lesion of the L5 nerve root in 1%.Interpretation Our results suggest that special attention should be paid to preoperative planning, reduction of the fracture, decompression of the nerve roots, and fixation of the most severe sacral fractures. Our results seem to favor internal fixation of displaced (> 10 mm) and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation, to achieve better stability of the whole pelvic ring.

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Outcome After Fixation of Unstable Posterior Pelvic Ring Injuries

Cited by 189 publications

References 18 publications

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

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

A Minimally Invasive Stabilizing System for Dorsal Pelvic Ring Injuries

Outcome of operatively treated type-C injuries of the pelvic ring

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