Pelvic Disruption: Principles of Management

Tile, Marvin; Pennal, George F.

doi:10.1055/s-0028-1100841

Cited by 41 publications

(67 citation statements)

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“…In our treatment algorithm, we used only one screw in all patients. In the classification of Tile and Pennal [29], a Type B fracture is defined as unstable for rotational movement and a Type C fracture is defined as unstable for vertical and rotational movements because of the disturbance of the integrity of the pelvic ring. Even with no or minimal dislocation, these fractures are unstable and have a high risk of dislocation under weightbearing.…”

Section: Discussionmentioning

confidence: 99%

“…We prospectively collected the data of our patients with unstable fractures of the posterior pelvic ring, including only Types B and C fractures according to the classification of Tile and Pennal [29]. Even with minimal or no dislocation, all Tile and Pennal Types B and C fractures are unstable and have a high risk of dislocation under weightbearing.…”

Section: Methodsmentioning

confidence: 99%

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Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Zwingmann¹,

Konrad²,

Kotter³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

150

110

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Insertion of percutaneous iliosacral screws with fluoroscopic guidance is associated with a relatively high screw malposition rate and long radiation exposure. We asked whether radiation exposure was reduced and screw position improved in patients having percutaneous iliosacral screw insertion using computer-assisted navigation compared with patients having conventional fluoroscopic screw placement. We inserted 26 screws in 24 patients using the navigation system and 35 screws in 32 patients using the conventional fluoroscopic technique. Two subgroups were analyzed, one in which only one iliosacral screw was placed and another with additional use of an external fixator. We determined screw positions by computed tomography and compared operation time, radiation exposure, and screw position. We observed no difference in operative times. Radiation exposure was reduced for the patients and operating room personnel with computer assistance. The postoperative computed tomography scan showed better screw position and fewer malpositioned screws in the three-dimensional navigated groups. Computer navigation reduced malposition rate and radiation exposure. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Zwingmann¹,

Konrad²,

Kotter³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

150

110

View full text Add to dashboard Cite

show abstract

“…From the eight studies [1,4,11,16,42,59,67,68] (245 patients) that used the Tile and Pennal classification system [63], 88.1% (200) of the patients had initially Type C pelvic fractures. In the 13 studies [1, 11, 17-19, 25, 31, 32, 40, 46, 47, 51, 69] (111 patients) in which the Young and Burgess system [10] was used, vertical shear was the most common mechanism of injury (44.1%, 49 patients).…”

Section: Predisposing Factors For Development Of Malunion/ Nonunionmentioning

confidence: 99%

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Kanakaris

Angoules

Nikolaou

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although acute management of pelvic fractures and their long-term functional outcome have been widely documented, important information regarding malunion and nonunion of these fractures is sparse. Despite their relative rarity, malunions and nonunions cause disabling symptoms and have major socioeconomic implications. We analyzed the factors predisposing a pelvic injury to develop malunion/nonunion, the clinical presentation of these complications, and the efficacy of the reported operative protocols in 437 malunions/nonunions of 25 clinical studies. Treatment of these demanding complications appeared effective in the majority of the cases: overall union rates averaged 86.1%, pain relief as much as 93%, patient satisfaction 79%, and return to a preinjury level of activities 50%. Nevertheless, the patient should be informed about the incidence of perioperative complications, including neurologic injury (5

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“…Tile [5,6] described the role of the major pelvic ligaments. Disrupting the pubic symphysis allows the iliac wings to rotate outward slightly.…”

Section: Biomechanical Considerationsmentioning

confidence: 99%

Severe Pelvic Bleeding: The Role of Primary Internal Fixation

Barootchi

Erdohelyi

2010

Eur J Trauma

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Pelvic ring injuries form part of the spectrum of polytraumaandmust be considered a potentially lethal injury with mortality rates of 10-20%. The stabilization of the unstable pelvic ring in acute resuscitation of multiply injured patients is now conventional wisdom.We aimed: (1) to design a new iliosacral (IS) screw, (2) to prove the clinical advantages of this new implant, and (3) to work out the optimal surgical strategy using this implant. Taking the demands of the above mentioned data into account, a 10 mm 2.8 mm-cannulated iliosacral screw seemed to be optimal for the special requirements. Before industrial production, finite element analysis (FEA) was performed to find out whether these screws would be enough to stabilize the posterior pelvic ring alone or not. Clinical experience led to the modification of the set of instruments, which finally yielded handy tools and implants. Building further on the surgical skills and experiences gained (by the surgeons and the O.R. personnel), we increased our capacity to perform more and more immediate pelvic fixations. Emergency pelvic stabilizationswere performed in patientswith pelvic injuries who had hemodynamic instability, despite immediate shockmanagement during the diagnostic period. During thelast eleven years, 244 patientswith Tile B3 and Cpelvic injuries have been stabilized with 10-mm diameter cannulated IS screws percutaneously posteriorly. Fortyeight hemodynamically unstable patientswere stabilized in the first 2 h with iliosacral screw fixation. The percutaneous pelvic ring stabilization with 10-mm cannulated screws provedstrongenoughin bothersome casesaswell.

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Pelvic Disruption: Principles of Management

Cited by 41 publications

References 0 publications

Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Severe Pelvic Bleeding: The Role of Primary Internal Fixation

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