Prospective study of fluoroscopy guided cannulated screw fixation in pelvic ring and acetabulum fractures through percutaneous or mini incision technique

Abstract

Open reduction and Internal fixation of pelvis and acetabulum fractures have required extensive surgical exposure of the deep structures of the pelvis, with problems of wound healing, damage to major vessels or nerves and infection. To overcome this percutaneous fixation of the pelvic and acetabulum fracture receiving increasing attention. Percutaneous techniques may offer advantage of soft tissue planes remain intact, which ease later arthroplasty of the hip if necessary. Percutaneous techniques may be an ideal treatment for pelvic and acetabulum in polytrauma. Advantages for percutaneous screw fixation of pelvic and acetabular fractures in these studies include less soft tissue injury, less blood loss, and a lower rate of infection. Furthermore, early weight bearing ambulation will be possible with percutaneous screw fixation. Neurovascular injuries, internal organ injuries, screw misplacement, and screw fracture are some potential complications of this technique. Aim: To investigates the clinical and radiological outcomes and complications of percutaneous screw fixation of Pelvic ring fracture and acetabulum fracture. Study design: Hospital based prospective type of observational study. Materials and Methods: After taking clearance from ethical committee a total 54 patient operated for 62 fractures and 95 cc screw were inserted through different percutaneous and mini incision (windows) approach for fracture of pelvis and acetabulum were operated based on preoperative CT SCAN in between January 2019 to November 2020. The pelvis and acetabulum fractures were classified based on young -burgess and judet-letournel classification system. The outcome variables for radiological outcome was evaluated by matta radiological score and functional outcome were evaluated by Harris hip score and Majeed pelvis score at 6 and 12 months follow up. Results: In post-operative follow up patient were started with active range of motion without weight bearing for 3 months then partially weight bear as tolerated after 3 months the respective functional Harris hip score, Majeed score were obtained at 6 and 12 months of follow up with p value of <0.001 suggesting highly significant. Matta radiological score was obtained at 12 months follow up with p value <0.001 suggesting highly significant. Conclusion: From our study we conclude that, treatment of pelvis fractures and acetabulum fracture through percutaneous approach is a challenging task for any orthopaedic surgeon with a definitive learning curve. Good preoperative evaluation, operative planning, surgical technique described above in our study, the use of 6.5 mm long cc screw in a fracture displacement of anterior column, posterior column and SI joint by buttressing of the fracture a good clinical and radiological outcome can be obtained. With good postoperative protocol and early rehabilitation it is possible to obtain improved outcome.