Pubic Rami Fractures

Kanakaris, Nikolaos K.; Giannoudis, Peter V.

doi:10.1007/978-1-4471-6572-9_61

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…Regarding the entry point, it has been proven that an antegrade screw placement is less likely to result in fixation failure, when compared to retropubic screw fixation [25]. However, antegrade screw placement requires significantly more soft tissue preparation with associated approach morbidities.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Berk

Schwarzenberg

Pastor

et al. 2023

International Orthopaedics (SICOT)

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Background/purpose Pubic ramus fractures account for the most common types of pelvic fractures. The standard surgical approach for superior pubic ramus fractures (SPRF) is a minimally invasive percutaneous screw fixation. However, percutaneous closed reduction and internal fixation of anterior pelvic ring injuries have high failure rates of up to 15%. The aim of this biomechanical study was to evaluate the stability of SPRF following stabilization with retrograde placed cannulated compression headless screw (CCHS) versus conventional fully and partially threaded screws in an artificial pelvic bone model. Methods SPRF type II as described by Nakatani et al. was created by means of osteotomies in eighteen anatomical composite hemi-pelvises. Specimens were stratified into three groups of six specimens each (n = 6) for fixation with either a 7.3 mm partially threaded cannulated screw (group RST), a 7.3 mm fully threaded cannulated screw (group RSV), or a 7.5 mm partially threaded cannulated CCHS (group CCS). Each hemi-pelvic specimen was tested in an inverted upright standing position under progressively increasing cyclic axial loading. The peak load, starting at 200 N, was monotonically increased at a rate of 0.1 N/cycle until 10 mm actuator displacement. Results Total and torsional displacement were associated with higher values for RST versus CCS and RSV, with significant differences between RST and CCS for both these parameters (p ≤ 0.033). The differences between RST and RSV were significant for total displacement (p = 0.020), and a trend toward significance for torsional displacement (p = 0.061) was observed. For both failure criteria 2 mm total displacement and 5° torsional displacement, CCS was associated with significantly higher number of cycles compared to RST (p ≤ 0.040). Conclusion CCHS fixation presented predominantly superior stability to the standard surgical treatment and could therefore be a possible alternative implant for retrograde SPRF screw fixation, whereas partially threaded screws in group RST were associated with inferior biomechanical stability.

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Section: Discussionmentioning

confidence: 99%

Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Berk

Schwarzenberg

Pastor

et al. 2023

International Orthopaedics (SICOT)

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Suggestions for Introducing Some New Terms in Pelvic and Acetabular Surgery

Zadneprovskiy,

Kulikov,

Vladimirova

et al. 2023

Traumatology and Orthopedics of Russia

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Abstract Background. The rapid development of modern surgical methods for the treatment of pelvic bone fractures has revealed the need to develop a new terminological apparatus, since the classical anatomical terminology of the pelvis no longer meets the demands of today's therapeutic and scientific processes. The classical set of anatomical names and landmarks does not allow for a detailed description of all the nuances of injuries and new complex surgical techniques. Aim of the study is to develop names for some parts of the bones of the pelvis and its regions, which to date do not have their own designations, and to propose the developed terms for professional discussion. Material and Methods. We analyzed radiologic and CT studies in 150 patients with pelvic bone injury during 2020-2022. A list of potential new anatomical terms was compiled using a systematic literature review and consultation with leading experts in pelvic surgery. Results. New terms have been developed to designate the pelvic regions and their injuries. Conclusion. The introduction of new anatomical terms into clinical practice helps to improve the accuracy of diagnosis and planning of pelvic surgery. Standardization of terminology also promotes uniformity of approaches and exchange of experience between medical specialists, which contributes to the quality of surgical practice.

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Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Иванов

Заднепровский

Nevedrov

et al. 2018

Traumatology and Orthopedics of Russia

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Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.

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Pubic Rami Fractures

Cited by 3 publications

References 4 publications

Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Suggestions for Introducing Some New Terms in Pelvic and Acetabular Surgery

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

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