Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients

Abstract

Introduction Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. Material and methods Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. Results The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. Conclusion The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques.

Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

“…Compared to open reduction, closed reduction techniques result in less peeling of the surrounding soft tissues and less secondary damage, which avoids complications that often associate with open reduction 2–4 .No post‐surgical complications emerged as the direct result of UCRT in this cohort of patients, and all patients regained their lower‐extremity functionality indicated by their excellent Majeed functional score.…”

“…Pelvic ring disruption (PRD) accounts for 3% of all adult fractures, and the majority of these cases, especially cases of irreducible, unilateral vertically displaced pelvic ring disruption (UVDPRD), requires surgical treatment 1 . Although many surgeons prefer open reduction and internal fixation through a posterior approach for achieving an accurate reduction, in fact achieving excellent reductions is so difficult through open reduction in a series of patients with unstable PRD and potential risk of infection still exists due to big exposure 1–3 .…”

“…Closed reduction through transcondylar traction‐based corridor screw (CS) fixation for adult PRD is preferred over open reduction 4–6 , however, this technique also encountered some challenges. A tremendous amount of caudad traction via transcondylar traction is required to reduce the cranially displaced posterior ring, but there are no good methods to resist this transcondylar traction 3, 5–8 . Several tools were developed to resist the transcondylar traction, including Matta frame 9 , Starr frame 10–12 , percutaneous Schantz screw in the greater trochanter 2 , and femoral distractor 4, 13 .…”

Management Of Sacral And Sacroiliac Joint Fractures By Percutaneous Screws

“…Another study done by Abou-Khalil S. et al [28] on 50 patients sustained an unstable posterior pelvic ring injury of these 50 patients, 36 adult patients were treated with iliosacral fixation. The patients were classified into two groups: the CRPF group had 22 patients stabilized under fluoroscopic (59 percent ) or O-Arm guidance (41 percent ) and the ORIF group had 14 patients.…”

Percutaneous two unilateral iliosacral S1 screw fixation for pelvic ring injuries: a retrospective review of 38 patients

“…Percutaneous iliosacral (IS) screw fixation for pelvic ring injuries is a minimally invasive technique that more effectively reduces blood loss and operative time than the open reduction technique [1][2][3]. Thus, it has several advantages, particularly in patients with unstable hemodynamic conditions.…”