Superior Pubic Ramus Fractures Fixed With Percutaneous Screws: What Predicts Fixation Failure?

Starr, Adam J.; Nakatani, Tetsuya; Reinert, Charles M.; Cederberg, Kevin B

doi:10.1097/bot.0b013e318162ab6e

Cited by 126 publications

(109 citation statements)

References 15 publications

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“…LC type-1 injuries of the pelvic ring have been the subject of heated discussion amongst orthopaedic trauma surgeons [2,[6][7][8][10][11][12]. The traditional dogma related to these injuries suggests their inherent stability because the amount of the pelvic displacement is minimal, the posterior elements of the pelvic ring remain relatively intact and consequently there is rarely a need for operative intervention [1,[13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Tosounidis

Kanakaris

Nikolaou

et al. 2012

International Orthopaedics (SICOT)

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Purpose We performed a prospective study to document, by intra-operative manipulation under anaesthesia (MUA) of the pelvic ring, the stability of lateral compression type 1 injuries that were managed in a Level-I Trauma Centre. The documentation of the short-term outcome of the management of these injuries was our secondary aim. Methods A total of 63 patients were included in the study. Thirty-five patients (group A) were treated surgically whereas 28 (group B) were managed nonoperatively. Intraoperative rotational instability, evident by more than two centimetres of translation during the manipulation manoeuvre, was combined with a complete sacral fracture in all cases. Results A statistically significant difference was present between the length of hospital stay, the time to independent painfree mobilisation, post-manipulation pain levels and opioid requirements between the two groups, with group A demonstrating significantly decreased values in all these four variables (p<0.05). There was also a significant difference between the pre-and 72-hour post-manipulation visual analogue scale and analgesic requirements of the group A patients, whereas the patients in group B did not demonstrate such a difference. Conclusion LC-1 injuries with a complete posterior sacral injury are inheritably rotationally unstable and patients presenting with these fracture patterns definitely gain benefit from surgical stabilisation.

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Section: Discussionmentioning

confidence: 99%

“…A review of the imaging studies (plain radiographs and CT scans) allowed us to classify all the injuries according to Nakatani [8] and Denis [9] systems. The sacral fracture was characterised as complete when there was a disruption of both the anterior and posterior cortices, at the S1 level on the axial CT scan.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Tosounidis

Kanakaris

Nikolaou

et al. 2012

International Orthopaedics (SICOT)

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“…In general pubic rami fractures may be treated either non-operatively following fi xation of the posterior pelvic elements [ 3 ], or by open reduction internal fi xation [ 3 ], or via indirect reduction and stabilisation by means of distraction external fi xation [ 4 ], or by closed/mini open reduction and percutaneous techniques [ 1 ].…”

Section: Treatment Strategymentioning

confidence: 99%

Pubic Rami Fractures

Kanakaris¹,

Giannoudis²

2014

Trauma and Orthopaedic Classifications

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“…Tile [9], Burgess et a. [10], Denis et al [11], Pohlemann et al [12] and Starr et al [13]. The radiological assessment of the initial fracture type, as well as the progress of radiological healing was carried out by two independent raters, blinded to the other study parameters.…”

Section: Methodsmentioning

confidence: 99%

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Kanakaris

Greven

West

et al. 2017

International Orthopaedics (SICOT)

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Purpose The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bonequality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results A total of 132 elderly patients (≥65 years) admitted during the period 2012-2014 with FPFs were enrolled. Highenergy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67-108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state.

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Superior Pubic Ramus Fractures Fixed With Percutaneous Screws: What Predicts Fixation Failure?

Cited by 126 publications

References 15 publications

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Pubic Rami Fractures

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

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