Operative Treatment of Unstable Pelvic Ring Injury

Sang Hong Lee; Sang Ho Ha; Young Kwan Lee; Sung Won Cho; Sang Soo Park

doi:10.12671/jkfs.2012.25.4.243

Journal List > J Korean Fract Soc > v.25(4) > 1037883

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Lee, Ha, Lee, Cho, and Park: Operative Treatment of Unstable Pelvic Ring Injury

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(4): 243-249.

Published online: 19 October 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.243

Operative Treatment of Unstable Pelvic Ring Injury

Sang Hong Lee, M.D., Sang Ho Ha, M.D., Young Kwan Lee, M.D., Sung Won Cho, M.D., Sang Soo Park, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, shalee@chosun.ac.kr

Received 2 February 2012 Revised 10 March 2012 Accepted 10 July 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical and radiological results of the different fixation methods according to the type and displacement of unstable pelvic ring injuries.

Materials and Methods

Twenty-three patients with unstable pelvic ring injuries from January 2005 to December 2009 were classified according to the AO/OTA classification system. When patients had been diagnosed with unstable pelvic ring injuries with partial instability, they were treated by anterior fixation with a plate and posterior percutaneous iliosacral screw fixation. When patients had been diagnosed with unstable pelvic ring injuries with complete instability, they were treated by open reduction and anterior to posterior fixation with a plate through the ilioinguinal approach. The radiological results were evaluated using Matta and Saucedo's method, and the clinical results were evaluated using Rommens and Hessmann's method.

Results

The outcomes from the radiological evaluation were that the displacement of the posterior pelvic ring were improved by about 6.65 mm in unstable pelvic ring injuries with partial instability. The displacement of the posterior pelvic ring were improved by about 7.8 mm in unstable pelvic ring injuries with complete instability. The clinical results were excellent in 13 cases and good in 6 cases on latest follow-up.

Conclusion

Good results can be achieved by selecting the treatment method according to the type of unstable pelvic ring injurie and displacement.

Keywords: Unstable pelvic ring injury, Plate, Percutaneous iliosacral screw

Figures and Tables

Fig. 1

(A, B) A 41-year-old male patient who had an unstable pelvic fracture with symphysis pubis diastasis and sacroiliac joint disruption.

(C, D) Plate fixation on symphysis pubis and percutaneous iliosacral screw fixation on sacroiliac joint.

(E) After 30 months, he had a complete union and excellent function.

Fig. 2

(A, B) A 65-year-old female patient who had unstable pelvic fracture with superior and inferior ramus fracture and sacroiliac joint disruption.

(C, D) Through the anterior approach, anatomical reconstruction was achieved with the fixation of the anterior and posterior rings.

(E) After 53 months, she had a complete union and excellent function.

Table 1

Patient Data

M: Male, F: Female, TA: Traffic accident, Fx: Fracture, DVT: Deep vein thrombosis, CRPS: Complex regional pain syndrome, SI: Sacro-Iliac.

References

1. Atlihan D, Tekdemir I, Ateŝ Y, Elhan A. Anatomy of the anterior sacroiliac joint with reference to lumbosacral nerves. Clin Orthop Relat Res. 2000. (376):236–241.

2. Bucholz RW. The pathological anatomy of Malgaigne fracture-dislocations of the pelvis. J Bone Joint Surg Am. 1981. 63:400–404.

3. Bucholz RW, Peters P. Assessment of pelvic stability. Instr Course Lect. 1988. 37:119–127.

4. Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990. 30:848–856.

5. Comstock CP, van der Meulen MC, Goodman SB. Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. J Orthop Trauma. 1996. 10:517–522.

6. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2006. 20:1 Suppl. S30–S36.

7. Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O'Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma. 1999. 13:107–113.

8. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987. 18:25–41.

9. Kim JJ, Kim JW, Chang JS. Clinical outcome of AO type C pelvic ring injury. J Korean Orthop Assoc. 2005. 40:181–187.

10. Kim WY, Ji JH, Kwon OS, Park SE, Kim YY, Moon CY. Comparison with number and position of percutaneous iliosacral screws as treatment of unstable pelvic fracture. J Korean Orthop Assoc. 2009. 44:1–7.

11. Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma. 1991. 31:28–31.

12. Lee JY, Moon DH, Kim GB. Prognosis of early internal fixation in unstable pelvic fractures. J Korean Soc Fract. 2000. 13:741–748.

13. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res. 1989. (242):83–97.

14. Min BW, Jeon SH, Kim TY. Plate fixation for sacroiliac joint separation through the anterior approach. J Korean Orthop Assoc. 2002. 37:478–482.

15. Oh CW, Kim PT, Park BC, et al. Anterior plating and ilio-sacral screwing for unstable pelvic injury. J Korean Orthop Assoc. 2007. 42:483–489.

16. Oh JK, Bae SY, Kim JO, Roh KJ, Lee JJ, Chang SY. Radiologic evaluation for the safe zone of percutaneous iliosacral screw fixation. J Korean Soc Fract. 2002. 15:336–341.

17. Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980. (151):12–21.

18. Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma. 1993. 7:107–117.

19. Pohlemann T, Bosch U, Gänsslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994. (305):69–80.

20. Rommens PM, Hessmann MH. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma. 2002. 16:92–98.

21. Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma. 1995. 9:207–214.

22. Routt ML Jr, Simonian PT, Agnew SG, Mann FA. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996. 10:171–177.

23. Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997. 11:584–589.

24. Simonian PT, Routt ML Jr, Harrington RM, Tencer AF. The unstable iliac fracture: a biomechanical evaluation of internal fixation. Injury. 1997. 28:469–475.

25. Stocks GW, Gabel GT, Noble PC, Hanson GW, Tullos HS. Anterior and posterior internal fixation of vertical shear fractures of the pelvis. J Orthop Res. 1991. 9:237–245.

26. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988. 70:1–12.

27. Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996. 4:143–151.

28. Tile M. Acute pelvic fractures: II. Principles of management. J Am Acad Orthop Surg. 1996. 4:152–161.

29. Tornetta P 3rd, Dickson K, Matta JM. Outcome of rotationally unstable pelvic ring injuries treated operatively. Clin Orthop Relat Res. 1996. (329):147–151.

30. Tsukushi S, Katagiri H, Nakashima H, Shido Y, Wasa J. Computed tomography-guided screw fixation of a sacroiliac joint dislocation fracture: a case report. J Orthop Sci. 2003. 8:729–732.

31. Ward EF, Tomasin J, Vander Griend RA. Open reduction and internal fixation of vertical shear pelvic fractures. J Trauma. 1987. 27:291–295.

32. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986. 160:445–451.

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