Anterior fixation of unstable pelvic ring fractures using the modified Stoppa approach: mid-term results are independent on patients’ age

Bastian, Johannes J D; Ansorge, Alexandre; Tomagra, Salvatore; Siebenrock, Klaus A.; Benneker, Lorin Michael; Büchler, Lorenz; Keel, Marius

doi:10.1007/s00068-015-0577-x

Cited by 18 publications

(12 citation statements)

References 30 publications

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“…Plate osteosynthesis has a higher stability than screw osteosynthesis (59). The approach may be extended into a modified Stoppa approach with the plate being placed below the pelvic brim and screws inserted above the acetabulum (60,61). External fixation is a minimally invasive bridging osteosynthesis of the anterior pelvic ring.…”

Section: Introductionmentioning

confidence: 99%

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Rommens¹,

Wagner²,

Hofmann³

2017

chr

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RezumatIncidenţa fracturilor de fragilitate ale pelvisului creşte rapid. Caracteristicile acestor fracturi sunt diferite de întreruperile de inel pelvin la adulţi. Fracturile de fragilitate pelviene sunt consecinţa unei traume de mică energie la pacienţi cu scădere importantă a densităţii minerale osoase. Ca urmare a unui model persistent de alterare a distribuţiei masei osoase la nivelul sacrumului, apar alte morfologii de fracturi osoase decât în cazul adulţilor tineri. Simptomul principal este durerea imobilizantă la nivel lombar, fesier, în regiunile inghinală şi/sau a simfizei pubiene. Imaginile radiologice convenţionale şi computerul tomograf vor revela prezenţa şi localizarea fracturilor la nivelul inelului pelvin anterior şi posterior. O nouă clasificare cuprinzătoare distinge 4 categorii de instabilitate. Primul criteriu este cel mai important, deoarece indică şi tipul de tratament preferenţial. Cel de-al doilea criteriu, care determină subtipurile celor patru categorii, este localizarea instabilităţii la nivelul inelului pelvin posterior. Acest criteriu indică tipul de procedură chirurgicală ce trebuie efectuată. Atunci când este ales tratamentul chirurgical, procedura aleasă ar trebui să fie cât mai puţin invazivă cu putinţă. Au fost dezvoltate diverse tehnici percutane sau de fixare mai puţin invazivă a inelului pelvin posterior. Sunt prezentate avantajele şi limitările acestora -sacroplastie, osteosinteză ileosacrată cu şurub, plasare de ciment, fixare internă transiliacă, osteosinteză transsacrată, fixare lombopelvină. Fracturile inelului pelvin anterior necesită de

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Section: Introductionmentioning

confidence: 99%

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Rommens¹,

Wagner²,

Hofmann³

2017

chr

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“…Thirty-eight studies [ 8 , 9 , 25 , 26 , 28 – 30 , 32 – 36 , 10 , 37 – 44 , 46 , 47 , 11 , 48 – 54 , 56 , 18 – 22 , 24 ] used a pelvic-specific PROM, either as a single instrument or in combination with a generic PROM. Generic PROMs for physical functioning and quality of life were used in 15 studies [ 8 , 10 , 39 , 40 , 46 , 57 , 58 , 12 , 13 , 15 , 17 , 19 , 23 , 27 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 34 studies [ 8 , 9 , 26 , 28 – 30 , 32 – 37 , 10 , 39 , 41 , 43 , 44 , 46 – 51 , 11 , 52 – 54 , 19 – 22 , 24 , 25 ] that used the Majeed Pelvic Score (MPS), in 28 of them [ 9 , 11 , 32 – 38 , 41 , 43 , 44 , 20 , 47 – 54 , 21 , 22 , 24 – 26 , 28 , 29 ] it was the only outcome instrument used. Most studies described the results in terms of the clinical grade.…”

Section: Resultsmentioning

confidence: 99%

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

et al. 2020

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Background Pelvic ring injuries are one of the most serious traumatic injuries with large consequences for the patients’ daily life. During recent years, the importance of the patients’ perception of their functioning and quality of life following injury has increasingly received attention. This systematic review reports on self-reported physical functioning and quality of life after all types of pelvic ring injuries. Methods The online databases MEDLINE-PubMed and Ovid-EMBASE were searched for studies published between 2008 and 2019 to identify published evidence of patient-reported physical functioning and quality of life after which they were assessed for their methodological quality. Results Of the 2577 articles, 46 were reviewed in full-text, including 3049 patients. Most studies were heterogeneous, with small cohorts of patients, a variety of injury types, treatment methods and use of different, often non-validated, outcome measures. The overall methodological quality was moderate to poor. Nine different PROMs were used, of which the Majeed Pelvic Score (MPS), SF-36 and EQ-5D were the most widely used. Mean scores respectively ranged from 75–95 (MPS), 53–69 (SF-36, physical functioning) and 0.63–0.80 (EQ-5D). Conclusions Physical functioning and quality of life following pelvic ring injuries seem fair and tend to improve during follow-up. However, differences in patient numbers, injury definition, treatment strategy, follow-up duration and type of PROMs used between studies hampers to elucidate the actual effects of pelvic ring injuries on a patient’s life. Implications of key findings Physicians and researchers should use valid and reliable patient-reported outcome instruments on large cohorts of patients with properly defined injuries to truly evaluate physical functioning and quality of life after pelvic ring injuries. Systematic review registration number PROSPERO International prospective register of systematic reviews; registration number CRD42019129176.

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“…Although fixation of the anterior pelvic ring provides considerable and rapid pain relief, complications after retrograde screw fixation still remain considerable. 7,18 …”

Section: Discussionmentioning

confidence: 99%

Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density?

Acklin

Grechenig

Richards

et al. 2017

Bone & Joint Research

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ObjectivesOsteosynthesis of anterior pubic ramus fractures using one large-diameter screw can be challenging in terms of both surgical procedure and fixation stability. Small-fragment screws have the advantage of following the pelvic cortex and being more flexible.The aim of the present study was to biomechanically compare retrograde intramedullary fixation of the superior pubic ramus using either one large- or two small-diameter screws.Materials and MethodsA total of 12 human cadaveric hemipelvises were analysed in a matched pair study design. Bone mineral density of the specimens was 68 mgHA/cm3 (standard deviation (sd) 52). The anterior pelvic ring fracture was fixed with either one 7.3 mm cannulated screw (Group 1) or two 3.5 mm pelvic cortex screws (Group 2). Progressively increasing cyclic axial loading was applied through the acetabulum. Relative movements in terms of interfragmentary displacement and gap angle at the fracture site were evaluated by means of optical movement tracking. The Wilcoxon signed-rank test was applied to identify significant differences between the groupsResultsInitial axial construct stiffness was not significantly different between the groups (p = 0.463). Interfragmentary displacement and gap angle at the fracture site were also not statistically significantly different between the groups throughout the evaluated cycles (p ⩾ 0.249). Similarly, cycles to failure were not statistically different between Group 1 (8438, sd 6968) and Group 2 (10 213, sd 10 334), p = 0.379. Failure mode in both groups was characterised by screw cutting through the cancellous bone.ConclusionFrom a biomechanical point of view, pubic ramus stabilisation with either one large or two small fragment screw osteosynthesis is comparable in osteoporotic bone. However, the two-screw fixation technique is less demanding as the smaller screws deflect at the cortical margins.Cite this article: Y. P. Acklin, I. Zderic, S. Grechenig, R. G. Richards, P. Schmitz, B. Gueorguiev. Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density? Bone Joint Res 2017;6:8–13. DOI: 10.1302/2046-3758.61.BJR-2016-0261.

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Anterior fixation of unstable pelvic ring fractures using the modified Stoppa approach: mid-term results are independent on patients’ age

Abstract: Increasing age did not impact the analysed parameters. Open reduction and internal fixation of the anterior pelvic ring through a modified Stoppa approach in unstable pelvic ring injuries did not result in an unfavourable outcome with increasing age of patients.

Cited by 18 publications

References 30 publications

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density?

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