Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in Tile C pelvic fracture treatment

Liu, Lin; Fan, Shicai; Zeng, Donggui; Chen, Yuhui; Song, Hui; Zeng, Letian; Jin, Dadi

doi:10.1186/s13018-021-02863-y

Cited by 8 publications

(8 citation statements)

References 39 publications

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“…In this study, the mean intraoperative blood loss and mean operative time were similar to the findings by Shetty et al and Liu et al [ 3 , 4 ]. Patients recovered rapidly without complications, such as wound necrosis or decubitus ulcers.…”

Section: Discussionsupporting

confidence: 91%

“…Modified percutaneous iliosacral screw and anterior INFIX techniques are primarily indicated for unstable pelvic fractures without sacral plexus injuries [ 3 , 4 ]. Vaidya et al [ 11 ] proposed anterior pelvic ring injuries combined with obesity as the best indication for INFIX use.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous iliosacral screws can be combined with anterior internal fixators (INFIXs) in a minimally invasive procedure for unstable pelvic fractures. Biomechanical [ 2 ] and clinical studies [ 3 , 4 ] have demonstrated the effectiveness of this procedure. However, we encountered some problems in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…However, we encountered some problems in clinical practice. First, INFIX may irritate the lateral femoral cutaneous nerve [3][4][5]. The most commonly used position (supine or prone) for iliosacral screw fixation is also problematic.…”

Section: Introductionmentioning

confidence: 99%

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Modified percutaneous iliosacral screw and anterior internal fixator technique for treating unstable pelvic fractures: a retrospective study

Huang

Kong

et al. 2022

BMC Musculoskelet Disord

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Background The commonly used technique for treating unstable pelvic fractures with sacroiliac screws and anterior internal fixator (INFIX) is prone to complications, such as injury to the pelvic vasculature and nerves, life-threatening bleeding, lateral femoral cutaneous neuritis, and wound infection. This study investigated the clinical effects of using a modified percutaneous iliosacral screw and INFIX technique for treating unstable pelvic fractures. Methods A retrospective analysis of minimally invasive internal fixation using modified incision of an anterior-ring INFIX application combined with modified percutaneous iliosacral screw placement was performed for 22 cases of unstable pelvic fractures from January 2017 to December 2018. Based on the Tile classification, there were 4 type B1, 7 type B2, 5 type B3 and 6 type C1 injuries. Preoperatively, the length and orientation of the internal fixation were computer-simulated and measured. On postoperative day 3, pelvic radiographs and three-dimensional computed tomograms were used to assess fracture reduction and fixation. All patients were regularly followed up at 4 weeks, 12 weeks, 6 months, 12 months, 24 months and annually thereafter. Fracture healing, complications, visual analogue scale (VAS) scores, the quality of fracture repositioning and Majeed score were assessed during follow-up. Results All patients were followed up for a mean of 25.23 ± 1.48 months. All fractures healed without loss of reduction and no patient showed evidence of delayed union or nonunion. Two years postoperatively, the mean VAS score was 0.32 ± 0.09 and the mean Majeed score was 94.32 ± 1.86. Conclusion The modified percutaneous iliosacral screw technique increases the anterior tilt of the sacroiliac screw by shifting the entry point posteriorly to increase the safety of the screw placement. Downward modification of the INFIX incision reduces the risk of lateral femoral cutaneous nerve injury. This technique is safe, effective and well tolerated by patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Modified percutaneous iliosacral screw and anterior internal fixator technique for treating unstable pelvic fractures: a retrospective study

Huang

Kong

et al. 2022

BMC Musculoskelet Disord

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“…At present, sacroiliac joint screws have been widely accepted for posterior ring fixation of Tile B2 pelvic fracture [ 5 ]. However, the stability of the anterior pelvic ring is practically as important as the stability of the posterior pelvic ring, and the anterior pelvic ring is an important mechanical element for reinforcing the weight-bearing arch of the pelvis [ 6 , 7 ]. Currently, the fixation of the anterior pelvic ring is still unclear, and the placement of a plate through a modified ilioinguinal approach is one of the more commonly used internal fixation methods.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Ren

Zhang

et al. 2023

JPM

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Objective: This study aims to analyze the biomechanical characteristics of tile B2 pelvic fractures using finite element analysis when the superior ramus of the pubis was fixed by a plate or hollow screws in standing and sitting positions, respectively. Methods: A three-dimensional digital model of the tile B2 pelvic fracture was obtained by CT scanning the patient. The main ligament structure was then reconstructed based on the anatomical characteristics to create a finite element model of the tile B2 pelvic fracture. The posterior pelvic ring was fixed by sacroiliac joint screws, while the anterior ring injury of the superior ramus of the pubis was fixed by plates and hollow compression screws, respectively. The degrees of freedom of the bilateral acetabulum or two sides of the ischial tuberosity were constrained in the two models. A vertical load of 600 N was applied to the upper surface of the sacrum to measure the displacement and stress distribution of the pelvis in the standing and sitting positions. Results: The displacement distribution of both the healthy and the affected side of the pelvis was relatively uniform in both the plate group and the hollow screw group according to the finite element simulation results. The maximum displacement value in the sitting position was greater than the standing position, and the maximum displacement value of the hollow screw fixation was greater than that of the plate fixation. In the four groups of fixation models, the maximum displacement value of the pelvis in the hollow screw sitting position group was 1616.80 × 10−3 mm, which was greater than that of the other three groups, and in this group the total displacement value of the hollow screw in the anterior ring was 556.31 × 10−3 mm. The stress distribution of the pelvis in the various models was similar in the four groups of models, in which the maximum stress of the pelvis in the hollow screw sitting position group was the largest, which was 201.33 MPa, while the maximum stress in the standing position was 149.85 MPa greater than that in the sitting position of the hollow screw fixation. Conclusion: The anterior ring of patients with Tile B2 pelvic fractures fixed with hollow screws or plates in both standing and sitting positions can achieve satisfactory biomechanical results with significant safety margins for plates and screws.

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Outcome of pelvic ring injuries

Gänsslen,

Lindahl,

Krappinger

et al. 2024

Arch Orthop Trauma Surg

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Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score. The lack in nearly all studies is that different treatment concepts are used, and only selected evaluation parameters are reported. Until today, no well-accepted standardized measurement instruments are available to analyze the clinical and radiological results after pelvic ring injuries. Overall, stability-based long-term sequelae can be expected with increasing complaints from stable type A injuries to completely unstable type C injuries. Beside a fracture-type specific treatment, concomitant injuries of other injury regions and associated local pelvic injuries (complex pelvic trauma) seem to additionally influence the results. Results of treatment of specific fracture types are sparse as a wide range of different injury types and different treatment concepts are analyzed within these analyses. A sufficient pelvic outcome instrument which addresses relevant pelvic outcome parameters is still missing. Thus, future evaluation of long-term results after pelvic ring. injuries should include prospective, multicenter outcome studies with comparable parameters.

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Clinical application of anterior ring internal fixator system combined with sacroiliac screw fixation in Tile C pelvic fracture treatment

Cited by 8 publications

References 39 publications

Modified percutaneous iliosacral screw and anterior internal fixator technique for treating unstable pelvic fractures: a retrospective study

Modified percutaneous iliosacral screw and anterior internal fixator technique for treating unstable pelvic fractures: a retrospective study

Finite Element Analysis of Channel Screw and Conventional Plate Technique in Tile B2 Pelvic Fracture

Outcome of pelvic ring injuries

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