Nonunions and malunions of the pelvis

Trıpathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

doi:10.1007/s00068-014-0461-0

Cited by 30 publications

(40 citation statements)

References 22 publications

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“…[ 6 ] Moreover, with this approach, the dissection of the sacrotuberal and sacrospinal ligaments is not required, thus decreasing the risk of ligamentous instability. [ 6 , 8 , 10 – 12 , 22 ] Postoperatively, no neurological deficits or other complications were observed in our case. Nevertheless, a complication rate of 19% to 24% following pelvic malunion correction has previously been reported.…”

Section: Discussionmentioning

confidence: 52%

“…[ 9 ] However, achieving adequate correction in all 3 planes—axial, sagittal, and coronal—as well as vertical displacement has been reported to be the most technically challenging component of this reconstructive surgery. [ 9 , 22 ] Moreover, correction of the limb length discrepancy increases the complexity of the procedure and cannot be realized through pelvic correction alone. [ 20 ] In contrast, transiliac osteotomy, as an alternative approach for treating pelvic malunions and their related deformities, can enable limb shortening by approximately 3 cm.…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional reduction and finite element analysis improves the treatment of pelvic malunion reconstructive surgery

Kurz¹,

Pieroh

Lenk³

et al. 2017

Medicine

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Rationale:Pelvic malunion is a rare complication and is technically challenging to correct owing to the complex three-dimensional (3D) geometry of the pelvic girdle. Hence, precise preoperative planning is required to ensure appropriate correction. Reconstructive surgery is generally a 2- or 3-stage procedure, with transiliac osteotomy serving as an alternative to address limb length discrepancy.Patient concerns:A 38-year-old female patient with a Mears type IV pelvic malunion with previous failed reconstructive surgery was admitted to our department due to progressive immobilization, increasing pain especially at the posterior pelvic arch and a leg length discrepancy. The leg discrepancy was approximately 4 cm and rotation of the right hip joint was associated with pain.Diagnosis:Radiography and computer tomography (CT) revealed a hypertrophic malunion at the site of the previous posterior osteotomy (Mears type IV) involving the anterior and middle column, according to the 3-column concept, as well as malunion of the left anterior arch (Mears type IV).Interventions:The surgery was planned virtually via 3D reconstruction, using the patient's CT, and subsequently performed via transiliac osteotomy and symphysiotomy. Finite element method (FEM) was used to plan the osteotomy and osteosynthesis as to include an estimation of the risk of implant failure.Outcomes:There was not incidence of neurological injury or infection, and the remaining leg length discrepancy was ≤ 2 cm. The patient recovered independent, pain free, mobility. Virtual 3D planning provided a more precise measurement of correction parameters than radiographic-based measurements. FEM analysis identified the highest risk for implant failure at the symphyseal plate osteosynthesis and the parasymphyseal screws. No implant failure was observed.Lessons:Transiliac osteotomy, with additional osteotomy or symphysiotomy, was a suitable surgical procedure for the correction of pelvic malunion and provided adequate correction of leg length discrepancy. Virtual 3D planning enabled precise determination of correction parameters, with FEM analysis providing an appropriate method to predict areas of implant failure.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Three-dimensional reduction and finite element analysis improves the treatment of pelvic malunion reconstructive surgery

Kurz¹,

Pieroh

Lenk³

et al. 2017

Medicine

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“…Da auch weltweit die Erfahrung in der Spätkorrektur von fehlverheilten bzw. nicht verheilten Beckenringfrakturen limitiert ist, kann im folgenden Artikel nur auf Grundregeln der Indikationsstellung, der Planung und Auswahl der Operationsverfahren eingegangen werden [8]. Durch die hohe Individualität der Probleme und Fallkonstellationen soll an dieser Stelle ein Teil der innerhalb der letzten 25 Jahre im eigenen Vorgehen etablierten Grundregeln eingegangen werden.…”

Section: Vorbemerkungunclassified

Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen am Becken

Pohlemann¹,

Herath²

2020

OP-JOURNAL

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ZusammenfassungKorrekturbedürftige Fehlheilungen und Pseudarthrosen sind nach aktuellen Prinzipien folgendener Primärbehandlung der Verletzung in Deutschland selten. Korrektureingriffe sind indiziert, wenn erheblicher, sicher beckenbedingter, Leidensdruck besteht und Fehlstellungen mit und ohne knöcherner Heilung vorliegen. Eine umfassende präoperative Diagnostik, Analyse und Planung ist die Grundlage von korrigierenden Eingriffen. Diese risikobeladenen, aufwendigen Operationen sollten daher nur spezialisierten Zentren vorbehalten werden. Bei strenger Indikationsstellung und konsequenter Operationsdurchführung ist in vielen Fällen allerdings eine deutliche Steigerung der Lebensqualität erreichbar.

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“…Just as for the treatment of acute pelvic ring fractures, the management of pelvic nonunions and malunions is very challenging to the attending surgeon. Different approaches and procedures have been described to facilitate surgical treatment of these complications.…”

Section: Introductionmentioning

confidence: 99%

Autologous Transplantation of Press‐fit Bone Cylinders in the Treatment of Pelvic Nonunion

Herath

Braun

Rollmann

et al. 2019

Orthopaedic Surgery

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The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone‐to‐bone interface (“press‐fit”) and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press‐fit bone‐baseplate‐cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond‐coated and fluid‐cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond‐coated trephine. This ensures an optimal press‐fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.

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Nonunions and malunions of the pelvis

Cited by 30 publications

References 22 publications

Three-dimensional reduction and finite element analysis improves the treatment of pelvic malunion reconstructive surgery

Three-dimensional reduction and finite element analysis improves the treatment of pelvic malunion reconstructive surgery

Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen am Becken

Autologous Transplantation of Press‐fit Bone Cylinders in the Treatment of Pelvic Nonunion

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