Pelvic post-traumatic asymmetry

Cano-Luís, P.; Giráldez‐Sánchez, Miguel Ángel; Cano, Pablo

doi:10.1302/2058-5241.3.170069

Cited by 14 publications

(12 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[16] Cano-Luis et al defined malunion as pelvic ring deformity that is stabilized and nonunion as deformity that is unstable. Based on the radiographic assessment, malunion has been observed in patients with one or more of the following parameters: vertical displacement or leg length discrepancy of more than one centimeter, internal or external malrotation of the hemipelvis of more than 15 degrees, anterior-to-posterior hemipelvis displacement of more than one centimeter, and difference in Keshishyan diagonal lines of more than four millimeters [2,10,12,13,17].…”

Section: Symptoms and Deformitiesmentioning

confidence: 99%

“…Chronic pain, cosmetic asymptomatic disfigurement, pelvic instability, and deformities that affect physiologic function are the main indicators for surgical intervention. [2,6,[17][18][19] Corrective surgery for pelvic malunion is technically difficult, time consuming, and accompanied with substantial blood loss; thus, extensive preoperative planning is necessary to determine the surgical approach and appropriate osteotomy technique for the associated deformity [2,6,10,13,19,20]. Various indications, results, and outcomes have been reported (Table 1).…”

Section: Indication For Treatment and Surgical Techniquesmentioning

confidence: 99%

“…Similar statistics were reported in a systematic review of pelvic malunion treatment: 106 patients with average blood loss of 1194 mL (ranging 12 mL to 7200 mL) and average surgical time of 6.14 h (ranging 1.1 to 10.4 h) [6]. Surgical intervention, done in a single operation or staged fashion, varied with the type and number of approaches used along with osteotomies depending on the severity of the malunion and the type of associated deformity [14,17]. The three stage method is the most routinely used in pelvic malunion and deformity correction with the posterior or anterior approach dependent upon the deformity [2][3][4]6,18].…”

Section: Indication For Treatment and Surgical Techniquesmentioning

confidence: 99%

See 2 more Smart Citations

Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment

et al. 2022

View full text Add to dashboard Cite

Background and Objectives: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. Materials and Methods: An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were “malunion” AND “pelvic” OR “pelvis”. Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. Results: Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.

show abstract

Section: Symptoms and Deformitiesmentioning

confidence: 99%

Section: Indication For Treatment and Surgical Techniquesmentioning

confidence: 99%

Section: Indication For Treatment and Surgical Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Medical facilities lacking pelvic fracture specialists, well-equipped operating rooms, or the ability to treat concomitant injuries are often forced to take nonoperative treatment approaches. [1][2][3] This can lead to pelvic deformities that are challenging to treat and increase the risk of serious complications. [4][5][6][7] Treatment of pelvic malunion requires specialized care, access to necessary equipment, and a clearly defined treatment approach.…”

Section: Introductionmentioning

confidence: 99%

Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman

Rikhter

2024

OTA International

View full text Add to dashboard Cite

Surgical fixation of pelvic fractures is often necessary to restore fracture stability and improve patient outcomes. However, early operative management of pelvis fractures is not widely available in many health systems, resulting in conservative treatment approaches. Conservative approaches can lead to uncorrected pelvic deformities, which are challenging to treat and increase the risk of serious complications such as malunion. Treatment of pelvic malunion requires specialized care, access to necessary equipment, and a clearly defined treatment protocol. However, there is a lack of literature describing treatment algorithms for pelvic fracture malunion. This case report aims to incrementally fill this gap in the literature and highlight a logical step-by-step approach for reconstruction of pelvic malunion. This report is a single case of an 18-year-old woman who sustained complex unstable pelvic fracture, indicated for a 3-step reconstruction at a hospital with limited resources but access to computed tomography scan and some specialized pelvis reduction instruments. Postoperative imaging of the pelvis indicated satisfactory reduction and stable fixation of the pelvic reconstruction. After surgery, the patient was able to perform full axial load with no reported pain. This report provides a detailed description of each step of the operative management of a pelvic malunion case with clearly defined sequences, reduction tools, and positioning maneuvers necessary. Demonstrated in this case report, strategic preoperative planning is critical to successfully treating pelvic malunion and improving patient outcomes. This case report provides the necessary information on the management of pelvic reconstruction to inform other surgeons in underserved regions.

show abstract

“…Cano-Luis et al have evaluated post-traumatic pelvic asymmetry and described a unique classification to evaluate and manage these post-traumatic sequalae. 32 In their classification, the authors have noted a type of rotational instability of L5/S1 that occurs due to the non-union of the articular facet of L5/S1 as seen in Isler 2 sacral fractures. The authors advised curettage and posterior surgical fixation.…”

Section: Introductionmentioning

confidence: 99%

Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler’s Classification Revisited – A Narrative Review

Kanna

Rajasekaran

Schroeder

et al. 2022

Global Spine Journal

View full text Add to dashboard Cite

Study Design Narrative review Objectives Multiple classifications have been proposed for sacral fractures since the last century. While initial classifications focussed on vertical and transverse fractures, the recent fracture classifications encompass all injury patterns. In 1990, Isler classified unilateral vertical sacral fractures based on its potential influence on lumbo-sacral joint (LSJ) stability. Methods We re-visited the original description of Isler’s classification of sacral fractures and subsequent studies that have cited it. We will further describe basic LSJ anatomy, evolution of sacral classification systems and the use of Isler’s classification system as it relates to LSJ instability and chronic low back pain. Results Isler described a subset of unilateral vertical sacral fractures where the fracture line exited medial or through the L5-S1 facet joint, based on radiographic review of 193 sacral fractures (incidence -3.5%). He stated that such a fracture should be recognised as it can impede hemi-pelvis reduction and can result in late LSJ instability. The article has been cited in 106 studies and only a few studies have described the incidence of this variant. Nevertheless, the injury is considered as an indication for surgical fixation. Conclusion A review of various classifications indicates that sacral fractures have three important bio-mechanical implications, namely, pelvic ring continuity (vertical fractures), spino-pelvic alignment (high transverse fractures) and lumbo-sacral joint integrity (Isler’s fractures). Though there is a universal recognition of Isler’s fractures and its impact on LSJ integrity, there is a lack of clinical and bio-mechanical evidence regarding the concept of instability caused by a unilateral Isler fracture.

show abstract

Pelvic post-traumatic asymmetry

Cited by 14 publications

References 26 publications

Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment

Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment

Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman

Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler’s Classification Revisited – A Narrative Review

Contact Info

Product

Resources

About