Quality of reduction correlates with clinical outcome in pelvic ring fractures

Pastor, Torsten; Tiziani, Simon; Kasper, Cla Duri; Pape, Hans-Christian; Osterhoff, Georg

doi:10.1016/j.injury.2019.04.015

Cited by 33 publications

(37 citation statements)

References 10 publications

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“…Although the reduction requirements for pelvic fractures are not as high as those for acetabular fractures, satisfactory reduction quality can effectively reduce the failure rate of internal fixation and postoperative patient satisfaction [ 34 ]. The learning curve for surgical management of pelvic fractures is relatively long.…”

Section: Discussionmentioning

confidence: 99%

“…Because the reduction of the anterior ring is relatively easy, most surgeons perform the reduction of the anterior ring first and then fix the posterior ring with sacroiliac joint screws or iliac lumbar fixation. However, if the rotation or vertical displacement of the posterior ring is not corrected when the anterior ring is fixed, the stress of the steel plate on the anterior ring will increase, eventually leading to internal fixation failure [ 34 ]. Therefore, when the anterior ring and the posterior ring are both unstable, especially in the case of large displacement, it is necessary to use lower limb traction to correct the vertical displacement [ 38 ] or use C-clamps to correct the posterior ring rotation displacement [ 39 ], which can effectively reduce the risk of internal fixation failure.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute

Zhang

Liu

et al. 2021

J Orthop Surg Res

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Background This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials From January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The exclusion criteria included: (1) pathological fracture, or combined with pelvic bone tumor or severe osteoporosis; (2) femoral fracture and thoracolumbar fracture; (3) open pelvic fracture; (4) Morel-Lavallée injury; (5) complicated acetabular fracture. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system. Results According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5 to 28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate. Five patients undergoing revision surgery were followed up for 6–36 months with an average of 18 months. According to Majeed’s score at the last follow-up in the 5 patients undergoing revision surgery, there were 2 cases of excellent, 2 cases of good, 1 case of fair. The excellent and good rate reached 80%. Conclusion The treatment of complicated unstable pelvic fractures requires performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute

Zhang

Liu

et al. 2021

J Orthop Surg Res

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“…PRF resulting from high-energy trauma is associated with increased mortality, 3 impaired QoL 32–34 and concomitant injuries of pelvic organs. 35 Among other adverse effects, ED is an underestimated functional complication in male patients after PRF.…”

Section: Discussionmentioning

confidence: 99%

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

et al. 2021

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ObjectiveTo investigate the rate of erectile dysfunction (ED) after pelvic ring fracture (PRF).DesignSystematic review and meta-analysis.MethodsA systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus and Web of Science Library databases was conducted in January 2020. Included were original studies performed on humans assessing ED after PRF according to the 5-item International Index of Erectile Function (IIEF-5) questionnaire and fracture classification following Young and Burgess, Tile or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association. Furthermore, interventional cohort studies assessing the effect of penile rehabilitation therapy with phosphodiesterase-5-inhibitors (PDE-5-I) on IIEF-5 scores compared before and after treatment were included. Results were presented as forest plots of proportions of patients with ED after PRF or mean changes on IIEF-5 questionnaires before and after penile rehabilitation. Studies not included in the quantitative analysis were narratively summarised. Risk of bias assessment was conducted using the revised tool for the Quality Assessment on Diagnostic Accuracy Studies.ResultsThe systematic literature search retrieved 617 articles. Seven articles were included in the qualitative analysis and the meta-analysis. Pooled proportions revealed 37% of patients with ED after suffering any form of PRF (result on probability scale pr=0.37, 95% CI: 0.26 to 0.50). Patients after 3 months of penile rehabilitation therapy reported a higher IIEF-5 score than before (change score=6.5 points, 95% CI: 2.54 to 10.46, p value=0.0013).ConclusionDespite some heterogeneity and limited high-quality research, this study concludes that patients suffering from any type of PRF have an increased risk of developing ED. Oral intake of PDE-5-I for the purpose of penile rehabilitation therapy increases IIEF-5 scores and may relevantly influence quality-of-life in these patients.PROSPERO registration numberCRD42020169699.

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“…We hypothesized that 3D assisted surgery could have an effect on these measures, which is the rationale to choose these outcome measures. Moreover, these are widely used for assessing pelvic ring surgery related to patient outcomes [ 9 , 10 , 11 ]. Except for case studies with N < 10 and conference abstracts, all study designs were accepted for inclusion.…”

Section: Methodsmentioning

confidence: 99%

Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?—A Systematic Review of the Literature

Banierink

Meesters

Duis

et al. 2021

JPM

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Background: There has been an exponential growth in the use of advanced technologies for three-dimensional (3D) virtual pre- and intra-operative planning of pelvic ring injury surgery but potential benefits remain unclear. The purpose of this study was to evaluate differences in intra- and post-operative results between 3D and conventional (2D) surgery. Methods: A systematic review was performed including published studies between 1 January 2010 and 22 May 2020 on all available 3D techniques in pelvic ring injury surgery. Studies were assessed for their methodological quality according to the Modified McMaster Critical Review form. Differences in operation time, blood loss, fluoroscopy time, screw malposition rate, fracture reduction and functional outcome between 3D-assisted and conventional (2D) pelvic injury treatment were evaluated and a best-evidence synthesis was performed. Results: Eighteen studies fulfilled the inclusion criteria, evaluating a total of 988 patients. Overall quality was moderate. Regarding intra-operative results of 3D-assisted versus conventional surgery: The weighted mean operation time per screw was 43 min versus 52 min; for overall operation time 126 min versus 141 min; blood loss 275 ± 197 mL versus 549 ± 404 mL; fluoroscopy time 74 s versus 125 s and fluoroscopy frequency 29 ± 4 versus 63 ± 3. In terms of post-operative outcomes of 3D-assisted versus conventional surgery: weighted mean screw malposition rate was 8% versus 18%; quality of fracture reduction measured by the total excellent/good rate by Matta was 86% versus 82% and Majeed excellent/good rate 88% versus 83%. Conclusion: The 3D-assisted surgery technologies seem to have a positive effect on operation time, blood loss, fluoroscopy dose, time and frequency as well as accuracy of screw placement. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. Due to a wide range of methodological quality and heterogeneity between the included studies, results should be interpreted with caution.

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Quality of reduction correlates with clinical outcome in pelvic ring fractures

Cited by 33 publications

References 10 publications

RETRACTED ARTICLE: Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute

RETRACTED ARTICLE: Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute

Erectile dysfunction and penile rehabilitation after pelvic fracture: a systematic review and meta-analysis

Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?—A Systematic Review of the Literature

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