Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment

Abstract

We have retrospectively reviewed the clinical and radiological results in 204 consecutive adult patients who had surgical correction of 70 late post-traumatic pelvic nonunions and 134 malalignments. The deformed pelvises were subdivided into united (true), unstable, ununited, and partially stable malalignments with heterotopic bone. The principal complaints were of pain, pelvic instability, sitting imbalance, and apparent limb-length discrepancy. After surgery, 195 patients (96%) achieved a primary union and 144 (71%) had slight, intermittent or no pelvic pain, while pelvic instability was entirely eliminated. Overall, 131 patients (64.2%) were extremely satisfied, 58 (28.4%) were satisfied and 15 (7.4%) were unsatisfied. After reconstruction of the malaligned pelvises, 67 results (50%) were anatomical, 47 (35%) were satisfactory and 20 (15%) were unsatisfactory. For a pelvic nonunion with local osteopenia and malalignment, stabilisation of all three pelvic columns is recommended. True pelvic (united) malunions were the most satisfactorily realigned and had the fewest complications. Ununited and unstable malalignments, especially those with heterotopic bone, had the poorest corrections and the most neurological complications. A therapeutic alternative, by the local resection of a symptomatic bony prominence, and fixation in situ of a posterior pelvic nonunion, gives highly effective symptomatic relief with fewer complications. Despite this, many patients had persistent low back pain.

Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation

“…The three patients with sacral plexus injury also principally recovered from saddle hypesthesia and dysuria. Evaluation of the reduction were made using postoperative anteroposterior, inlet, and outlet radiographs of the pelvic ring, with the maximum fracture displacement distance on any film or rotation deformity angle on any plane as the basis for evaluation, according to the standard proposed by Mears et al 7 . Anatomic reduction was achieved if there was no residual displacement in any film.…”

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

“…The level of evidence of these studies was IV (retrospective/prospective uncontrolled case series [12,16,25,39,42,43,47,51,59,67] or case reports [1, 4, 6, 11, 17-19, 31, 32, 40, 46, 50, 61, 68, 69]). Four hundred thirtyseven patients were included for the final analysis (Table 1).…”

Two-stage surgical procedure for treating pelvic malunions

“…Matta reported three neurological complications and one vascular complication out of 37 patients [8]. Mears reported eight cases of sciatic palsy in 204 patients; three of them were permanent [10]. We noted three partial sciatic deficits.…”

“…In these terms, the two-stage technique was successful with various types of deformities including vertical, horizontal, and rotational malunions. Complete reduction was achieved in 75% of cases in our series, while Mears reported 85% anatomical and satisfactory reduction [10], and Matta presented 89% correct reduction using a prone/supine/prone procedure.…”

“…Though specific and anecdotal cases have been successfully treated with one-stage intervention [4], all late anterior and posterior reconstruction of the pelvic ring reported in the literature required major surgery with threestage interventions, including prone-supine-prone or supine-prone-supine procedures [5,8,10,11,15]. However, operative duration and consequently operative morbidity could be reduced by limiting these surgical techniques to a prone-supine two-stage-only procedure.…”