Two-stage surgical procedure for treating pelvic malunions

Abstract

When surgically treated, pelvic-ring deformities due to post-traumatic malunions in adults usually require invasive three-stage (prone/supine/prone or supine/prone/ supine) procedures. A standardised two-stage prone/supine procedure was developed by the authors. Technical points and first clinical results are presented. Malunuions related to Tile B and C types of fracture were successfully corrected.Résumé lorsque les fractures du bassin avec déformation de l'anneau pelvien nécessitent un traitement chirurgical il peut en résulter des pseudarthroses ou des cals vicieux chez l'adulte, qui nécessitent, habituellement un traitement en trois temps. Un traitement standardisé en deux temps a été développé par les auteurs. Les points techniques et les premiers résultats cliniques en sont présentés. Les pseudarthroses ou les cals vicieux secondaires aux fractures de type Tile B ou C ont été traitées correctement et avec succès.

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

“…Four hundred thirtyseven patients were included for the final analysis (Table 1). Solely malunions were recorded in 113 patients [19,39,40,42,46,47,59,68] and solely nonunions in 198 patients [1, 4, 6, 11, 12, 16-19, 25, 31, 32, 39, 40, 42, 43, 46, 47, 50, 51, 61, 67-69]. Mears and Velyvis [42] introduced the rationale of classifying late complications of pelvic trauma separately.…”

“…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).…”

“…In the large series of Mears and Velyvis [42], nonoperative treatment and external fixation were described together in 166 patients. External fixation was used and led to malunion/nonunions in another 24 patients described in four other studies [39,47,59,67,68]. Overall, 341 of 437 (78.9%) malunion/nonunions of the pelvic girdle were treated initially either nonoperatively or just by external fixation systems.…”

“…From the eight studies [1,4,11,16,42,59,67,68] (245 patients) that used the Tile and Pennal classification system [63], 88.1% (200) of the patients had initially Type C pelvic fractures. In the 13 studies [1, 11, 17-19, 25, 31, 32, 40, 46, 47, 51, 69] (111 patients) in which the Young and Burgess system [10] was used, vertical shear was the most common mechanism of injury (44.1%, 49 patients).…”

“…It was recorded as anterior, posterior, or simultaneously at both areas, nonradicular, activity-related, or disabling at various levels (from restricting pain at the extremes of the range of motion of the hips [4], sitting discomfort [39,42,47,51,69], dyspareunia, and sexual problems of mechanical origin [1,19,25,42,59] to bed confinement for patients with continuous debilitating pain [18,25,42,43,47,51]). Nonunions of the anterior elements could be pain-free [4,31,50] in contrast to those of the posterior elements in which they were mostly symptomatic [39,42,51].…”