What’s New in Percutaneous Pelvis Fracture Surgery?

Grewal, Ishvinder S.; Starr, Adam J.

doi:10.1016/j.ocl.2020.02.010

Cited by 16 publications

(15 citation statements)

References 15 publications

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“…Pubic ramus fractures are still treated more often conservatively than operatively in the clinical practice, due to the known risk of chronic pain, long-term immobilization, and delayed functional outcome [28]. Grewal et al state that there is a justifiable reluctancy towards percutaneous instrumentation of the structures at the front of the pelvis [29]. Finding a convenient and simple solution for an unpopular surgery technique was one of the main objectives of this study.…”

Section: Discussionmentioning

confidence: 97%

A Novel Implant for Superior Pubic Ramus Fracture Fixation—Development and a Biomechanical Feasibility Study

et al. 2023

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Background and Objectives: Pubic ramus fractures are common in compound pelvic injuries known to have an increased rate of morbidity and mortality along with recurrent and chronic pain, impeding a patient’s quality of life. The current standard treatment of these fractures is percutaneous screw fixation due to its reduced risk of blood loss and shorter surgery times. However, this is an intricate surgical technique associated with high failure rates of up to 15%, related to implant failure and loss of reduction. Therefore, the aim of this biomechanical feasibility study was to develop and test a novel intramedullary splinting implant for fixation of superior pubic ramus fractures (SPRF), and to evaluate its biomechanical viability in comparison with established fixation methods using conventional partially or fully threaded cannulated screws. Materials and Methods: A type II superior pubic ramus fracture according to the Nakatani classification was created in 18 composite hemi-pelvises via a vertical osteotomy with an additional osteotomy in the inferior pubic ramus to isolate the testing of three SPRF fixation techniques performed in 6 semi-pelvises each using either (1) a novel ramus intramedullary splint, (2) a partially threaded ramus screw, or (3) a fully threaded ramus screw. Results: No significant differences were detected among the fixation techniques in terms of initial construct stiffness and number of cycles to failure, p ≥ 0.213. Conclusion: The novel ramus intramedullary splint can be used as an alternative option for treatment of pubic ramus fractures and has the potential to decrease the rate of implant failures due to its minimally invasive implantation procedure.

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Section: Discussionmentioning

confidence: 97%

A Novel Implant for Superior Pubic Ramus Fracture Fixation—Development and a Biomechanical Feasibility Study

et al. 2023

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“…6 With more lateral extension of the incision, the risk of damage to the inguinal canal and its content increases, which can result in ongoing pain symptoms. 19 It is important to note that there is sparse literature regarding the complications associated with such extensive surgical approaches, specifically in the elderly or frail patient.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly: case report and literature review

Strydom

Snyckers²

2021

SA orthop. j.

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BACKGROUND: As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies between the management of these injuries. Although a number of pelvic fragility fractures can be treated successfully with conservative means, early treatment with appropriate surgical means should be considered in those failing conservative treatment or with unstable fracture patterns. CASE REPORT: We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent mobility. She had three syncope-related falls during this period, but radiographs revealed no sign of implant displacement. One year after her surgery she had complete union of her fracture, good function and no desire to have the implant removed. DISCUSSION: With the expected increase in pelvic fragility fractures due to the growing elderly population, our understanding of these injuries has begun to change. Occult posterior ring injuries have been described in up to 80% of cases, while fracture progression to unstable patterns can occur in up to 15% of stable patterns. Despite conservative management being the primary treatment of choice, these patients suffer morbidity and mortality rates comparable to proximal femur fractures. Early appropriate surgical management should be considered in patients failing to mobilise. Various surgical techniques have been described, each with their own advantages and disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in elderly patients. These constructs combine the low profile benefits of internal plate fixation with ex-fix principles. CONCLUSION: The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases where patients are too frail for extensive or invasive surgeries, such as open reduction and internal fixation with plate and screws. Level of evidence: Level 5 Keywords: pelvic fracture, anterior pelvic fixation, elderly, minimally invasive

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“…These techniques have been published previously with detailed case examples. 4,18 Standard postoperative restrictions were for the patients to remain foot flat weight bearing on the injured side for 12 weeks after surgery and then advance to weight bearing as tolerated. However, 7 patients were ordered to remain non weight bearing and utilize wheelchair transfers only for 6 or 12 weeks due to associated injuries or functional status.…”

Section: Surgical Treatment and Postoperative Protocolmentioning

confidence: 99%

“…1,2 Multiple options exist for fixation of disruptions that meet operative indications, however, symphysis plating is generally considered the "gold standard" treatment in the United States. 3,4 Reasons for this preference are that open reduction and plating allows direct anatomic reduction, improved stability, low morbidity, and does not routinely require implant removal. 5 This is despite published rates of fixation failure between 12 and 75%, loss of reduction between 7 and 24%, and revision rates between 3 and 9%.…”

Section: Introductionmentioning

confidence: 99%