Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jianchao , SHENG Weichao ,  LIAO Wensheng

Department of Spinal and Spinal Cord Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou Henan, 450003, P.R.China;

Corresponding author：

LIAO Wensheng, Email: 13937109606@163.com

Keywords：

Pelvic fracture; unstable fracture; internal fixator; plate

DOI：

10.7507/1002-1892.201912126

Video：

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Objective To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.Methods Between January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated.Results All patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%.Conclusion For unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.

Citation： WANG Jianchao, SHENG Weichao, LIAO Wensheng. Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 878-882. doi: 10.7507/1002-1892.201912126 Copy

1.	Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury, 2004, 35(7): 671-677.
2.	Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury, 2005, 36(1): 1-13.
3.	Demetriades D, Karaiskakis M, Toutouzas K, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg, 2002, 195(1): 1-10.
4.	Smith W, Williams A, Agudelo J, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma, 2007, 21(1): 31-37.
5.	陈家磊, Walter M Chirume, 方跃. 内置外固定架治疗骨盆前环损伤的研究进展. 中国修复重建外科杂志, 2019, 33(11): 1462-1465.
6.	项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
7.	Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
8.	Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg (Br), 1990, 72(4): 612-614.
9.	Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
10.	Kim JJ, Kim JW, Oh HK. The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof. Orthop Traumatol Surg Res, 2014, 100(8): 967-970.
11.	Elzohairy MM, Salama AM. Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions. Orthop Traumatol Surg Res, 2017, 103(2): 223-227.
12.	吴晓天, 陈农, 潘福根, 等. 皮下钉棒系统改良置钉法治疗 Tile B型骨盆骨折的临床观察. 中国骨伤, 2017, 30(3): 208-212.
13.	Hung CC, Wu JL, Li YT, et al. Minimally invasive treatment for anterion pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study. J Orthop Surg Res, 2018, 13(1): 238-245.
14.	Wang Q, Wang Q, Wang J. Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique. Arch Orthop Trauma Surg, 2017, 137(7): 887-893.
15.	Scheyerer MJ, Zimmermann SM, Osterhoff G, et al. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes, 2014, 7(1): 133.
16.	Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res, 2012, 470(8): 2124-2131.
17.	Vaidya R, Martin AJ, Roth M, et al. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop, 2017, 41(8): 1671-1678.
18.	Grüneweller N, Raschke MJ, Zderic I, et al. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res, 2017, 35(7): 1485-1493.
19.	Bi C, Wang Q, Nagelli C, et al. Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator versus locking compression plate: a comparative study. Med Sci Monit, 2016, 22(17): 3764-3770.
20.	Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Joint Surg (Br), 2011, 93(2): 237-244.

1. Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury, 2004, 35(7): 671-677.
2. Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury, 2005, 36(1): 1-13.
3. Demetriades D, Karaiskakis M, Toutouzas K, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg, 2002, 195(1): 1-10.
4. Smith W, Williams A, Agudelo J, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma, 2007, 21(1): 31-37.
5. 陈家磊, Walter M Chirume, 方跃. 内置外固定架治疗骨盆前环损伤的研究进展. 中国修复重建外科杂志, 2019, 33(11): 1462-1465.
6. 项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
7. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
8. Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg (Br), 1990, 72(4): 612-614.
9. Vaidya R, Colen R, Vigdorchik J, et al. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma, 2012, 26(1): 1-8.
10. Kim JJ, Kim JW, Oh HK. The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof. Orthop Traumatol Surg Res, 2014, 100(8): 967-970.
11. Elzohairy MM, Salama AM. Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions. Orthop Traumatol Surg Res, 2017, 103(2): 223-227.
12. 吴晓天, 陈农, 潘福根, 等. 皮下钉棒系统改良置钉法治疗 Tile B型骨盆骨折的临床观察. 中国骨伤, 2017, 30(3): 208-212.
13. Hung CC, Wu JL, Li YT, et al. Minimally invasive treatment for anterion pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study. J Orthop Surg Res, 2018, 13(1): 238-245.
14. Wang Q, Wang Q, Wang J. Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique. Arch Orthop Trauma Surg, 2017, 137(7): 887-893.
15. Scheyerer MJ, Zimmermann SM, Osterhoff G, et al. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures. BMC Res Notes, 2014, 7(1): 133.
16. Vaidya R, Kubiak EN, Bergin PF, et al. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res, 2012, 470(8): 2124-2131.
17. Vaidya R, Martin AJ, Roth M, et al. INFIX versus plating for pelvic fractures with disruption of the symphysis pubis. Int Orthop, 2017, 41(8): 1671-1678.
18. Grüneweller N, Raschke MJ, Zderic I, et al. Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model. J Orthop Res, 2017, 35(7): 1485-1493.
19. Bi C, Wang Q, Nagelli C, et al. Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator versus locking compression plate: a comparative study. Med Sci Monit, 2016, 22(17): 3764-3770.
20. Berber O, Amis AA, Day AC. Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Joint Surg (Br), 2011, 93(2): 237-244.

Chinese Journal of Reparative and Reconstructive Surgery

Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures

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