Objective To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch. Methods The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D’Aubigne Postel score system at last follow-up. Results Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group (P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant (P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups (P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups (P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D’Aubigne Postel scoring system between the two groups was not significant (P>0.05). Conclusion TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.
Objective To investigate the application experiences and effectiveness of the infra-acetabular screw (IAS) placement technique in acetabular fracture surgery. MethodsA clinical data of 34 patients with complex acetabular fractures with anterior and posterior columns separation, who were admitted between January 2019 and October 2023 and treated with IAS fixation, was retrospectively analyzed. There were 23 males and 11 females with an average age of 55.3 years (range, 18-78 years). The acetabular fractures caused by traffic accident in 20 cases, falling from height in 12 cases, crushing injury in 1 case, and bruising with a heavy object in 1 case. According to the Letournel-Judet classification, there were 7 cases of anterior column fracture, 8 cases of anterior wall/column plus posterior hemi-transverse fracture, 2 cases of T-shaped fracture, and 17 cases of both-column fracture. The time from injury to surgery was 4-21 days (mean, 8.6 days). The time of IAS placement and the intraoperative blood loss were recorded. After surgery, the X-ray film and CT scan were re-examined, and the modified Matta score was used to assess the quality of fracture reduction. The trajectory of IAS in the channel was analyzed based on CT scan, and the screw length was measured. During follow-up, the fracture healing was observed and the hip function was assessed according to the modified Merle d’Aubigné-Postel scoring system at last follow-up. Results The IAS was successfully implanted in all 34 patients. The length of IAS ranged from 70 to 100 mm (mean, 86.2 mm). The time of IAS placement ranged from 10 to 40 minutes (mean, 20.7 minutes). The intraoperative blood loss ranged from 520 to 820 mL (mean, 716.8 mL). All patients were followed up 8-62 months (mean, 21.8 months). After surgery, 4 patients developed lateral femoral cutaneous nerve injury, 2 developed popliteal vein thrombosis of the lower extremity, 3 developed incision infection, and no surgical complication such as arteriovenous injury or obturator nerve palsy occurred. At last follow-up, the hip function was rated as excellent in 14 cases, good in 13 cases, fair in 4 cases, and poor in 3 cases according to the Merle d’Aubigné-Postel scoring system, with an excellent and good rate of 79.41%. Imaging re-examined showed that the quality of fracture reduction was rated as excellent in 9 cases, good in 19 cases, and poor in 6 cases according to the modified Matta score, with an excellent and good rate of 82.35%; and 25 (73.53%) IAS trajectories were located in the channel. All fractures obtained bony union, and the healing time was 12-24 weeks (mean, 18 weeks). During follow-up, there was no loosening or fracture of the plate and screws. Conclusion IAS placement technique can effectively strengthen internal fixation and prevent fracture re-displacement, making it a useful adjunct for treating complex acetabular fractures with anterior and posterior columns separation.