Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.
An incision is made over each anterior iliac crest and a 6- to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability.
A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores.
As of January 2012, 23 patients met inclusion; however, 12 patients refused participation because of the possibility of external fixation, leaving 11 patients (four male, seven female) enrolled. At 6-month followup, there was a single pin tract infection in the APEF cohort and no complications or pain in the APIF cohort.
This clinical experience lends support to the use of a new minimally invasive technique to stabilize the anterior pelvis, particularly given the resistance on the part of patients to consider external fixation.
Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
[Show abstract][Hide abstract] ABSTRACT: Percutaneous anterior stabilization of pelvic ring instability may be useful if closed reduction and stability can be achieved. The first clinical results are promising showing sufficient anterior stabilization, where the soft tissue is spared. In this report we describe the indication and technique for the percutaneous anterior internal pelvic fixator and discuss advantages and disadvantages in context of the current literature. After posterior stability is restored by the standard techniques (eg iliosacral screw placement or posterior plating), the patient is prepared in supine position with the lower limbs included to facilitate reduction. An oblique incision of 3 cm beneath the anterior superior iliac spine bilaterally is made. Blunt dissection of the soft tissue, including the fascia, is followed by the use of a Jamshidi needle to establish the corridor in the ilium. A C-arm and wire-guided implantation of the cannulated pedicle screw is followed by subcutaneous placement of a contoured connecting rod above the abdominal muscle fascia. The described technique facilitates a definitive anterior fixation of vertically and rotationally unstable pelvic ring fractures. Sufficient posterior stability or fixation has to be assumed. Implant removal is required in a second operation. To our opinion, this technique has several advantages, but as an elective surgical approach is not applicable in hemodynamically unstable patients.
Operative Techniques in Orthopaedics 03/2013; 23(1):33–37. DOI:10.1053/j.oto.2013.04.005
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Fractures of the pubic rami due to low energy trauma are common in the elderly, with an incidence of 26 per 100,000 people per year in those aged more than 60 years. The purpose of this study was to evaluate the clinical application of this minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury, including its feasibility, merits, and limitations.
Fifteen patients with pubic ramus fractures combined with sacroiliac joint injury were treated with the minimally invasive technique from June 2008 until April 2012. The quality of fracture reduction was evaluated according to the Matta standard.
Fourteen cases were excellent (93.3 %), and one case was good (6.7 %). The fracture lines were healed 12 weeks after the surgery. The 15 patients had follow-up visits between four to 50 months (mean, 22.47 months). All patients returned to their pre-injury jobs and lifestyles. One patient suffered a deep vein thrombosis during the peri-operative period. A filter was placed in the patient before the surgery and was removed six weeks later. There was no thrombus found at the follow-up visits of this patient.
The minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury provided satisfactory efficacy.
International Orthopaedics 06/2013; 37(8). DOI:10.1007/s00264-013-1954-x · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic disruptions of the pelvic ring are high energy life threatening injuries. Management represents a significant challenge, particularly in the acute setting in the presence of severe haemorrhage. Initial management is focused on preserving life by controlling haemorrhage and associated injuries. Advances in prehospital care, surgery, interventional radiology and the introduction of treatment algorithms to streamline decision making have improved patient survival. As more patients with unstable pelvic injuries survive, the poor results associated with nonoperative management and increasing patient expectations of outcome are making surgical management of these fractures increasingly common. The aim of operative fracture fixation is to correct deformity and restore function. The advent of percutaneous fixation techniques has reduced the morbidity previously associated with large operative exposures and internal fixation.
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