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01-06-2020 | Original Paper

Comparison of posterior ring fixation with combined anterior and posterior ring fixation for the treatment of lateral compression type 2 pelvic fractures

Authors: Bin-Fei Zhang, Kun Shang, Peng-Fei Wang, Chao Ke, Shuang Han, Kun Yang, Chen Fei, Xin Xu, Kun Zhang, Yan Zhuang

Published in: International Orthopaedics | Issue 6/2020

Abstract

Purpose

The aim of surgical treatment for lateral compression type 2 (LC-2) pelvic fractures is to enable early mobilization and provide pain relief. Anterior and posterior ring fixation is usually performed simultaneously, with the goal of providing good biomechanical stability. However, it is unclear whether anterior ring fixation is necessary. This study therefore aimed to determine the feasibility of isolated posterior ring fixation for LC-2 pelvic fractures.

Methods

Records of patients with LC-2 pelvic fractures were extracted from a medical database. Patients who underwent posterior pelvic ring fixation alone (PR fixation group) or anterior and posterior ring fixation (APR fixation group) were included. Patients’ operative characteristics, time to clinical healing, length of hospital stay, time to weight bearing, and complications were recorded at follow-up. Radiography was used to assess healing and fracture displacement. Functional outcomes were evaluated using the Majeed grading system.

Results

The PR fixation group included 44 patients, and the APR fixation group included 49 patients. Operative time, intra-operative blood loss, units of blood transfused, intra-operative fluid administered, and post-operative drainage were lower in the PR fixation group than in the APR fixation group. Length of hospital stay was also shorter in the PR fixation group than in the APR fixation group. Although the frequency (8/44) of fracture displacement in the superior ramus prior to union was high in the PR fixation group, no significant differences in time to weight bearing, time to clinical healing, or Majeed scores were found between the groups at follow-up.

Conclusions

Isolated posterior ring fixation for LC-2 pelvic fractures is feasible; patients who underwent treatment with this technique had functional outcomes similar to that of those who underwent anterior and posterior ring fixation.

Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H (1989) Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 29(7):981–1000 discussion 1000-2CrossRefPubMed

Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160(2):445–451. https://doi.org/10.1148/radiology.160.2.3726125 CrossRefPubMed

Young JW, Burgess AR, Brumback RJ, Poka A (1986) Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management. Skelet Radiol 15(2):103–109CrossRef

Tile M, Helfet D, Kellam J (2003) Fractures of the pelvis and acetabulum. Lippincott Williams & Wilkins, Philadelphia

Queipo-de-Llano A, Perez-Blanca A, Ezquerro F, Luna-Gonzalez F (2013) Simultaneous anterior and posterior compression of the pelvic ring with external fixation using a pre-tensed curved bar: a biomechanical study. Injury 44(12):1787–1792. https://doi.org/10.1016/j.injury.2013.08.016 CrossRefPubMed

Xu QF, Lin KR, Zhao DJ, Zhang SQ, Feng SK, Li C (2017) Clinical application of percutaneous iliosacral screws combined with pubic ramus screws in Tile B pelvic fracture. Zhongguo Gu Shang 30(3):202–207. https://doi.org/10.3969/j.issn.1003-0034.2017.03.003 CrossRefPubMed

Avilucea FR, Archdeacon MT, Collinge CA, Sciadini M, Sagi HC, Mir HR (2018) Fixation strategy using sequential intraoperative examination under anesthesia for unstable lateral compression pelvic ring injuries reliably predicts union with minimal displacement. J Bone Joint Surg Am 100(17):1503–1508. https://doi.org/10.2106/JBJS.17.01650 CrossRefPubMed

Matta JM, Tornetta P 3rd (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129–140. https://doi.org/10.1097/00003086-199608000-00016 CrossRef

Matta JM (1996) Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res 329:88–96. https://doi.org/10.1097/00003086-199608000-00011 CrossRef

10.

Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83–97

11.

Ponsen KJ, Joosse P, Schigt A, Goslings JC, Luitse JS (2006) Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results. J Trauma 61(3):662–667. https://doi.org/10.1097/01.ta.0000219693.95873.24 CrossRefPubMed

12.

Gerbershagen HJ, Dagtekin O, Isenberg J, Martens N, Ozgur E, Krep H, Sabatowski R, Petzke F (2010) Chronic pain and disability after pelvic and acetabular fractures--assessment with the Mainz pain staging system. J Trauma 69(1):128–136. https://doi.org/10.1097/TA.0b013e3181bbd703 CrossRefPubMed

13.

Lei J, Zhang Y, Wu G, Wang Z, Cai X (2015, 2015) The influence of pelvic ramus fracture on the stability of fixed pelvic complex fracture. Comput Math Methods Med:790575. https://doi.org/10.1155/2015/790575 CrossRef

14.

Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg (Br) 70(1):1–12CrossRef

15.

Comstock CP, van der Meulen MC, Goodman SB (1996) Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. J Orthop Trauma 10(8):517–522CrossRefPubMed

16.

Turgut A, Kalenderer O, Akan I, Ilyas G, Kumbaraci M, Karapinar L (2017) Do patients with acute isolated pubic ramus fractures have to be hospitalized? Acta Orthop Belg 83(4):574–580PubMed

17.

Ismail HD, Lubis MF, Djaja YP (2016) The outcome of complex pelvic fracture after internal fixation surgery. Malays Orthop J 10(1):16–21. https://doi.org/10.5704/MOJ.1603.004 CrossRefPubMedPubMedCentral

18.

Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg (Br) 71(2):304–306CrossRef

19.

Cai L, Lou Y, Guo X, Wang J (2017) Surgical treatment of unstable pelvic fractures with concomitant acetabular fractures. Int Orthop 41(9):1803–1811. https://doi.org/10.1007/s00264-017-3532-0 CrossRefPubMed

20.

Wang P, Kandemir U, Zhang B, Wang B, Li J, Zhuang Y, Wang H, Zhang H, Liu P, Zhang K (2019) Incidence and risk factors of deep vein thrombosis in patients with pelvic and acetabular fractures. Clin Appl Thromb Hemost 25:1076029619845066. https://doi.org/10.1177/1076029619845066 CrossRefPubMedPubMedCentral

Title: Comparison of posterior ring fixation with combined anterior and posterior ring fixation for the treatment of lateral compression type 2 pelvic fractures
Authors: Bin-Fei Zhang
Kun Shang
Peng-Fei Wang
Chao Ke
Shuang Han
Kun Yang
Chen Fei
Xin Xu
Kun Zhang
Yan Zhuang
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04512-1

At a glance: The STEP trials

Springer Medicine

Comparison of posterior ring fixation with combined anterior and posterior ring fixation for the treatment of lateral compression type 2 pelvic fractures

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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