Skip to main content
Top
Published in: International Orthopaedics 8/2013

01-08-2013 | Original Paper

Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury

Authors: Xiaowei Yu, Mingjie Tang, Zubin Zhou, Xiaochun Peng, Tianyi Wu, Yuqiang Sun

Published in: International Orthopaedics | Issue 8/2013

Login to get access

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.

Methods

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.

Results

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.

Conclusion

The minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury provided satisfactory efficacy.
Literature
1.
go back to reference Hill RM, Robinson CM, Keating JF (2011) Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg Br 83(8):1141–1144CrossRef Hill RM, Robinson CM, Keating JF (2011) Fractures of the pubic rami. Epidemiology and five-year survival. J Bone Joint Surg Br 83(8):1141–1144CrossRef
2.
go back to reference Scheyerer MJ, Osterhoff G, Wehrle S, Wanner GA, Simmen HP, Werner CM (2012) Detection of posterior pelvic injuries in fractures of the pubic rami. Injury 43(8):1326–1329PubMedCrossRef Scheyerer MJ, Osterhoff G, Wehrle S, Wanner GA, Simmen HP, Werner CM (2012) Detection of posterior pelvic injuries in fractures of the pubic rami. Injury 43(8):1326–1329PubMedCrossRef
3.
go back to reference Gao H, Luo CF, Hu CF, Zhang CQ, Zeng BF (2011) Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries. Surg Innov 18(3):279–284PubMedCrossRef Gao H, Luo CF, Hu CF, Zhang CQ, Zeng BF (2011) Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries. Surg Innov 18(3):279–284PubMedCrossRef
4.
go back to reference Starr AJ, Walter JC, Harris RW, Reinert CM, Jones AL (2002) Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA types 61-B2.2 and 61-B2.3, or Young-Burgess “lateral compression type II” pelvic fractures). J Orthop Trauma 16(2):116–123PubMedCrossRef Starr AJ, Walter JC, Harris RW, Reinert CM, Jones AL (2002) Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA types 61-B2.2 and 61-B2.3, or Young-Burgess “lateral compression type II” pelvic fractures). J Orthop Trauma 16(2):116–123PubMedCrossRef
5.
go back to reference Nicodemo A, Decaroli D, Pallavicini J, Sivieri R, Aprato A, Massè A (2008) A treatment protocol for abdomino-pelvic injuries. J Orthop Traumatol 9(2):89–95PubMedCrossRef Nicodemo A, Decaroli D, Pallavicini J, Sivieri R, Aprato A, Massè A (2008) A treatment protocol for abdomino-pelvic injuries. J Orthop Traumatol 9(2):89–95PubMedCrossRef
6.
go back to reference Ghanayem AJ, Wilber JH, Lieberman JM, Motta AO (1995) The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury. J Trauma 38(3):396–400PubMedCrossRef Ghanayem AJ, Wilber JH, Lieberman JM, Motta AO (1995) The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury. J Trauma 38(3):396–400PubMedCrossRef
7.
go back to reference Matta JM (1996) Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res 329:88–96PubMedCrossRef Matta JM (1996) Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res 329:88–96PubMedCrossRef
8.
go back to reference Shuler TE, Boone DC, Gruen GS, Peitzman AB (1995) Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 38(3):453–458PubMedCrossRef Shuler TE, Boone DC, Gruen GS, Peitzman AB (1995) Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 38(3):453–458PubMedCrossRef
9.
go back to reference Templeman DC, Simpson T, Matta JM (2005) Surgical management of pelvic ring injuries. Instr Course Lect 54:395–400PubMed Templeman DC, Simpson T, Matta JM (2005) Surgical management of pelvic ring injuries. Instr Course Lect 54:395–400PubMed
10.
go back to reference Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A (2012) Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma 26(1):1–8PubMedCrossRef Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A (2012) Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma 26(1):1–8PubMedCrossRef
11.
go back to reference Gökay NS, Bagatur AE (2012) The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc 46(4):243–249PubMedCrossRef Gökay NS, Bagatur AE (2012) The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc 46(4):243–249PubMedCrossRef
12.
go back to reference Adams JE, Davis GG, Heidepriem RW 3rd, Alonso JE, Alexander CB (2002) Analysis of the incidence of pelvic trauma in fatal automobile accidents. Am J Forensic Med Pathol 23(2):132–136PubMedCrossRef Adams JE, Davis GG, Heidepriem RW 3rd, Alonso JE, Alexander CB (2002) Analysis of the incidence of pelvic trauma in fatal automobile accidents. Am J Forensic Med Pathol 23(2):132–136PubMedCrossRef
13.
go back to reference Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA (2011) Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury 42(10):985–991PubMedCrossRef Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA (2011) Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury 42(10):985–991PubMedCrossRef
14.
go back to reference Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, Offner PJ, Ray CE Jr, Franciose RJ, Burch JM (2001) Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 233(6):843–850PubMedCrossRef Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, Offner PJ, Ray CE Jr, Franciose RJ, Burch JM (2001) Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 233(6):843–850PubMedCrossRef
15.
go back to reference Gruen GS, Leit ME, Gruen RJ, Peitzman AB (1994) The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures. J Trauma 36(5):706–711PubMedCrossRef Gruen GS, Leit ME, Gruen RJ, Peitzman AB (1994) The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures. J Trauma 36(5):706–711PubMedCrossRef
16.
go back to reference Hiesterman TG, Hill BW, Cole PA (2012) Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res 470(8):2116–2123PubMedCrossRef Hiesterman TG, Hill BW, Cole PA (2012) Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res 470(8):2116–2123PubMedCrossRef
17.
go back to reference Tosounidis T, Kanakaris N, Nikolaou V, Tan B, Giannoudis PV (2012) Assessment of lateral compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable? Int Orthop 36(12):2553–2558PubMedCrossRef Tosounidis T, Kanakaris N, Nikolaou V, Tan B, Giannoudis PV (2012) Assessment of lateral compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable? Int Orthop 36(12):2553–2558PubMedCrossRef
18.
go back to reference Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T (2012) Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. Int Orthop 36(1):159–164PubMedCrossRef Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T (2012) Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. Int Orthop 36(1):159–164PubMedCrossRef
19.
go back to reference Karadimas EJ, Nicolson T, Kakagia DD, Matthews SJ, Richards PJ, Giannoudis PV (2011) Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature. Int Orthop 35(9):1381–1390PubMedCrossRef Karadimas EJ, Nicolson T, Kakagia DD, Matthews SJ, Richards PJ, Giannoudis PV (2011) Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature. Int Orthop 35(9):1381–1390PubMedCrossRef
20.
go back to reference Hao T, Changwei Y, Qiulin Z (2009) Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis. Int Orthop 33(5):1435–1439PubMedCrossRef Hao T, Changwei Y, Qiulin Z (2009) Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis. Int Orthop 33(5):1435–1439PubMedCrossRef
21.
go back to reference Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV (2009) Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 33(2):329–338PubMedCrossRef Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV (2009) Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 33(2):329–338PubMedCrossRef
Metadata
Title
Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury
Authors
Xiaowei Yu
Mingjie Tang
Zubin Zhou
Xiaochun Peng
Tianyi Wu
Yuqiang Sun
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 8/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1954-x

Other articles of this Issue 8/2013

International Orthopaedics 8/2013 Go to the issue