Journal of Orthopedics and Joint Surgery

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VOLUME 6 , ISSUE 1 ( January-June, 2024 ) > List of Articles

CLINICAL TECHNIQUE

An Innovation to Address the Anterior Pelvic Ring Disruptions

Ramesh Perumal, Harish Mahesan, Dheenadhayalan Jayaramaraju, Rajasekaran Shanmuganathan

Keywords : Anterior ring fixation, Diastasis, Pelvic injury, Pelvic ring disruption, Pubic symphysis

Citation Information : Perumal R, Mahesan H, Jayaramaraju D, Shanmuganathan R. An Innovation to Address the Anterior Pelvic Ring Disruptions. 2024; 6 (1):69-73.

DOI: 10.5005/jojs-10079-1127

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic in the early phase. Most commonly preferred fixation mode is plating, contoured 3.5 Matta plate, 3.5 reconstruction plates, and it may be single or dual. The purpose of this study is to report a case series of patients with disrupted anterior pelvic ring fixed with 4.5 dynamic compression plate (DCP). We innovated a technique in modifying the profile of the plate and contouring before it is applied over the superior surface of pubic symphysis. Materials and methods: A total of 21 patients between 2015 and 2018 with disrupted pelvic ring injuries for which open reduction and 4.5 DCP fixation are included in the study and classified according to Young–Burgess. All are evaluated as per advanced trauma life support (ATLS) protocol, and appropriate X-rays and computed tomography (CT) scans are taken. Hemodynamically unstable are stabilized with external fixator as a damage control procedure and planned for plating as a secondary procedure. Postoperative X-rays included AP, inlet, outlet, and lateral views and were reviewed at 4 and 12 weeks and 6 and 12 months for the evidence of loss of reduction, loosening of screws, hardware failure, and functional outcome (Majeed score). Three patients were lost to follow-up; hence, 18 are available for radiological and functional outcome. Results: Six patients showed evidence of early loss of reduction and screw loosening. However, none of the patients are symptomatic, which requires a revision surgery to restore the ring. There is no difference in the functional outcome between the early loss of reduction and the others. Conclusion: Modified 4.5 DCP fixation for the anterior ring fixation has shown excellent outcomes in disrupted pelvic ring injuries. It has no hardware failure, and six patients with loosening of the screws were asymptomatic and had good functional outcomes.


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