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

Harish Mahesan

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

Citation Information : Mahesan H. An Innovation to Address the Anterior Pelvic Ring Disruptions. J Orth Joint Surg 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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  1. Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30(7):848–856.
  2. Young JW, Burgess AR, Brumback RJ, et al. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986:160(2):445–451. DOI: 10.1148/radiology
  3. Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indications for surgical stabilization. Clin Orthop Relat Res 1996;329:15–27. DOI: 10.1097/00003086-199608000-00004
  4. Tile M, Hearn T, Vrahas M. Fractures of the Pelvis and Acetabulum, 3rd edition. Philadelphia: Lippincott Williams & Wilkins; 2003. pp. 32–45.
  5. Lange RH, Hansen ST Jr. Pelvic ring disruptions with symphysis pubis diastasis. Indications, technique, and limitations of anterior internal fixation. Clin Orthop Relat Res 1985;201:130–137.
  6. Sagi HC, Ordway NR, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma 2004;18(3):138–143. DOI: 10.1097/00005131-200403000-00002
  7. Putnis SE, Pearce R, Wali UJ, et al. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. J Bone Joint Surg Br 2011;93(1):78–84. DOI: 10.1302/0301-620X.93B1.23941
  8. Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg Br 1990;72(4):612–614. DOI: 10.1302/0301-620X.72B4.2380212
  9. Giannoudis PV, Chalidis BE, Roberts CS. Internal fixation of traumatic diastasis of pubic symphysis: is plate removal essential? Arch Orthop Trauma Surg 2008;128(3):325–331. DOI: 10.1007/s00402-007-0429-1
  10. Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma 2008;22(6):373–378. DOI: 10.1097/BOT.0b013e31817e49ee
  11. Routt M Jr, Meier MC, Kregor PJ, et al. Percutaneous iliosacral screws with the patient supine technique. Oper Tech Orthop 1993;3(1):35–45. DOI: 10.1016/S1048-6666(06)80007-8
  12. Morris SA, Loveridge J, Smart DK, et al. Is fixation failure after plate fixation of the symphysis pubis clinically important? Clin Orthop Relat Res 2012;470(8):2154–2160. DOI: 10.1007/s11999-012-2427-z
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