scholarly journals Instability of the Pelvic Ring: A Special Clinical Entity?

2020 ◽  
Vol 9 (6) ◽  
pp. 1985
Author(s):  
Peter V Giannoudis
Keyword(s):  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Clinical Entity ◽  
Pelvic Ring Instability

The presence of the pathological movement of pubic symphysis under normal activities characterises a syndrome know as anterior pelvic ring instability [...]

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

scholarly journals Trans-obturator cable fixation of open book pelvic injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Martin C. Jordan ◽  
Veronika Jäckle ◽  
Sebastian Scheidt ◽  
Fabian Gilbert ◽  
Stefanie Hölscher-Doht ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Pubic Symphysis ◽  
Cadaver Study ◽  
Steel Cable ◽  
Reliable Technique ◽  
Peak Displacement ◽  
Total Displacement ◽  
Cable Fixation

AbstractOperative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

scholarly journals Therapy of Pelvic Ring Instability.

1991 ◽  
Vol 39 (4) ◽  
pp. 1506-1511
Author(s):  
Naoya Haramaki ◽  
Naoya Matsuyama ◽  
Masaki Miyazaki
Keyword(s):  
Pelvic Ring ◽  
Pelvic Ring Instability

scholarly journals Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

2021 ◽  
Author(s):  
Sheng Zhang ◽  
Huagui Mo ◽  
Yucheng Liu ◽  
Guohua Zhu ◽  
Bin Yu
Keyword(s):  
Internal Fixation ◽  
Pelvic Ring ◽  
Treatment Strategies ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Fixation Failure ◽  
Initial Surgery ◽  
Multidisciplinary Cooperation ◽  
Preoperative Plan ◽  
Anterior Ring

Abstract Background: This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials: From January 2009 to December 2018, 93 patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system.Results: According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5-28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients were fixed with a plate. Five patients undergoing revision surgery were followed up for 6-36 months with an average of 18 months. According to Majeedscore at the last follow-up, there were 2 cases of excellent, 2 cases of good, 1 case of fair, and the excellent and good rate reached 80%.Conclusion: The treatment of complicated unstable pelvic fractures requires early multidisciplinary cooperation, proper management of hemodynamic stability and other comorbidities, and performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

Overlapping Dislocation of the Pubic Symphysis with an Open Reduction and Anterior and Posterior Pelvic Ring Fixation

2015 ◽  
Vol 5 (1) ◽  
pp. e6 ◽  
Author(s):  
Alan T. Blank ◽  
Mark Gage ◽  
Nirmal Tejwani ◽  
Toni McLaurin
Keyword(s):  
Open Reduction ◽  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Posterior Pelvic Ring

scholarly journals The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Jianyin Lei ◽  
Yue Zhang ◽  
Guiying Wu ◽  
Zhihua Wang ◽  
Xianhua Cai
Keyword(s):  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Stable Condition ◽  
Pubic Symphysis ◽  
Pelvic Bone ◽  
Anterior Plate ◽  
Fe Method ◽  
Pubic Ramus ◽  
Complex Fracture ◽  
The Stability

This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.

Instability of the posterior pelvic ring associated with disruption of the pubic symphysis

2004 ◽  
Vol 35 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Laura S. Phieffer ◽  
William P. Lundberg ◽  
David C. Templeman
Keyword(s):  
Pelvic Ring ◽  
Pubic Symphysis ◽  
Posterior Pelvic Ring

Less Invasive Lumbopelvic Stabilization of Posterior Pelvic Ring Instability: Technique and Preliminary Results

2011 ◽  
Vol 71 (3) ◽  
pp. E62-E70 ◽  
Author(s):  
Marius Johann Baptist Keel ◽  
Lorin Michael Benneker ◽  
Klaus Arno Siebenrock ◽  
Johannes Dominik Bastian
Keyword(s):  
Pelvic Ring ◽  
Posterior Pelvic Ring ◽  
Preliminary Results ◽  
Less Invasive ◽  
Pelvic Ring Instability ◽  
Lumbopelvic Stabilization
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