Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries

详细信息    查看全文

• 作者：Dr. Dr. Y.P. Acklin MD ; DMedSc ; G. Marco MD…
• 关键词：Pelvis ; Dislocations ; Osteosynthesis ; Sacroiliac joint ; Injury severity score ; Becken ; Dislozierung ; Osteosynthese ; Illiosakralgelenk ; Verletzungsschwere ; Score
• 刊名：Operative Orthop?die und Traumatologie
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：27
• 期：1
• 页码：74-79
• 全文大小：765 KB
• 参考文献：1. Berber O, Amis AA, Day AC (2011) Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures. J Bone Joint Surg Br 93:237-44 CrossRef
  2. Burgess AR, Eastridge BJ, Young JW et al (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30:848-56 CrossRef
  3. Choy WS, Kim KJ, Lee SK et al (2012) Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries. Yonsei Med J 53:422-26 CrossRef
  4. Dalal SA, Burgess AR, Siegel JH et al (1989) Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 29:981-000 (discussion 1000-002) CrossRef
  5. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67-1
  6. Griffin DR, Starr AJ, Reinert CM et al (2006) Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 20:S30–S36 (discussion S36)
  7. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium-007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133 CrossRef
  8. Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83-7
  9. Nepola JV, Trenhaile SW, Miranda MA et al (1999) Vertical shear injuries: is there a relationship between residual displacement and functional outcome? J Trauma 46:1024-029 (discussion 1029-030) CrossRef
  10. Osterhoff G, Ossendorf C, Wanner GA et al (2011) Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg 131:809-13 CrossRef
  11. Pohlemann T, Tscherne H, Baumgartel F et al (1996) Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg 99:160-67 CrossRef
  12. Templeman D, Goulet J, Duwelius PJ et al (1996) Internal fixation of displaced fractures of the sacrum. Clin Orthop Relat Res 329:180-85 CrossRef
  13. Templeman DC, Simpson T, Matta JM (2005) Surgical management of pelvic ring injuries. Instr Course Lect 54:395-00
  14. Tile M (1996) Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg 4:143-51
  15. Tile M (1996) Acute pelvic fractures: II. Principles of management. J Am Acad Orthop Surg 4:152-61
  
• 刊物主题：Surgical Orthopedics; Traumatic Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1439-0981

文摘

Objective Alternative sacrum fixation with double-plate osteosynthesis in vertical unstable pelvic fractures. The surgical technique allows anatomic reduction and osteosynthesis of the sacrum component. Indications All vertical unstable pelvic ring fractures 61-C type according to AO/OTA system with associated displaced sacrum fractures Contraindications Hemodynamic unstable patients, fractures with major sacroiliac joint involvement, nondisplaced sacrum fractures. Surgical technique In prone position, a midline incision exposing the sacrum fracture is needed. The fracture is distracted and interjacent bone fragments or hematoma can be evacuated. The fracture is anatomically reduced and compressed. Two anatomically bent 3.5-mm locked compression plates (LCP) are placed on the dorsal aspect of the sacrum. In Denis type?II and?III fractures, the lateral screws can be placed in the lateral aspect of the sacrum. In Denis type?I fractures, the lateral screws are placed in the ilium lateral to the sacroiliac joint to improve purchase. Additional short monocortical locking screws in the middle part of the plates increase the vertical stability to the osteosynthesis. Fracture fixation of the anterior ring follows the dorsal procedure. Postoperative management The patient is mobilized with partial weight bearing. Clinical and radiological follow-up is planned after 6?and 12?weeks. Results A total of 27?patients with vertical unstable pelvic fractures were identified and treated with open reduction and double-plate osteosynthesis. The Iowa pelvic score was rated excellent in 83- and good in 17- of cases. One patient developed a nonunion and had to be revised.