Fixation of anterior pelvic ring fracture with long reconstruction plate combined with MIPPO technique / 中国骨伤

OBJECTIVE@#To evaluate the efficacy of long reconstruction plate combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technique in the treatment of unstable pelvic anterior ring fractures.@*METHODS@#From January 2013 to February 2019, 16 patients with unstable pelvic fracture were treated, including 12 males and 4 females, aged from 20 to 60 years(mean 46.5 years). According to Tile classification, there were 4 cases of type B1, 6 cases of type B2, 4 cases of type C1 and 2 cases of type C2. The fracture of all patients was closed, and the time from injury to operation was 7 to 10 days with an average of 6.2 days. The operation time, intraoperative blood loss, fracture reduction quality, fracture healing time, complications and limb function during the final follow-up were evaluated in 16 patients.@*RESULTS@#All 16 patients were followed up for 12 to 23 months (mean 19.1 months). The operation time was 60 to 180 min (mean 107.8 min). The intraoperative blood loss was 120 to 600 ml (mean 368.1 ml). The fracture healing time was 12 to 20 weeks (mean 16.3 weeks). According to Matta criteria, the fracture reduction was excellent in 6 cases, good in 8 cases and fair in 2 cases. One patient suffered from lateral femoral cutaneous nerve injury during the operation, and the lateral thigh sensation decreased after operation, which recovered after 6 months. One patient had pain stimulated by internal fixation at the iliac fossa. The symptoms were improved after the internal fixation was removed. The fractures of 16 patients were healed satisfactorily and there was no internal fixation loosening. Majeed score at the final follow-up was 67 to 95, excellent in 10 cases, good in 4 cases and fair in 2 cases.@*CONCLUSION@#Closed reduction and fixation of pelvic anterior ring fracture with long reconstruction plate combined with MIPPO technique through anterior approach has the advantages of less injury, less bleeding time during operation, saving operation time, high intraoperative safety, high fracture healing rate, early functional exercise after operation, and effective treatment of pelvic anterior ring fracture.

Effect analysis of trajectory screw technique in fragility fracture of pelvic ring / 中国骨伤

OBJECTIVE@#To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP).@*METHODS@#A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively.@*RESULTS@#All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05).@*CONCLUSION@#For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.

Outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect / 北京大学学报(医学版)

OBJECTIVE@#To summarize the clinical outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect (PFUDD) and discuss the skills of partial pubectomy.@*METHODS@#The clinical data of 63 male patients with PFUDD were retrospective reviewed. The procedure of the anastomotic urethroplasty was as follows: (1) circumferentially mobilizing the bulbar urethra; (2) separating the corporal bodies; (3) performing the urethral anastomosis after partial pubectomy and exposure of the healthy two ends of the urethra.@*RESULTS@#The mean age of the patients was (39.2±15.6) years (range: 15-72 years). The median time between incidents and operation was 15 months (range: 3-240 months) and the mean length of stricture was (3.85±0.91) cm (range: 1.5-5.5 cm). All the patients had undergone suprapubic cystostomy in acute setting. Thirteen patients (20.6%) were re-do cases and the patients who had undergone dilation, direct vision internal urethrotomy (DVIU), and open primary realignment were 22 (34.9%), 8 (12.7%), and 8 (12.7%), respectively. Assisted with partial pubectomy, the anastomotic urethroplasty had been successfully performed in all the patients. The mean time of operation was (160.2±28.1) min (110-210 min), and the mean evaluated blood loss was (261.1±130.3) mL (100-800 mL). There were 3 cases (4.8%) with perioperative blood transfusions. The postoperative complications were bleeding and urinary tract infection, which were controlled conservatively. The mean maximum urine flow rate was (23.7±7.4) mL/s (15.0-48.2 mL/s) after removing the catheters 4 weeks after urethroplasty. The median follow-up was 23 months (12-37 months). The urethroscopy showed 2 cases of stricture recurrences and 1 case of iatrogenic penile urethral stricture due the symptoms of urinary tract infection and decreased urine flow and all of them were successfully managed with dilation.@*CONCLUSION@#Partial pubectomy can effectively reduce the gap between the ends of the urethra and promote tension-free anastomosis during the anastomotic urethroplsty for patients with PFUDD. The skills of the procedure include good exposure of the anterior surface of pubic symphysis between the separated corporal bodies, carefully mobilizing and securing the deep dorsal vein of the penis, removing the partial pubic bone and the harden scar beneath the pubic bone for good exposure of the proximal urethral end.

Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality / Trauma pélvico e inestabilidad hemodinámica: Un algoritmo quirúrgico de control de daños que se adapta con su realidad

Abstract Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.

Resumen Las fracturas de pelvis ocurren en más del 25% de los pacientes con trauma severo y su mortalidad es alta, a pesar de los avances en la resucitación hemodinámica y las técnicas quirúrgicas. Esta mortalidad se explica por la hemorragia inherente y las lesiones extra pélvicas asociadas, las fracturas o las disrupciones ligamentarias de la pelvis aumentan el volumen del espacio pélvico, y conlleva a que la hemorragia pélvica se acumule en el espacio retroperitoneal. En poco tiempo, esto conduce a la inestabilidad hemodinámica y el rombo de la muerte. La hemorragia pélvica es un 80% venosa proveniente de los plexos pre-sacro / pre-peritoneal. El restante 20% es arterial por sangrado de las ramas de la arteria iliaca interna. Esta realidad podría ser cambiada a través de un manejo secuencial enfocado según la disposición de recursos del centro de atención y de un trabajo colaborativo entre ortopedistas, cirujanos de trauma e intensivistas. Este articulo propone dos algoritmos de manejo que están enfocados según la disponibilidad de un equipo calificado e infraestructura existente: uno para un centro de trauma totalmente equipado, y el otro para un centro con recursos limitados.

Comparison of different minimally invasive internal fixation in the treatment of pelvic anterior ring fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of three minimally invasive methods of anterior column screw, plate and screw rod system in the treatment of anterior pelvic ring fracture.@*METHODS@#From December 2015 to September 2018, 77 patients with pelvic anterior ring fracture were treated and followed up, including 45 males and 32 females, aged 19 to 73 years. According to AO / OTA classification, there were 26 cases of type B1, 20 cases of type B2, 17 cases of type B3 and 14 cases of type C. According to the different internal fixation methods, they were divided into three groups:anterior column screw group(35 cases), plate group(20 cases), and screw rod system group(22 cases). The operation time, intraoperative fluoroscopy times, blood loss, fracture reduction quality, complications and curative effect of the three groups were compared.@*RESULTS@#All 77 patients were followed up for 12 to 33 (16.5±5.7) months. The operation time, intraoperative blood loss and incision length of anterior column screw group were significantly shorter than those of plate group and screw rod system group, and intraoperative fluoroscopy times of plate group were significantly less than those of anterior column screw group and screw rod system group (@*CONCLUSION@#Minimally invasive internal fixation with anterior column screw, plate and screw rod system can obtain good clinical effect, but anterior column screw fixation has less trauma and lower incidence of surgicalcomplications.

Mega prótesis a medida para la reconstrucción de defectos óseos masivos en pelvis ¨El cirujano como diseñador del implante¨ / ORTHOPAEDIC RECONSTRUCTION OF MASSIVE PELVIC BONE DEFECTS AFTER PELVIC TUMOUR RESECTION

Despite major developments in the field of orthopaedic reconstruction of pelvic bone defects after pelvic tumour resection, massive pelvic bone loss with bone defect and pelvic discontinuity, still remains a complex problem. Resection of big musculoskeletal sarcomas of the pelvis and the later reconstruction of the residual defect constitutes one of the more exigent challenges of orthopaedic surgery. The authors present a method for reconstruction with a personalized prosthesis by mean of a rapid prototype specially designed for each occasion. The authors describe this individually prefabricated prosthesis based on rapid prototyíng technique with a computer-assisted design in a 3D printing based version. The results obtained are presented and commented.

Uso de packing preperitoneal en paciente politraumatizado / Use of preperitoneal packing in politraumatized patient

Objetivo Reportar un caso de grave fractura pélvica y sangrado masivo tratado inicialmente con packing pélvico. Caso clínico Paciente precipitado hemodinámicamente debido a varias fracturas abiertas, entre las que se incluye fractura pélvica con importante diástasis púbica. Se decide intervención quirúrgica procediendo a fijación externa de la pelvis, y posteriormente se realiza un packing extraperitoneal dado el gran hematoma extraperitoneal con sangrado en sábana. Finalmente, se practica arteriografía donde se ve sangrado arterial activo dependiente del tronco pudendo obturador y de la arteria glútea superior izquierda que se embolizan, con posterior estabilización hemodinámica. Conclusión La arteriografía puede mejorar el control de la hemorragia en los pacientes con sangrado arterial y hemodinámicamente estables, pero el packing tiene prioridad en los pacientes con fracturas de pelvis e inestabilidad hemodinámica.

Aim To report a case of severe pelvic fracture and massive bleeding initially treated with pelvic packing. Clinical case Patient who falls off a high place, hemodynamically unstable due to several open fractures including a pelvic fracture with significant pubic diastasis. It is decided to operate on the patient, proceeding to external fixation of the pelvis and performing, afterwards, an extraperitoneal packing due to the large extraperitoneal hematoma with oozing hemorrhage. Lastly an arteriography is done, where active arterial bleeding is observed localized at the obturator pudendal trunk and the left superior gluteal artery, which are embolized with hemodynamic stabilization. Conclusion Arteriography can improve hemorrhage control in hemodynamically stable patients with arterial bleeding, but packing has the priority on patients with pelvic fractures and hemodynamic instability.

Uso del Clamp pélvico en un paciente pediátrico politraumatizado / Pelvic Clamp in a polytraumatized pediatric patient

Las fracturas de pelvis en pacientes pediátricos son poco comunes y difieren de su contraparte en los adultos en cuanto a etiología, tipos de fracturas y lesiones asociadas; suelen estar acompañados, además, de lesiones viscerales y hemorragias letales. Presentamos el caso de paciente femenino de 10 años, con fractura inestable de la pelvis e inestabilidad hemodinámica que fue tratada con Clamp Pélvico como medida de resucitación y control de daños en la emergencia. El manejo de las fracturas de pelvis con el Clamp Pélvico en pacientes pediátricos con inestabilidad hemodinámica "in extremis" o "borderline" es un procedimiento práctico que debe ser dominada por residentes y especialistas de Ortopedia y Traumatología de todos los hospitales de nuestro país(AU)

Pelvic fractures in pediatric patients are rare and differs from their counterparts in adults in terms of etiology, fractures types and associated injuries. Can be accompanied by visceral lesions and lethal hemorrhages. We report the case 10 years old female patient with unstable pelvic fracture and hemodynamic instability who was treated with Pelvic C-Clamp as a measure of damage control and resuscitation in the emergency. The management of fractures of the pelvis in pediatric patients with hemodynamic instability "in extremis" or "borderline" with the Pelvic C-Clamp is a practical procedure to be dominated by residents and specialists of Orthopedics and Traumatology of all hospitals in our country(AU)

Outcome after Surgical Treatment of Pelvic Sarcomas

BACKGROUND: We present here the oncological and functional outcomes of limb salvage with or without reconstruction for primary sarcomas in the pelvic bone. METHODS: Forty-four patients who underwent pelvic resection for primary sarcomas involving the pelvis were reviewed. The average follow-up period was 39 months (range, 0 to 146 months). Chondrosarcoma (n = 17) and osteosarcoma (n = 10) were the most common diagnoses. Various clinicopathologic factors were analyzed in relation to the oncological outcomes of overall survival and local recurrence. The Musculoskeletal Tumor Society functional scores and complications were compared according to the tumor location, pelvic continuity and the type of resection. RESULTS: The overall 5-year survival rate was 40%. Metastasis at the time of diagnosis, the surgical margin and the histologic grade were the independent prognostic factors for survival. The surgical margin was an independent prognostic factor for local recurrence. An ischiopubic location of the tumor, restoration of pelvic continuity and hip joint reconstruction with total hip replacement arthroplasty were related with higher functional scores. Complications occurred in 50% of the patients and the complications varied according to the tumor location with infection being the most common complication. CONCLUSIONS: Achieving an adequate surgical margin is necessary for improving the oncological outcome of pelvic sarcomas. Restoration of the pelvic continuity and the hip joint improves the functional outcome. However, complications are common and so careful selection of the reconstruction method is needed.

Fijación externa supra-acetabular de pelvis: nota técnica / Supra acetabular pelvic external fixation: technical note

Introduction: External fixation is a useful technique for the treatment of instable pelvic fractures. There are several configuration alternatives regarding to Schanz pin placement. In order to assure safe placement of the Shanz pins, it is useful to obtain an intraoperative fluoroscopic image of the supra-acetabular teardrop, wich indicates the linear osseous path between the anterior inferior iliac spine (AIIS) and the posterior superior iliac spine (PSIS). Material and Method: The surgical technique for safe supra-acetabular pin placement is described using an anatomic piece corresponding to the pelvis of a middle-aged male. A combination of outlet and obturador projections is sued to show an adequate fluoroscopic vision of the supra-acetabular teardrop. The result of this technique is demonstrated with a case report. Results: Having achieved a proper intraoperative vision of the supra-acetabular teardrop, the Schanz pins can be safely placed from the anterior inferior iliac spine (AIIS) through the osseous corridor in order to reach the posterior superior iliac spine (PSIS). Conclusions: Placing both Schanz pins in the supra-acetabular area and guided under fluoroscopic vision as described in this technique, allows reaching the posterior pelvis, achieving better control of bone fragments and compression of the posterior pelvic ring through an anterior approach. Therefore, this technique is an excellent alternative for external fixation of an unstable pelvic fracture.

Introducción: La fijación externa es de gran utilidad para el tratamiento de fracturas inestables de pelvis. Existen diversas opciones de configuración y alternativas para la colocación de los fijadores externos. Para la colocación segura de estas agujas de Schanz, la imagen fluoroscópica intra operatoria de la “lágrima” supra-acetabular, que indica el trayecto lineal entre la espina ilíaca antero inferior (EIAI) y la espina ilíaca postero superior (EIPS), resulta de gran utilidad. Material y Método: Se describe la técnica para la colocación de estas agujas en una pieza anatómica bajo visión fluoroscópica y cómo obtener una adecuada visión de la “lágrima” supra-acetabular al colocar el aparato de rayos en outlet-obsturatriz. Además se muestra el resultado de esta técnica en un caso clínico. Resultados: Obteniendo una adecuada visión intra-operatoria de la “lágrima” supra-acetabular se pueden colocar agujas de Schanz o cualquier material de osteosíntesis desde la espina ilíaca antero inferior hasta la espina ilíaca postero superior a través de un corredor óseo supra-acetabular. Conclusiones: Las agujas de Schanz colocadas en la zona supra-acetabular bajo control de rayos con la técnica aquí descrita permiten alcanzar la zona posterior de la pelvis (EIPS), logrando un mejor control de los fragmentos óseos y permitiendo la compresión desde anterior de la pelvis posterior. Son por lo tanto una excelente alternativa al momento de decidir una fijación externa de fracturas inestables de pelvis.

Abordaje en U invertida para resecciones oncologicas mayores en la pelvis. Informe de complicaciones / Inverted U approach for major oncologic resections around the pelvis. Complications report

Introducción: La cirugía de “salvataje de miembros” en la región pelviana (hueso innominado ysacro) es un procedimiento demandante y complejo, que conlleva una alta morbilidad (20 por ciento a 80 por ciento). El abordaje triirradiado es el más frecuente y clásicamente utilizado en estas grandes y complejas cirugías. Sin embargo, se han informado numerosas complicaciones locales con su aplicación. El objetivo del siguiente trabajo fue desarrollar como alternativa al clásico abordaje triirradiado, una variante de exposición quirúrgica en U invertida de base distalamplia sobre la cresta ilíaca e informar el índice de complicaciones locales. La hipótesis propuesta es que la exposición quirúrgica descrita respeta la vascularización cutánea en esa región, permite desarrollar colgajos complacientes y disminuye el índice de complicaciones locales de la herida. Materiales y métodos: Durante los años 2004-2008 se realizaron 8 hemipelvectomías (internas y externas) por diferentes tumores musculoesqueléticos (4 condrosarcomas, 3 lesiones metastásicas (1 tiroides 2 mielomas) y 1 displasia epifisaria hemimélica. Se detalla la técnica quirúrgica empleada. Resultados: En todos los casos la anatomía patológica definitiva de la lesión confirmó la obtenida por biopsia previa y los márgenes fueron clasificados como “amplios”. El promedio de días de internación fue de 7,1 (4 a 10) días. No se evidenciaron dehiscencias ni infecciones superficiales sobre la herida. Se presentó como complicación una necrosis parcial que requirió limpieza quirúrgica de la zona apical del colgajo inferior Conclusiones: El abordaje en U invertida surge como una alternativa, en casos seleccionados, al abordaje triirradiado clásico para las hemipelvectomías, tanto internas como externas, ya que conlleva menor índice de complicaciones locales y permite una correcta exposición a la pelvis, con posibilidades de extenderla hacia el miembro o zona lumbar sin comprometer los márgenes de resección.

Painless nonunion after triple pelvic osteotomy

Triple pelvic osteotomy is an accepted technique to correct acetabular dysplasia and degenerative labral pathology in young adults. Few papers mentioned the rate of nonunion at site of osteotomy of pubic bone and ischeal bone. No report about nonunion at site of osteotomy of iliac bone [up to the author's knowledge]. Here the author reported a case of triple pelvic osteotomy which is complicated by painless nonunion at site of osteotomy of iliac bone which required excision of pseudarthrosis and autologous bone grafting. Healing was achieved after three months

Manejo de tumores de la pelvis / Treatment of primary pelvic tumors

Pelvic resection surgeries due to primary bone tumors are infrequent. According to the compromised area we can divide it in three zones, being those who affect the acetabulum the ones with the major functional alterations, pelvic stability and leg length discrepancy. The aim of this study is to present our experience in the surgical management of this type of lesions. From series of 17 patients, eight (47 percent) presented complications, the most frequents was surgical wound infection (23 percent) and deep venous thrombosis (18 percent). 4 patients died (23 percent). The other 13 patients answered the Musculo Skeletal Tumor Society (MSTS) scale being the average score 22,3. One local recurrence appeared in this group. The acceptance of the patients in this kind of surgeries is very good. These surgeries are complex, there is a high rate of complications. They must be performed in centers with a suitable professional and technical equipment.

Las cirugías de resecciones pélvicas por tumores óseos primarios son infrecuentes. Según el área comprometida se divide principalmente en 3 zonas, siendo las que afectan al acetábulo las que producen mayor alteración (funcional, en la estabilidad pélvica y la longitud de las extremidades inferiores). El objetivo de este trabajo es presentar la experiencia del equipo de tumores del Instituto Traumatológico y la Clínica Santa María en el manejo quirúrgico de este tipo de lesiones. Con un total de 17 pacientes, 8 presentaron complicaciones (47 por ciento), la más frecuente fue la infección de herida operatoria (4 pacientes 23 por ciento) y la trombosis venosa profunda (3 pacientes 18 por ciento). Cuatro pacientes (24 por ciento) fallecieron, los 13 restantes respondieron la escala Musculo Skeletal Tumor Society (MSTS) siendo el puntaje promedio de 22,3. Se presentó una recidiva local en este grupo. El grado de aceptación de los pacientes es muy bueno. Deben realizarse en centros con el equipamiento profesional y técnico adecuado para las exigentes y complejas cirugías a realizar.

Fractura de pélvis: traumatismo de alta energía / Pelvis fracture: high energy injury

La fractura de pélvis es una de las lesiones consideradas de las más importantes dentro de la traumatología. No sólo por la considerable mortalidad asociada -por lo que en la literatura es conocida como "la fractura asesina"- sino también por el potencial daño a otros sistemas que puedan comprometer la vida del paciente. La comprensión de los tres tipos de fractura (A, B ó C), determinados por el grado de inestabilidad, es importante tanto para el tratamiento inicial en la sala de reanimación, que incluye la comprensión extrínseca de la pelvis para disminuir el diámetro del anillo pelviano y con ello el riesgo de progresión de hematomas retroperitoneales, como para la definición del tipo de estabilización a seleccionar para el manejo definitivo de la lesión. Esta es una lesión característica de pacientes politraumatizados, por lo que el manejo oportuno por un equipo multidisciplinario, bajo los principios del Advanced Trauma Life Support (ATLS), es vital para la sobrevida del paciente. Bajo el mismo principio, deben descartarse lesiones de otros parénquimas, en especial de vísceras contenidas en la cavidad pélvica que requieran un accionar inmediato. La estabilización provisoria con tutor externo está reservada para pacientes en cuyo patrón de fractura se evidencia aumento del diámetro de la pelvis y compromiso hemodinámico. El manejo definitivo de la fractura debe llevarse a cabo en forma diferida, tomando en cuenta el concepto de cirugía de control de daño, es decir, en el momento en que nuestro accionar no aumente en forma considerable la morbimortalidad propia de la lesión.

External fixation for pelvic ring disruptions anatomical and functional outcomes

Unstable pelvic ring disruptions are often associated with significant morbidity and mortality specially in patients with multiple injuries . stabilization of the pelvic ring by external fixator helps to control haemorrhage and allows comfortable mobility of the patient. Thirty five patients were treated by pelvic external fixator for their unstable pelvic injuries, but the analysis of the results included only 26 cases .Open technique for pin placement was used in seventeen cases, while the closed technique was used in nine cases. The fixator pins were inserted into the iliac crest between the iliac cortical tables to a depth of 5 cm . All patients had closed manipulative reduction of the pelvic ring under image control. The average hospitalization period was 16 days for the patients with isolated pelvic injuries. The average hospitalization for all patients was 37 days .Evalualution of the anatomical results depended on the diastasis of the symphysis pubis and proximal migration of the hemipelvis. The satisfactory anatomical results were 57.4% .The functional results were assessed by a numerical scoring system [Majeed 1989] . The satisfactory functional results were 65.38%. The complications were mainly related to the pins of the fixator . These complications were lower for the pins inserted by closed technique . There were two cases of delayed union due to imperfect reduction. External fixation for pelvic ring disruption is a safe simple method .It is suitable for all cases of pelvic ring injuries those are rotationally unstable but vertically stable

Fixation of bilateral pelvic osteotomies with external fixator in exstrophy bladder complex

To present the early results of pelvic osteotomies performed for repair of exstrophy bladder. Five cases of exstrophy bladder were treated with closure following bilateral iliac osteotomies. Three patients underwent closure of pubic symphysis diastasis by use of external fixator, one by screws and cerclage wires, and one by use of K-wires and suture. The patients were followed up by the pediatric urologist and orthopedic surgeon. All patients achieved a closure of diastasis and a tension free repair after the index surgery. The average follow-up was 3.6 years with range of 4 months to 6 years. All osteotomies healed within two months and had closure of the diastasis, except one which had a partial failure with loss of 50% correction. No patient had any wound dehiscence or breakdown of the bladder repair. Preoperative mean diastasis of symphysis pubis was 6 cm [range; 4.5 cm to 7 cm] and post operative mean diastasis was 3.5 cm with the range of 2.5 cm to 4 cm at 12 months follow up. All patients achieved urinary continence post operatively and were passing urine per-urethra with satisfactory urinary control as followed-up with the pediatric urologists. Bilateral iliac osteotomies and use of external fixator in our series was found to be helpful in achieving a tension free closure and preventing dehiscence of the repair

Pelvic ring fractures: epidemiological study / Fraturas do anel pélvico: estudo epidemiológico

De fevereiro de 2000 a setembro de 2001, 84 pacientes apresentando fratura do anel pélvico foram avaliados, segundo determinado protocolo aplicado. Houve predomínio do sexo masculino (67 por cento), a maioria dos pacientes eram brancos (86 por cento) e a idade média foi de 37 anos. Quanto ao tipo de acidente, os mais freqüentes foram os relacionados ao trânsito (58 por cento) - carro, moto e atropelamento - pacientes vítimas de traumas de alta energia. As fraturas foram classificadas de acordo com Tile(13) em estáveis, em 55 por cento (fraturas do tipo A); rotacionalmente instáveis, em 30 por cento (fraturas do tipo B) e rotacional e verticalmente instáveis, em 15 por cento (fraturas do tipo C). A fratura mais freqüentemente encontrada foi a dos ramos isquiopúbicos. O tratamento cirúrgico foi realizado em 29 por cento dos pacientes. Houve necessidade de transfusão sangüínea em 20 por cento dos pacientes, utilizando-se uma média de cinco unidades de sangue total; exceto dois pacientes (2,4 por cento) com lesão arterial intra pélvica que necessitaram mais de 10 unidades de sangue nas primeiras 48 horas. A mortalidade foi de sete por cento tendo relacão significativa com traumas extra pélvicos.

Unstable pelvic ring injuries. Outcome and timing of surgical treatment by internal fixation

To evaluate the radiological and functional results of surgical treatment of unstable pelvic injuries and to study the factors affecting the final outcome. Thirty-eight patients with unstable type C pelvic injuries from King Khalid University Hospital, Riyadh and North West Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia during the period January 1996 through to January 2001 were reviewed. There were 31 males and 7 females. The mean age was 37-years. Thirty-two patients had 76 associated skeletal fractures. A percutaneous iliosacral screw was carried out for all patients in the study. Anterior stabilization was needed for 23 patients. There were 2 complications of fixation, an iatrogenic S1 root injury and dismantled symphyseal plate. The average hospital stay was 29 days and the average time to start mobilization was 15 days. The radiological result was satisfactory in 32 patients [84%] while functional result was satisfactory in 27 patients [71%].Unstable pelvic ring injuries should be managed surgically and must be carried out as soon as the general condition of the patient allows, even up to 4-weeks