ABSTRACT
BACKGROUND: Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis. DESCRIPTION OF TECHNIQUE: An incision is made over each anterior iliac crest and a 6- to 8-cm incision is centered over the symphysis. Either a locking reconstruction plate or a spinal rod is placed through a subcutaneous tunnel overlying the external oblique fascia in the subcutaneous tissue, and fixation into the iliac crest and pubis is achieved to effect stability. METHODS: A randomized controlled trial comparing anterior pelvic external fixation (APEF) versus anterior pelvic internal fixation (APIF) for unstable pelvic ring injuries was begun in October 2010. Patients with unstable pelvic ring injuries were enrolled and followed with respect to fracture reduction, surgical pain, complications, and functional outcome scores. RESULTS: As of January 2012, 23 patients met inclusion; however, 12 patients refused participation because of the possibility of external fixation, leaving 11 patients (four male, seven female) enrolled. At 6-month followup, there was a single pin tract infection in the APEF cohort and no complications or pain in the APIF cohort. CONCLUSIONS: This clinical experience lends support to the use of a new minimally invasive technique to stabilize the anterior pelvis, particularly given the resistance on the part of patients to consider external fixation. LEVEL OF EVIDENCE: Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)
Bone Malalignment/surgery , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Minimally Invasive Surgical Procedures/methods , Pelvic Bones/injuries , Bone Malalignment/diagnostic imaging , Bone Malalignment/rehabilitation , Bone Nails , Bone Plates , Female , Hip Fractures/diagnostic imaging , Hip Fractures/rehabilitation , Humans , Ilium/diagnostic imaging , Ilium/surgery , Male , Outcome Assessment, Health Care , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgery , Pubic Symphysis/diagnostic imaging , Pubic Symphysis/surgery , Radiography , Treatment OutcomeABSTRACT
Tibial fractures are the most common long bone fractures. Extra-articular proximal tibia fractures account for approximately 5% to 11% of all tibial shaft fractures. The benefits of intramedullary nailing of these fractures include load sharing, sparing of the extraosseous blood supply, and avoidance of additional soft-tissue dissection, thereby minimizing the risk of postoperative complications. A significant rate of malalignment has been reported with intramedullary nailing of proximal tibia fractures, however. Malalignment typically presents as apex anterior and valgus angulation. Several nailing methods and reduction techniques have been developed to minimize this complication, including the use of a proper starting point and insertion angle, blocking screws, unicortical plates, a universal distractor, and alternative positioning and approaches. Use of one or more of these techniques has resulted in a reported average malreduction rate of 8.2%.
