Advertisement

Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure

  • Yangxing Luo
    Affiliations
    Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    Search for articles by this author
  • Hua Chen
    Affiliations
    Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
    Search for articles by this author
  • Li He
    Correspondence
    Corresponding author at: Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Hubei, Wuhan 430030, China
    Affiliations
    Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    Search for articles by this author
  • Chengla Yi
    Correspondence
    Corresponding author at: Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Hubei, Wuhan 430030, China
    Affiliations
    Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    Search for articles by this author
Published:January 04, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.001

      Abstract

      Purposes

      This study aimed to evaluate the clinical effect of the unlocking closed reduction technique (UCRT) for the displaced posterior pelvic ring fractures and to analyze the factors associated with failure of closed reduction and fixation.

      Patients and methods

      Data from patients admitted with displaced posterior pelvic ring fractures initially treated with the URCT from July 2017 to January 2020 were extracted. Clinical and radiological factors including fracture classification, interval days from injury to surgery, number of screws, and type of fixation for the posterior pelvic ring were analyzed to evaluate their correlation with closed reduction failure, reduction quality, and fixation failure. Then a logistic regression model was used for statistical analysis to eliminate confusion factors.

      Results

      Ninety-seven patients with displaced posterior pelvic ring fractures were followed for a mean of 1.7 years after surgery. Successful closed reduction and percutaneous fixation were achieved for 89 patients (91.8%), of which 82 patients (92.1%) achieved an excellent or good reduction. Closed reduction failure which converted to open reduction was recorded for eight patients (8.2%). AO/OTA type C3 fracture (p = 0.036) and osteoporosis (p = 0.012) were significant factors for closed reduction failure. Excellent was recorded for 76 patients (78.4%) and acute (1-21 days) interval days from injury to surgery was an associated factor for reduction quality. For AO/OTA type C1 fractures, no more than two short screws (unilateral iliosacral screws) or a single long screw (transiliac-transsacral screws) were independent prognostic factors of fixation failure (p = 0.026).

      Conclusions

      Displaced posterior pelvic ring fractures treated with the UCRT are associated with excellent/ good radiological results. However, in patients with AO/OTA type C3 pelvic fracture and osteoporosis, the backup plan of open reduction should be routinely prepared. The patient should be brought to the operating room within three weeks to get a good reduction result. Two long screws or one long screw combined with two short screws are required to create a strong construct for AO/OTA type C1 pelvic fractures.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • He L
        • Yi C
        • Hak DJ
        • Hou Z.
        Functional outcome of surgically treated U-shaped sacral fractures: experience from 41 cases.
        Eur Spine J. 2019; 28: 1146-1155
        • Verbeek DO
        • Routt ML
        Jr. High-energy pelvic ring disruptions with complete posterior Instability: contemporary reduction and fixation strategies.
        J Bone Joint Surg Am. 2018; 100: 1704-1712
        • Boudissa M
        • Roudet A
        • Fumat V
        • Ruatti S
        • Kerschbaumer G
        • Milaire M
        • et al.
        Part 1: outcome of posterior pelvic ring injuries and associated prognostic factors - a five-year retrospective study of one hundred and sixty five operated cases with closed reduction and percutaneous fixation.
        Int Orthop. 2020; 44: 1209-1215
        • Lefaivre KA
        • Starr AJ
        • Barker BP
        • Overturf S
        • Reinert CM.
        Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame.
        J Bone Joint Surg Br. 2009; 91: 1201-1207
        • Chen H
        • Zhang Q
        • Wu Y
        • Chang Z
        • Zhu Z
        • Zhang W
        • et al.
        Achieve closed reduction of irreducible, unilateral vertically displaced pelvic ring disruption with an unlocking closed reduction technique.
        Orthop Surg. 2021; 13: 942-948
        • Li YL
        • Wong KH
        • Law MW
        • Fang BX
        • Lau VW
        • Vardhanabuti VV
        • et al.
        Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population.
        Arch Osteoporos. 2018; 13: 76
        • Ko SB
        • Lee SW.
        Open reduction without fusion of bilateral jumped lumbosacral facet dislocation associated with symphysis pubis separation and cauda equina syndrome: case report.
        Asian Spine J. 2010; 4: 128-131
        • Ebraheim NA
        • Savolaine ER
        • Shapiro P
        • Houston T
        • Jackson WT.
        Unilateral lumbosacral facet joint dislocation associated with vertical shear sacral fracture.
        J Orthop Trauma. 1991; 5: 498-503
        • Isler B.
        Lumbosacral lesions associated with pelvic ring injuries.
        J Orthop Trauma. 1990; 4: 1-6
        • Hopf JC
        • Krieglstein CF
        • Müller LP
        • Koslowsky TC.
        Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients.
        Injury. 2015; 46: 1631-1636
        • Wilson DGG
        • Kelly J
        • Rickman M.
        Operative management of fragility fractures of the pelvis - a systematic review.
        BMC Musculoskelet Disord. 2021; 22: 717
        • Shannon SF
        • Oppizzi G
        • Schloss MG
        • Atchison J
        • Nascone J
        • Sciadini M
        • et al.
        Do fully threaded transiliac-transsacral screws improve mechanical stability of vertically unstable pelvic fractures? a cadaveric biomechanical analysis.
        J Orthop Trauma. 2021; 35: e18-e24
        • Hollensteiner M
        • Sandriesser S
        • Bliven E
        • von Rüden C
        • Augat P.
        Biomechanics of osteoporotic fracture fixation.
        Curr Osteoporos Rep. 2019; 17: 363-374
        • Pidgeon TS
        • Johnson JP
        • Deren ME
        • Evans AR
        • Hayda RA.
        Analysis of mortality and fixation failure in geriatric fractures using quantitative computed tomography.
        Injury. 2018; 49: 249-255
        • Grechenig S
        • Gänsslen A
        • Gueorguiev B
        • Berner A
        • Müller M
        • Nerlich M
        • et al.
        PMMA-augmented SI screw: a biomechanical analysis of stiffness and pull-out force in a matched paired human cadaveric model.
        Injury. 2015; 46 (Suppl 4S125-8)
        • Müller F
        • Füchtmeier B.
        Percutaneous cement-augmented screw fixation of bilateral osteoporotic sacral fracture.
        Unfallchirurg. 2013; 116: 950-954
        • Collinge CA
        • Crist BD.
        Combined percutaneous iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery.
        J Orthop Trauma. 2016; 30: e217-e222
        • Hegde V
        • Jo JE
        • Andreopoulou P
        • Lane JM.
        Effect of osteoporosis medications on fracture healing.
        Osteoporos Int. 2016; 27: 861-871
        • Johnston CB
        • Dagar M.
        Osteoporosis in older adults.
        Med Clin North Am. 2020; 104: 873-884