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
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Article info
Publication history
Published online: January 04, 2022
Accepted:
January 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
