Surgical treatment of chronic vertically unstable pelvic ring injuries

Abstract

BACKGROUND: The initial severity of patients with vertically unstable pelvic injuries often does not allow to perform timely reconstructive surgical intervention. Thus, the number of chronic injuries increases. Treatment of patients with long-term pelvic ring damage (after 3 weeks from injury) with significant vertical displacement (over 20 mm) is a problem of its own.

AIM: To analyze the immediate and long-term results obtained in patients with unresectable and chronic vertical unstable pelvic ring injuries.

MATERIALS AND METHODS: The results for 58 patients treated at the Priorov National Medical Research Center with chronic vertically unstable damage to the pelvic ring in the period from 2017 to 2022 were analyzed. Clinical and radiological diagnostic methods, as well as the Majeed questionnaire, were used to assess the treatment results.

RESULTS: The follow-up period for the patients ranged from 1 to 3 years (2.1 years on average). All patients after surgical treatment showed pain syndrome regression in the posterior pelvic area, decreased pain in sitting and standing positions, which improved their quality of life. All patients were able to move independently, to self-care after the treatment. Excellent results according to Majeed questionnaire one year after surgery were achieved in 4 (8.2%) patients, good — in 40 (81.6%), acceptable — in 5 (10.2%), there were no unsatisfactory results.

CONCLUSION: The vertebral-pelvic fixation technique allows specialists to effectively treat long-standing vertically pelvic ring unstable injuries and perform one-stage repositioning and stable fixation of the posterior pelvic ring.

Keywords

pelvis / posterior pelvic ring injuries / sacrum / sacrum fracture / spino-pelvic dissociation

References

[1] Balogh Z, King KL, Mackay P, et al. The epidemiology of pelvic ring fractures: a population-based study. J Trauma. 2007;63(5):1066–1073. doi: 10.1097/TA.0b013e3181589fa4

[2] Balogh Z., King K.L., Mackay P., et al. The epidemiology of pelvic ring fractures: a population-based study // J Trauma. 2007. Vol. 63, N 5. P. 1066–1073. doi: 10.1097/TA.0b013e3181589fa4

[3] Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30(7):848–856.

[4] Burgess A.R., Eastridge B.J., Young J.W., et al. Pelvic ring disruptions: effective classification system and treatment protocols // J Trauma. 1990. Vol. 30, N 7. P. 848–856.

[5] Bents RT, France JC, Glover JM, Kaylor KL. Traumatic spondylopelvic dissociation. A case report and literature review. Spine (Phila Pa 1976). 1996;21(15):1814–1819. doi: 10.1097/00007632-199608010-00020

[6] Bents R.T., France J.C., Glover J.M., Kaylor K.L. Traumatic spondylopelvic dissociation. A case report and literature review // Spine (Phila Pa 1976). 1996. Vol. 21, N 15. P. 1814–1819. doi: 10.1097/00007632-199608010-00020

[7] Cody JP, Kang DG, Lehman RA Jr. Combat-related lumbopelvic dissociation treated with percutaneous sacroiliac screw placement. Spine J. 2012;12(9):858–859. doi: 10.1016/j.spinee.2011.05.015

[8] Cody J.P., Kang D.G., Lehman R.A. Jr. Combat-related lumbopelvic dissociation treated with percutaneous sacroiliac screw placement // Spine J. 2012. Vol. 12, N 9. P. 858–859. doi: 10.1016/j.spinee.2011.05.015

[9] Lykomitros VA, Papavasiliou KA, Alzeer ZM, et al. Management of traumatic sacral fractures: a retrospective case-series study and review of the literature. Injury. 2010;41(3):266–272. doi: 10.1016/j.injury.2009.09.008

[10] Lykomitros V.A., Papavasiliou K.A., Alzeer Z.M., et al. Management of traumatic sacral fractures: a retrospective case-series study and review of the literature // Injury. 2010. Vol. 41, N 3. P. 266–272. doi: 10.1016/j.injury.2009.09.008

[11] Markel DC, Raskas DS, Graziano GP. A case of traumatic spino-pelvic dissociation. J Orthop Trauma. 1993;7(6):562–566. doi: 10.1097/00005131-199312000-00013

[12] Markel D.C., Raskas D.S., Graziano G.P. A case of traumatic spino-pelvic dissociation // J Orthop Trauma. 1993. Vol. 7, N 6. P. 562–566. doi: 10.1097/00005131-199312000-00013

[13] Martin CT, Witham TF, Kebaish KM. Sacropelvic fixation: two case reports of a new percutaneous technique. Spine (Phila Pa 1976). 2011;36(9):E618–E621. doi: 10.1097/BRS.0b013e3181f79aba

[14] Martin C.T., Witham T.F., Kebaish K.M. Sacropelvic fixation: two case reports of a new percutaneous technique // Spine (Phila Pa 1976). 2011. Vol. 36, N 9. P. E618–E621. doi: 10.1097/BRS.0b013e3181f79aba

[15] Gudushauri YaG. Operativnoe lechenie oslozhnennykh perelomov kostei taza [dissertation]. Moscow; 2016.

[16] Гудушаури Я.Г. Оперативное лечение осложненных переломов костей таза: дис. … д-ра мед. наук. Москва, 2016.

[17] Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27 Suppl 1:S-A13-20.

[18] Gänsslen A., Pohlemann T., Paul C., Lobenhoffer P., Tscherne H. Epidemiology of pelvic ring injuries // Injury. 1996. Vol. 27, Suppl 1. P. S-A13-20.

[19] Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980;(151):12–21.

[20] Pennal G.F., Tile M., Waddell J.P., Garside H. Pelvic disruption: assessment and classification // Clin Orthop Relat Res. 1980. N 151. P. 12–21.

[21] Bucholz RW. The pathological anatomy of Malgaigne fracture-dislocations of the pelvis. J Bone Joint Surg Am. 1981;63(3):400–404.

[22] Bucholz R.W. The pathological anatomy of Malgaigne fracture-dislocations of the pelvis // J Bone Joint Surg Am. 1981. Vol. 63, N 3. P. 400–404.

[23] Cherkes-Zade DI, Lazarev AF. Operativnoe lechenie zastarelykh povrezhdenii tazovogo kol’tsa: metodicheskie rekomendatsii. Moscow; 2004.

[24] Черкес-Заде Д.И., Лазарев А.Ф. Оперативное лечение осложнённых переломов костей таза: методические рекомендации. Москва, 2004.

[25] Donchenko SV, Dubrov VE, Slinyakov LYu, et al. Surgical Treatment For Unstable Pelvic Ring Injuries. N.N. Priorov Journal of Traumatology and Orthopedics. 2013;20(4):9–16. doi: 10.17816/vto2013049-16

[26] Донченко С.В., Дубров В.Э., Слиняков Л.Ю., и др. Алгоритм хирургического лечения нестабильных повреждений тазового кольца // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2013. Т. 20, № 4. С. 9–16. doi: 10.17816/vto2013049-16

[27] Majeed SA. Grading the outcome of pelvic fracture. J Bone Joint Surg Br. 1989;71(2):304–306.

[28] Majeed S.A. Grading the outcome of pelvic fracture // J Bone Joint Surg Br. 1989. Vol. 71, N 2. P. 304–306.

[29] Shlykov IL. Operativnoe lechenie bol’nykh s posledstviyami povrezhdenii tazovogo kol’tsa [dissertation]. Ekaterinburg, 2004.

[30] Шлыков И.Л. Оперативное лечение больных с последствиями повреждений тазового кольца: дис. … канд. мед. наук. Екатеринбург, 2004.

[31] Smirnov AA. Surgical Treatment Of Vertically Unstable Injuries Of The Pelvis (Type C According Ао Classification). Traumatology and Orthopedics of Russia. 2012;1(63):73–76.

[32] Смирнов А.А. Оперативное лечение вертикально-нестабильных повреждений таза (тип С по классификации АО) // Травматология и ортопедия России. 2012. Т. 18, № 1. С. 73–76. doi: 10.21823/2311-2905-2012-0-1-81-88

[33] Enninghorst N, Toth L, King KL, et al. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma. 2010;68(4):935–941. doi: 10.1097/TA.0b013e3181d27b48

[34] Enninghorst N., Toth L., King K.L., et al. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option // J Trauma. 2010. Vol. 68, N 4. P. 935–941. doi: 10.1097/TA.0b013e3181d27b48

[35] Kolesnik AI, Dokalin AYu, Solodilov IM, et al. Restrospective Analysis of Therapeutic and Surgical Management Outcomes in Patients with Hip Injuries. Kursk Scientific and Practical Bulletin Man and His Health. 2017;(2):17–23. doi: 10.21626/vestnik/2017-2/03

[36] Колесник А.И., Докалин А.Ю., Солодилов И.М., и др. Ретроспективный анализ результатов консервативного и оперативного лечения больных с повреждениями таза // Курский научно-практический вестник Человек и его здоровье. 2017. № 2. С. 17–23. doi: 10.21626/vestnik/2017-2/03

[37] Stover MD, Edelstein AI, Matta JM. Chronic Anterior Pelvic Instability: Diagnosis and Management. J Am Acad Orthop Surg. 2017;25(7):509–517. doi: 10.5435/JAAOS-D-15-00338

[38] Stover M.D., Edelstein A.I., Matta J.M. Chronic Anterior Pelvic Instability: Diagnosis and Management // J Am Acad Orthop Surg. 2017. Vol. 25, N 7. P. 509–517. doi: 10.5435/JAAOS-D-15-00338

[39] Shlykov IL. Varianty khirurgicheskoi tekhniki v zavisimosti ot vida deformatsii taza. Perm Medical Journal. 2009;26(6):50–53.

[40] Шлыков И.Л. Варианты хирургической техники в зависимости от вида деформации таза // Пермский медицинский журнал. 2009. Т. 26, № 6. С. 50–53.

[41] Grishchuk AN, Puseva ME, Tishkov NV, Vasilyev VYu. Operative Treatment of Old and Inveterate Bilateral Rotary-Unstable Pelvis Injuries (Review of Literature). Bulletin of the East Siberian Scientific Center SB RAMS. 2010;(5):222–232.

[42] Грищук А.Н., Пусева М.Э., Тишков Н.В., Васильев В.Ю. Оперативное лечение несвежих и застарелых двусторонних ротационно-нестабильных повреждений таза (обзор литературы) // Бюллетень Восточно-Сибирского научного центра СО РАМН. 2010. № 5. С. 222–232.

[43] Solod EI, Lazarev AF, Petrovskiy RA, et al. Potentialities of low invasive fixation of the anterior pelvic ring with threaded pin. N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(3–4):6–11. (In Russ). doi: 10.17116/vto201803-0416

[44] Солод Э.И., Лазарев А.Ф., Петровский Р.А., и др. Возможности малоинвазивной фиксации переднего отдела тазового кольца спицей с нарезкой // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2018. Т. 25, № 3–4. С. 6–11. https://doi.org/10.17116/vto201803-0416

RIGHTS & PERMISSIONS

Eco-Vector