Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purposes

The aim of this study was to evaluate: 1. the outcome of pelvic ring fractures treated by closed reduction and percutaneous fixation, 2. the prognostic factors associated with a poor quality reduction, 3. the prognostic factors associated with ilio-sacral screws misplacement and 4. the prognostic factors associated with nonunion.

Methods

Data from medical charts for all patients admitted with unstable posterior pelvic ring injuries from 2009 to 2013 were extracted. A total of 165 patients with a mean age of 40 years were included. One hundred and five patients were reviewed at a mean of 32 months of follow-up. The prognostic factors analyzed were clinical and radiological factors. Tile B and Tile C pelvic ring fractures were compared and analyzed separately. Then specific statistical analysis was performed using a logistic regression model to eliminate confusion factors.

Results

An excellent or good clinical result was achieved for 94 patients (90%). An excellent or good reduction was achieved for 141 patients (85%). Nonunion rate, smoking patients, bad reductions, age of patients and ISS score were significantly higher in Tile C group. To eliminate confusion factors we used a multivariate analysis logistic regression model. Only unstable vertical bilateral posterior injuries (Tile C2 and C3) were independent prognostic factors for unsatisfactory reduction (p = 0.001; OR = 4.72; CI 95% [2.08–16.72]). Screw misplacement was recorded for 30 patients (16%) and sacral dysmorphia was an associated prognostic factor (p = 0.0001; OR = 15.6; CI95% [3.41–98.11]). Nonunion was recorded for ten patients (6%) and smoking was an associated prognostic factor (p = 0.01, OR = 5.12; CI95% [1.1–24.1]).

Conclusions

Posterior pelvic ring fractures treated by closed reduction and percutaneous fixation are associated with excellent/good clinical results if excellent/good reduction and bone healing are achieved without screw misplacement. Bilateral unstable vertical posterior pelvic ring injuries, and sacral dysmorphia are risk factors for bad quality reduction and screw misplacement respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

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

    Google Scholar 

  2. Ruatti S, Guillot S, Brun J, Thony F, Bouzat P, Payen JF, Tonetti J (2015) Which pelvic ring fractures are potentially lethal? Injury 46:1059–1063

    Article  CAS  PubMed  Google Scholar 

  3. Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13-20

    Article  Google Scholar 

  4. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV (2009) Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 33:329–338

    Article  CAS  PubMed  Google Scholar 

  5. Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA (1995) Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 9:207–214

    Article  PubMed  Google Scholar 

  6. Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein J, Panetta T, Shaftan G (1986) Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma 26:325–333

    Article  CAS  PubMed  Google Scholar 

  7. Lindsay A, Tornetta P 3rd, Diwan A, Templeman D (2016) Is closed reduction and percutaneous fixation of unstable posterior ring injuries as accurate as open reduction and internal fixation? J Orthop Trauma 30:29–33

    Article  PubMed  Google Scholar 

  8. Wang H, Wang F, Leong AP, Xu L, Chen X, Wang Q (2016) Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study. Int Orthop 40:1941–1947

    Article  PubMed  Google Scholar 

  9. Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br 71:304–306

    Article  CAS  PubMed  Google Scholar 

  10. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81

    PubMed  CAS  Google Scholar 

  11. Tornetta P 3rd, Matta JM (1996) Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res 329:186–193

    Article  Google Scholar 

  12. Lefaivre KA, Starr AJ, Barker BP, Overturf S, Reinert CM (2009) Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame. The Journal of bone and joint surgery British 91:1201–1207

    Article  CAS  Google Scholar 

  13. Thaunat M, Laude F, Paillard P, Saillant G, Catonné Y (2008) Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption. Int Orthop 32:7–12

    Article  CAS  PubMed  Google Scholar 

  14. Oliver CW, Twaddle B, Agel J, Routt ML Jr (1996) Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36. Injury 27:635–641

    Article  CAS  PubMed  Google Scholar 

  15. Boyoud-Garnier L, Boudissa M, Ruatti S, Kerschbaumer G, Grobost P, Tonetti J (2017) Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance. Orthop Traumatol Surg Res 103:523–526

    Article  CAS  PubMed  Google Scholar 

  16. Grossterlinden L, Rueger J, Catala-Lehnen P, Rupprecht M, Lehmann W, Rücker A, Briem D (2011) Factors influencing the accuracy of iliosacral screw placement in trauma patients. Int Orthop 35:1391–1396

    Article  PubMed  Google Scholar 

  17. Pishnamaz M, Dienstknecht T, Hoppe B, Garving C, Lange H, Hildebrand F, Kobbe P, Pape HC (2016) Assessment of pelvic injuries treated with Ilio-sacral screws: injury severity and accuracy of screw positioning. Int Orthop 40:1495–1501

    Article  PubMed  Google Scholar 

  18. Mears DC, Velyvis J (2003) Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment. J Bone Joint Surg Br 85:21–30

    Article  CAS  PubMed  Google Scholar 

  19. Tripathy SK, Goyal T, Sen RK (2015) Nonunions and malunions of the pelvis. Eur J Trauma Emerg Surg 41:335–342

    Article  CAS  PubMed  Google Scholar 

  20. Wright JL, Nathens AB, Rivara FP, MacKenzie EJ, Wessells H (2006) Specific fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture. J Urol 176:1540–1545

    Article  PubMed  Google Scholar 

  21. Lindahl J, Hirvensalo E (2005) Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop 76:667–678

    Article  PubMed  Google Scholar 

  22. Reilly MC, Zinar DM, Matta JM (1996) Neurologic injuries in pelvic ring fractures. Clin Orthop Relat Res 329:28–36

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France

    Mehdi Boudissa, A. Roudet, V. Fumat, S. Ruatti, G. Kerschbaumer, M. Milaire, P. Merloz & J. Tonetti

  2. Grenoble Alpes University, Grenoble, France

    Mehdi Boudissa, A. Roudet, V. Fumat, S. Ruatti, G. Kerschbaumer, M. Milaire, P. Merloz & J. Tonetti

  3. TIMC-IMAG lab, Univ. Grenoble Alpes, CNRS UMR, 5525, Saint-Martin-d’Hères, France

    Mehdi Boudissa & J. Tonetti

Authors
  1. Mehdi Boudissa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Roudet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Fumat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Ruatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Kerschbaumer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Milaire
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Merloz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Tonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehdi Boudissa.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest concerning this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of Evidence: Level 4, retrospective study

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boudissa, M., Roudet, A., Fumat, V. 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. International Orthopaedics (SICOT) 44, 1209–1215 (2020). https://doi.org/10.1007/s00264-020-04574-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04574-1

Keywords

Search

Navigation