Lumbopelvic transpedicular fixation of vertically unstable pelvic ring injuries

Dulaev A.K., Kazhanov I.V., Manukovsky V.A., Petrov A.V., Mikityuk S.I.

Abstract


Introduction
Identification of a proper fixation of the posterior pelvic ring is of paramount importance in treatment of patients with vertically unstable pelvic injuries.
Material and methods
Outcomes of 29 patients with polytrauma and vertically unstable pelvic injuries treated at Level I Trauma Center between 2013 and 2017 were analyzed. The mean age of the patients was 34.8 ± 99 years. The severity of the injuries and patients’ condition were evaluated using Injury Severity Score (ISS), VPKh-P (MT), VPKh-SP, and Yu. N. Tsibin scales (1975) to determine the sequence of treatment and diagnostic procedures. Classification offered by Pape H. C. (2005) was used to evaluate physiological condition. The ISS score was 27.1 ± 9.9. All patients underwent computed tomography (CT) scan of pelvic for preoperative planning. Lumbopelvic transpedicular fixation (LPTF) was employed as a definitive treatment of vertically unstable pelvic ring fractures in all clinical observations. Posterior half-ring morphology, a need for decompression of the nerve roots of the sacral plexus, timing of surgery were considered to decide on LPTF configuration.
Results
Three-month-to-six-year follow-ups of 22 patients showed good and excellent results achieved in 72.7 % of the cases that are in line with findings reported in the literature.
Discussion
Biomechanically adequate method of internal fixation is the method of choice in the definitive treatment of vertical unstable pelvic injuries with the possibility of decompression of compromised neural structures. Lumbopelvic fixation with the possibility of simultaneous access for decompression of neural structures is the most optimal technique for these complicated injuries.

Keywords


unstable pelvic ring injury, sacral fracture, lumbosacral fixation, minimally invasive osteosynthesis

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