An Innovation to Address the Anterior Pelvic Ring Disruptions
Background: Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic...
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| Format: | Article |
| Language: | English |
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Jaypee Brothers Medical Publisher
2024-01-01
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| Series: | Journal of Orthopedics and Joint Surgery |
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| Online Access: | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1127 |
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| author | Ramesh Perumal Harish Mahesan Dheenadhayalan Jayaramaraju Rajasekaran Shanmuganathan |
| author_facet | Ramesh Perumal Harish Mahesan Dheenadhayalan Jayaramaraju Rajasekaran Shanmuganathan |
| author_sort | Ramesh Perumal |
| collection | DOAJ |
| description | Background: Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic in the early phase. Most commonly preferred fixation mode is plating, contoured 3.5 Matta plate, 3.5 reconstruction plates, and it may be single or dual. The purpose of this study is to report a case series of patients with disrupted anterior pelvic ring fixed with 4.5 dynamic compression plate (DCP). We innovated a technique in modifying the profile of the plate and contouring before it is applied over the superior surface of pubic symphysis.
Materials and methods: A total of 21 patients between 2015 and 2018 with disrupted pelvic ring injuries for which open reduction and 4.5 DCP fixation are included in the study and classified according to Young–Burgess. All are evaluated as per advanced trauma life support (ATLS) protocol, and appropriate X-rays and computed tomography (CT) scans are taken. Hemodynamically unstable are stabilized with external fixator as a damage control procedure and planned for plating as a secondary procedure. Postoperative X-rays included AP, inlet, outlet, and lateral views and were reviewed at 4 and 12 weeks and 6 and 12 months for the evidence of loss of reduction, loosening of screws, hardware failure, and functional outcome (Majeed score). Three patients were lost to follow-up; hence, 18 are available for radiological and functional outcome.
Results: Six patients showed evidence of early loss of reduction and screw loosening. However, none of the patients are symptomatic, which requires a revision surgery to restore the ring. There is no difference in the functional outcome between the early loss of reduction and the others.
Conclusion: Modified 4.5 DCP fixation for the anterior ring fixation has shown excellent outcomes in disrupted pelvic ring injuries. It has no hardware failure, and six patients with loosening of the screws were asymptomatic and had good functional outcomes. |
| format | Article |
| id | doaj-art-30f4b7126e5b4af2bdab8211bdd2dff5 |
| institution | Kabale University |
| issn | 2582-7863 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Jaypee Brothers Medical Publisher |
| record_format | Article |
| series | Journal of Orthopedics and Joint Surgery |
| spelling | doaj-art-30f4b7126e5b4af2bdab8211bdd2dff52025-02-07T11:17:47ZengJaypee Brothers Medical PublisherJournal of Orthopedics and Joint Surgery2582-78632024-01-0161697310.5005/jojs-10079-112713An Innovation to Address the Anterior Pelvic Ring DisruptionsRamesh Perumal0https://orcid.org/0000-0001-7573-6299Harish Mahesan1https://orcid.org/0000-0002-3018-5005Dheenadhayalan Jayaramaraju2https://orcid.org/0000-0002-1295-136XRajasekaran Shanmuganathan3https://orcid.org/0000-0001-6043-006XRamesh Perumal, Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India, Phone: +91 9444107393Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, IndiaDepartment of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, IndiaDepartment of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, IndiaBackground: Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic in the early phase. Most commonly preferred fixation mode is plating, contoured 3.5 Matta plate, 3.5 reconstruction plates, and it may be single or dual. The purpose of this study is to report a case series of patients with disrupted anterior pelvic ring fixed with 4.5 dynamic compression plate (DCP). We innovated a technique in modifying the profile of the plate and contouring before it is applied over the superior surface of pubic symphysis. Materials and methods: A total of 21 patients between 2015 and 2018 with disrupted pelvic ring injuries for which open reduction and 4.5 DCP fixation are included in the study and classified according to Young–Burgess. All are evaluated as per advanced trauma life support (ATLS) protocol, and appropriate X-rays and computed tomography (CT) scans are taken. Hemodynamically unstable are stabilized with external fixator as a damage control procedure and planned for plating as a secondary procedure. Postoperative X-rays included AP, inlet, outlet, and lateral views and were reviewed at 4 and 12 weeks and 6 and 12 months for the evidence of loss of reduction, loosening of screws, hardware failure, and functional outcome (Majeed score). Three patients were lost to follow-up; hence, 18 are available for radiological and functional outcome. Results: Six patients showed evidence of early loss of reduction and screw loosening. However, none of the patients are symptomatic, which requires a revision surgery to restore the ring. There is no difference in the functional outcome between the early loss of reduction and the others. Conclusion: Modified 4.5 DCP fixation for the anterior ring fixation has shown excellent outcomes in disrupted pelvic ring injuries. It has no hardware failure, and six patients with loosening of the screws were asymptomatic and had good functional outcomes.https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1127anterior ring fixationdiastasispelvic injurypelvic ring disruptionpubic symphysis |
| spellingShingle | Ramesh Perumal Harish Mahesan Dheenadhayalan Jayaramaraju Rajasekaran Shanmuganathan An Innovation to Address the Anterior Pelvic Ring Disruptions Journal of Orthopedics and Joint Surgery anterior ring fixation diastasis pelvic injury pelvic ring disruption pubic symphysis |
| title | An Innovation to Address the Anterior Pelvic Ring Disruptions |
| title_full | An Innovation to Address the Anterior Pelvic Ring Disruptions |
| title_fullStr | An Innovation to Address the Anterior Pelvic Ring Disruptions |
| title_full_unstemmed | An Innovation to Address the Anterior Pelvic Ring Disruptions |
| title_short | An Innovation to Address the Anterior Pelvic Ring Disruptions |
| title_sort | innovation to address the anterior pelvic ring disruptions |
| topic | anterior ring fixation diastasis pelvic injury pelvic ring disruption pubic symphysis |
| url | https://www.jojs.in/doi/JOJS/pdf/10.5005/jojs-10079-1127 |
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