Innovative Technique for Posterior Fixation of Vertically Unstable Pelvic Ring Fracture: A Case Report

Document Type : CASE REPORT

Authors

1 Department of Orthopedic Surgery, Arak University of Medical Sciences, Arak, Iran

2 Student Research Committee, Arak University of Medical Sciences, Arak, Iran

Abstract

An obese 57-year-old woman with known hypertension and diabetes mellitus sustained multiple injuries 
during an accident, which caused anterior-posterior fracture-dislocation of the pelvic ring. Due to the 
drawbacks of conventional stabilizing methods for anterior-posterior fracture-dislocations of the hip in 
this setting, such as the inability to visualize anatomical landmarks fluoroscopically for the iliosacral 
screw technique and the compromised L5 pedicle preventing lumbopelvic fixation, the patient 
underwent an innovative Hula Hoop technique described here. Using the Hula Hoop technique, a 
technique that has rarely been studied in humans, we avoided an invasive open procedure, decreased 
anesthesia time, reduced the size and number of incisions, and minim ized bleeding. After three months 
of routine physiotherapy and occupational therapy, the patient was able to walk with a walker and an 
ankle-foot orthosis.
 Level of evidence: V

Keywords

Main Subjects

References

  1. Rodrigues-Pinto R, Kurd MF, Schroeder GD, et al. Sacral fractures and associated injuries. Global Spine J. 2017; 7(7):609-616. doi: 10.1177/2192568217701097.
  2. Tian W, Chen Wh, Jia J. Traumatic Spino‐pelvic dissociation with bilateral triangular fixation. Orthop Surg. 2018; 10(3):205-211. doi: 10.1111/os.12392.
  3. Trikha V, Singh V, Kumar VS. Anterior fracture dislocation of sacrothe iliac joint: A rare type of crescent fracture. Indian J Orthop. 2015; 49(2):255-9. doi: 10.4103/0019-5413.152527.
  4. Toogood P, mcdonald E, Pekmezci M. A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures. J Orthop Trauma. 2013; 27(9):515-20. doi: 10.1097/BOT.0b013e3182787d54.
  5. Li Y, Sang X, Wang Z, et al. Iliac screw for reconstructing posterior pelvic ring in Tile type C1 pelvic fractures. Orthop Traumatol Surg Res. 2018; 104(6):923-928. doi: 10.1016/j.otsr.2018.04.021.
  6. Osterhoff G, Ossendorf C, Wanner GA, Simmen H-P, Werner CM. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011; 42(10):992-996. doi: 10.1016/j.injury.2011.04.005.
  7. Gänsslen A, Hüfner T, Krettek C. Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper Orthop Traumatol. 2006;18(3):225-44. doi: 10.1007/s00064-006-1173-3.
  8. Cascio V, Hon M, Haramati LB, et al. imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients. Br J Radiol. 2018; 91(1089):20170956. doi: 10.1259/bjr.20170956.
  9. Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol. 2018; 91(1089):20170931. doi: 10.1259/bjr.20170931.

10.              Weil YA, Nousiainen MT, Helfet DL. Removal of an iliosacral 

  1. Rodrigues-Pinto R, Kurd MF, Schroeder GD, et al. Sacral fractures and associated injuries. Global Spine J. 2017; 7(7):609-616. doi: 10.1177/2192568217701097.
  2. Tian W, Chen Wh, Jia J. Traumatic Spino‐pelvic dissociation with bilateral triangular fixation. Orthop Surg. 2018; 10(3):205-211. doi: 10.1111/os.12392.
  3. Trikha V, Singh V, Kumar VS. Anterior fracture dislocation of sacrothe iliac joint: A rare type of crescent fracture. Indian J Orthop. 2015; 49(2):255-9. doi: 10.4103/0019-5413.152527.
  4. Toogood P, mcdonald E, Pekmezci M. A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures. J Orthop Trauma. 2013; 27(9):515-20. doi: 10.1097/BOT.0b013e3182787d54.
  5. Li Y, Sang X, Wang Z, et al. Iliac screw for reconstructing posterior pelvic ring in Tile type C1 pelvic fractures. Orthop Traumatol Surg Res. 2018; 104(6):923-928. doi: 10.1016/j.otsr.2018.04.021.
  6. Osterhoff G, Ossendorf C, Wanner GA, Simmen H-P, Werner CM. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011; 42(10):992-996. doi: 10.1016/j.injury.2011.04.005.
  7. Gänsslen A, Hüfner T, Krettek C. Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy. Oper Orthop Traumatol. 2006;18(3):225-44. doi: 10.1007/s00064-006-1173-3.
  8. Cascio V, Hon M, Haramati LB, et al. imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients. Br J Radiol. 2018; 91(1089):20170956. doi: 10.1259/bjr.20170956.
  9. Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol. 2018; 91(1089):20170931. doi: 10.1259/bjr.20170931.
  10. Weil YA, Nousiainen MT, Helfet DL. Removal of an iliosacral screw entrapping the L5 nerve root after failed posterior pelvic ring fixation: a case report. J Orthop Trauma. 2007; 21(6):414-7. doi: 10.1097/BOT.0b013e3180cab6b5.
  11. Kang S, Chung PH, Kim JP, Kim YS, Lee HM, Eum GS. Superior gluteal artery injury during percutaneous iliosacral screw fixation: a case report. Hip Pelvis. 2015; 27(1):57-62. doi: 10.5371/hp.2015.27.1.57.
  12. Semba RT, Yasukawa K, Gustilo RB. Critical analysis of results of 53 Malgaigne fractures of the pelvis. J Trauma. 1983;23(6):535-7. doi: 10.1097/00005373-198306000-00016.
  13. Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma. 1993; 7(2):107-17. doi: 10.1097/00005131-199304000-00002.
  14. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2006; 20(1 Suppl):S30-6; discussion S36.
  15. Schmitz P, Kerschbaum M, Lamby P, Lang S, Alt V, Worlicek M. Iliac Bone Corridors to Host the Transiliac Internal Fixator—An Experimental CT Based Analysis. J Clin Med. 2021; 10(7):1500. doi: 10.3390/jcm10071500.
  16. Chaiyamongkol W, Kritsaneephaiboon A, Bintachitt P, Suwannaphisit S, Tangtrakulwanich B. Biomechanical study of posterior pelvic fixations in vertically unstable sacral fractures: an alternative to triangular osteosynthesis. Asian Spine Journal. 2018; 12(6):967.

 

  1. Balbachevsky D, Pires RE, Sabongi RG, et al. Combination of Anterior and Posterior Subcutaneous Internal Fixation for Unstable Pelvic Ring Injuries: The. Journal of Trauma and Injury. 2019; 32(1):51-59.
  2. Mcdonald E, Theologis A, Horst P, Kandemir U, Pekmezci M. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study. Eur J Trauma Emerg Surg. 2015; 41(6):665-71. doi: 10.1007/s00068-014-0482-8.
  3. Wu X-T, Liu Z-Q, Fu W-Q, Zhao S. Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw–rod fixator. J Int Med Res. 2018; 46(1):368-380. doi: 10.1177/0300060517715529.
  4. Korovessis P, Stamatakis M, Baikousis A. Posterior stabilization of unstable sacroiliac injuries with the Texas Scottish Rite Hospital spinal instrumentation. Orthopedics. 2000; 23(4):323-7. doi: 10.3928/0147-7447-20000401-12.
  5. Fuechtmeier B, Maghsudi M, Neumann C, Hente R, Roll C, Nerlich M. The minimally invasive stabilization of the dorsal pelvic ring with the transiliacal internal fixator (TIFI)--surgical technique and first clinical findings. Unfallchirurg. 2004; 107(12):1142-51. doi: 10.1007/s00113-004-0824-9.
  6. Schmitz P, Baumann F, Grechenig S, Gaensslen A, Nerlich M, Müller MB. The cement-augmented transiliacal internal fixator (catifi): an innovative surgical technique for stabilization of fragility fractures of the pelvis. Injury. 2015; 46 Suppl 4:S114-20. doi: 10.1016/S0020-1383(15)30029-2.

 

 

The Archives of Bone and Joint Surgery
Volume 11, Issue 10
October 2023
Pages 658-661

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History

  • Receive Date: 08 January 2023
  • Revise Date: 22 June 2023
  • Accept Date: 18 April 2023

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