Pol M Rommens1, Marcus Graafen2, Charlotte Arand3, Isabella Mehling4, Alexander Hofmann5, Daniel Wagner6. 1. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany. Electronic address: Pol.Rommens@unimedizin-mainz.de. 2. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany. Electronic address: mgraafen@gmx.net. 3. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany. Electronic address: charlotte.arand@unimedizin-mainz.de. 4. Saint Vinzenz-Hospital, Hanau, Germany. Electronic address: isabellamehling@web.de. 5. Department of Orthopaedics and Traumatology, Westpfalz-Klinikum Kauserslautern, Kaiserslautern, Germany. Electronic address: Hofmann.Trauma-Surgery@gmx.net. 6. Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany. Electronic address: wagner.daniel@gmx.ch.
Abstract
BACKGROUND: In the vast majority of patients with pelvic ring lesions, there is a combination of fractures of the posterior and anterior pelvic ring. Anterior fractures are painful and contribute to loss of stability of the pelvic ring. For these reasons, stabilization of pubic rami fractures is recommended together with posterior pelvic ring fixation. Retrograde transpubic screw osteosynthesis enjoys increasing acceptance due to its minimal invasive technique and adequate stability. PATIENTS AND METHODS: We retrospectively reviewed the results of 158 retrograde transpubic screw osteosyntheses in 128 patients with pelvic ring lesions including a pubic ramus fracture. Sixty-three patients suffered a high-energy injury, 65 a fragility fracture of the pelvis. RESULTS: One hundred and forty-six screws (92.4%) were inserted through a percutaneous procedure. There were no vascular, neurological or urological complications. Fifty-nine screws (39%) yielded an excellent reduction with less than one cortical width of displacement. Slight secondary displacement was seen in 33 of these fractures (55.9%). Early surgical complications were seen in 16 screws (10.1%): suboptimal pathway in 10, local hematoma in 4 and local infection in 3. Early revision surgery was done in 7 screws (4.4%). Median follow-up was 27.6 weeks, 83 screws (52.5%) had a follow-up of more than 6 months. During follow-up, 7.6% of screws loosened. Operative revision was performed in 13%. 75 fractures (90.3%) with a follow-up of ≥ 6 months showed radiographic evidence of healing. There was no difference in the healing rate of high-energy and fragility fractures. Nonunion rate was not dependent on the quality of primary reduction, secondary displacement, or screw loosening. Infection (p 0.001) and surgery ≥ 6 months after trauma (p 0.02) more often led to nonunion. CONCLUSION: Retrograde transpubic screw osteosynthesis is a reliable method for splinting pubic rami fractures in high and low energy pelvic trauma. Although a slight secondary fracture displacement is seen in most cases, it does not affect fracture healing. Retrograde transpubic screw is a adequate minimal-invasive osteosynthesis to stabilize the anterior pelvic ring, especially in fragility fracture of the pelvis. Delayed operation (> 6 months) and infection show higher rate of nonunion.
BACKGROUND: In the vast majority of patients with pelvic ring lesions, there is a combination of fractures of the posterior and anterior pelvic ring. Anterior fractures are painful and contribute to loss of stability of the pelvic ring. For these reasons, stabilization of pubic rami fractures is recommended together with posterior pelvic ring fixation. Retrograde transpubic screw osteosynthesis enjoys increasing acceptance due to its minimal invasive technique and adequate stability. PATIENTS AND METHODS: We retrospectively reviewed the results of 158 retrograde transpubic screw osteosyntheses in 128 patients with pelvic ring lesions including a pubic ramus fracture. Sixty-three patients suffered a high-energy injury, 65 a fragility fracture of the pelvis. RESULTS: One hundred and forty-six screws (92.4%) were inserted through a percutaneous procedure. There were no vascular, neurological or urological complications. Fifty-nine screws (39%) yielded an excellent reduction with less than one cortical width of displacement. Slight secondary displacement was seen in 33 of these fractures (55.9%). Early surgical complications were seen in 16 screws (10.1%): suboptimal pathway in 10, local hematoma in 4 and local infection in 3. Early revision surgery was done in 7 screws (4.4%). Median follow-up was 27.6 weeks, 83 screws (52.5%) had a follow-up of more than 6 months. During follow-up, 7.6% of screws loosened. Operative revision was performed in 13%. 75 fractures (90.3%) with a follow-up of ≥ 6 months showed radiographic evidence of healing. There was no difference in the healing rate of high-energy and fragility fractures. Nonunion rate was not dependent on the quality of primary reduction, secondary displacement, or screw loosening. Infection (p 0.001) and surgery ≥ 6 months after trauma (p 0.02) more often led to nonunion. CONCLUSION: Retrograde transpubic screw osteosynthesis is a reliable method for splinting pubic rami fractures in high and low energy pelvic trauma. Although a slight secondary fracture displacement is seen in most cases, it does not affect fracture healing. Retrograde transpubic screw is a adequate minimal-invasive osteosynthesis to stabilize the anterior pelvic ring, especially in fragility fracture of the pelvis. Delayed operation (> 6 months) and infection show higher rate of nonunion.
Authors: Pol M Rommens; Daniel Wagner; Charlotte Arand; Mehdi Boudissa; Johannes Hopf; Alexander Hofmann Journal: Oper Orthop Traumatol Date: 2022-03-17 Impact factor: 1.154
Authors: Konrad Schuetze; Alexander Eickhoff; Christoph Dehner; Alexander Blidon; Florian Gebhard; Peter Hinnerk Richter Journal: Eur J Trauma Emerg Surg Date: 2021-09-21 Impact factor: 2.374
Authors: Daniel Wagner; Andreas Höch; Philipp Pieroh; Tim Hohmann; Florian Gras; Sven Märdian; Alexander Pflug; Silvan Wittenberg; Christoph Ihle; Notker Blankenburg; Kevin Dallacker-Losensky; Tanja Schröder; Steven C Herath; Hans-Georg Palm; Christoph Josten; Fabian M Stuby Journal: Sci Rep Date: 2022-02-11 Impact factor: 4.379
Authors: Pol Maria Rommens; Alexander Hofmann; Sven Kraemer; Miha Kisilak; Mehdi Boudissa; Daniel Wagner Journal: Eur J Trauma Emerg Surg Date: 2021-10-11 Impact factor: 2.374
Authors: Moritz F Lodde; J Christoph Katthagen; Clemens O Schopper; Ivan Zderic; Geoff Richards; Boyko Gueorguiev; Michael J Raschke; René Hartensuer Journal: J Clin Med Date: 2021-05-26 Impact factor: 4.241
Authors: Daniel Wagner; Miha Kisilak; Geoffrey Porcheron; Sven Krämer; Isabella Mehling; Alexander Hofmann; Pol M Rommens Journal: Sci Rep Date: 2021-07-09 Impact factor: 4.379