Treatment of posterior pelvic ring disruptions using a minimally invasive adjustable plate

Abstract

Objective: Iliosacral (IS) screw fixation and posterior tension band plate (TBP) technique are two treatment alternatives for posterior pelvic ring injuries. However, IS screw fixation requires continuous fluoroscopic guidance for appropriate screw insertion and carries a risk of neurovascular injuries. TBP technique also has some disadvantages, including limited reduction potential, difficulty in precontouring the plate and a higher rate of symptomatic implants. To address these limitations, we introduced a minimally invasive adjustable plate (MIAP). This study aims to present the preliminary radiological and clinical results of posterior pelvic ring disruptions treated with MIAP.

Methods: The MIAP conforms to the irregular shape of posterior pelvic ring and can be used without prebending. This plate has a role in reducing compressed or separated fractures/dislocations. Sixteen patients, including seven males and nine females, were treated with MIAP through a minimally invasive approach. The fracture patterns consisted of six Type B and ten Type C fractures according to OTA classification of fracture. Preoperative and postoperative radiography was taken to assess the fracture displacement and reduction quality. Postoperative rehabilitation programme was individualised and early exercise was encouraged. Patients were followed up and the functional outcome was evaluated based upon the scoring system proposed by Lindahl and associates.

Results: All posterior pelvic ring disruptions were reduced and fixed with MIAP. The average duration of surgery was 49 min, the average radiation exposure was 6s, and the average blood loss was 80 mL for the treatment of posterior pelvic ring injuries. Overall radiological results of the reduction were excellent in eleven patients and good in five. The patients were followed up for 30 months on average. All fractures healed. The functional outcome was excellent in ten patients, good in four and fair in two. There were no iatrogenic neurovascular injuries, implant failures, irritative symptoms or pressure sores due to subcutaneous implantation.

Conclusion: Favourable clinical and radiological outcomes can be achieved in treating posterior pelvic disruptions with MIAP. This plate is effective in view of its simplicity, less radiation exposure, safety, minimal invasion and stable fixation.