Percutaneous robot-assisted screw fixation for nondisplaced pelvic fractures: a good choice?
Cannulated screw
Complication
Majeed score
Nondisplaced pelvic fracture
Robot-assisted surgery
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
10
02
2023
accepted:
22
03
2023
medline:
22
5
2023
pubmed:
30
3
2023
entrez:
29
3
2023
Statut:
ppublish
Résumé
To compare the merits and demerits of percutaneous robot-assisted screw fixation for nondisplaced pelvic fractures with other treatments via long-term follow-up. This was a retrospective analysis of nondisplaced pelvic fractures treated between January 2015 and December 2021. The number of fluoroscopy exposures, operative duration, intraoperative blood loss, surgical complications, screw placement accuracy and Majeed score were compared among the nonoperative group (24 cases), open reduction and internal fixation (ORIF) group (45 cases), free-hand empirical screw fixation (FH) group (10 cases) and robot-assisted screw fixation (RA) group (40 cases). There was less intraoperative blood loss in the RA and FH groups than in the ORIF group. The number of fluoroscopy exposures in the RA group was lower than that in the FH group but much higher than that in the ORIF group. There were five cases of wound infection in the ORIF group and no surgical complications in the FH or RA group. The medical expenses were higher in the RA group than in the FH group, with no significant difference from the ORIF group. The Majeed score was lowest in the nonoperative group three months after injury (64.5±12.0) but lowest in the ORIF group one year after injury (88.6±4.1). Percutaneous RA for nondisplaced pelvic fractures is effective and minimally invasive and does not increase medical expenses compared with ORIF. Therefore, it is the best choice for patients with nondisplaced pelvic fractures.
Identifiants
pubmed: 36991283
doi: 10.1007/s00264-023-05794-x
pii: 10.1007/s00264-023-05794-x
pmc: PMC10199866
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1601-1608Informations de copyright
© 2023. The Author(s).
Références
Wilson DGG, Kelly J, Rickman M (2021) Operative management of fragility fractures of the pelvis a systematic review. BMC Musculoskelet Disord 22(1):717. https://doi.org/10.1186/s12891⁃021⁃04579⁃w
doi: 10.1186/s12891⁃021⁃04579⁃w
pubmed: 34419037
pmcid: 8380328
Ueda Y, Inui T, Kurata Y, Tsuji H, Saito J, Shitan Y (2021) Prolonged pain in patients with fragility fractures of the pelvis may be due to fracture progression. Eur J Trauma Emerg Surg 47(2):507–513. https://doi.org/10.1007/s00068-019-01150-0
doi: 10.1007/s00068-019-01150-0
pubmed: 31111165
Osterhoff G, Noser J, Held U, Werner CML, Pape HC, Dietrich M (2019) Early operative versus nonoperative treatment of fragility fractures of the pelvis: a propensity-matched multicenter study. J Orthop Trauma 33:e410–e415. https://doi.org/10.1097/BOT.0000000000001584
doi: 10.1097/BOT.0000000000001584
pubmed: 31633644
Fisher ND, Solasz SJ, Tensae A, Konda SR, Egol KA (2022) Low-energy lateral compression type 1 (LC1) pelvic ring fractures in the middle-aged and elderly affect hospital quality measures and functional outcomes. Eur J Orthop Surg Traumatol 32(7):1379–1384. https://doi.org/10.1007/s00590-021-03125-7
doi: 10.1007/s00590-021-03125-7
pubmed: 34545463
Maier GS, Kolbow K, Lazovic D et al (2016) Risk factors for pelvic in⁃sufficiency fractures and outcome after conservative therapy. Arch Gerontol Geriatr 67:80–85. https://doi.org/10.1016/j.arch⁃ger.2016.06.020
doi: 10.1016/j.arch⁃ger.2016.06.020
pubmed: 27448040
Breuil V, Roux CH, Carle GF (2016) Pelvic fractures: epidemiology, consequences, and medical management. Curr Opin Rheumatol 28:442–447. https://doi.org/10.1097/BOR.0000000000000293
doi: 10.1097/BOR.0000000000000293
pubmed: 27077891
Rommens PM (2007) Is there a role for percutaneous pelvic and acetabular reconstruction? Injury 38(4):463–477. https://doi.org/10.1016/j.injury.2007.01.025
doi: 10.1016/j.injury.2007.01.025
pubmed: 17397846
Hopf JC, Krieglstein CF, Müller LP, Koslowsky TC (2015) Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury 46(8):1631–1636. https://doi.org/10.1016/j.injury.2015.04.036
doi: 10.1016/j.injury.2015.04.036
pubmed: 26052052
Barei DP, Bellabarba C, Mills WJ, Routt ML Jr (2001) Percutaneous management of unstable pelvic ring disruptions. Injury 32(Suppl 1):SA33–SA44. https://doi.org/10.1016/s0020-1383(01)00059-6
doi: 10.1016/s0020-1383(01)00059-6
pubmed: 11521704
Gänsslen A, Krettek C (2006) Retrograde transpubic screw fixation of transpubic instabilities. Oper Orthop Traumatol 18(4):330–340. https://doi.org/10.1007/s00064-006-1181-3
doi: 10.1007/s00064-006-1181-3
pubmed: 17103131
Starr AJ, Nakatani T, Reinert CM, Cederberg K (2008) Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop Trauma 22(2):81–87. https://doi.org/10.1097/BOT.0b013e318162ab6e
doi: 10.1097/BOT.0b013e318162ab6e
pubmed: 18349774
Liu HS, Duan SJ, Xin FZ, Zhang Z, Wang XG, Liu SD (2019) Robot-assisted Minimally-invasive Internal Fixation of Pelvic Ring Injuries: A Single-center Experience. Orthop Surg 11(1):42–51. https://doi.org/10.1111/os.12423
doi: 10.1111/os.12423
pubmed: 30714333
pmcid: 6430472
Han W, Zhang T, Su YG et al (2022) Percutaneous Robot-Assisted versus Freehand S2 Iliosacral Screw Fixation in Unstable Posterior Pelvic Ring Fracture. Orthop Surg 14(2):221–228. https://doi.org/10.1111/os.13056
doi: 10.1111/os.13056
pubmed: 34904387
Matta JM, Tornetta P (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129–140. https://doi.org/10.1097/00003086-199608000-00016
doi: 10.1097/00003086-199608000-00016
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/intact-posterior-arch-innominate-bone-avulsion-fracture/nonoperative . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/si-joint/orif-anterior-fixation-si-joint#reduction . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/sacrum/orif-ilioiliac-plate#patient-preparation-and-approach . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/sacrum/orif-triangular-osteosynthesis . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/pubic-ramus/orif-pubic-ramus-plate#aftercare-following-open-reduction-and-fixation . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/si-joint/mio-iliosacral-screw-for-sacrum#reduction . Accessed 11 Nov 2022
Association for the study of Internal Fixation (2022) AO surgery reference. Aofoundation homepage on the internet. https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/pelvic-ring/pubic-ramus/orif-pubic-ramus-screw#aftercare-following-open-reduction-and-fixation . Accessed 11 Nov 2022
Smith HE, Yuan PS, Sasso R, Papadopolous S, Vaccaro AR (2016) An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine (Phila Pa 1976) 31(2):234–238. https://doi.org/10.1097/01.brs.0000194788.45002.1b
doi: 10.1097/01.brs.0000194788.45002.1b
Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg (Br) 71(2):304–306. https://doi.org/10.1302/0301-620X.71B2.2925751
doi: 10.1302/0301-620X.71B2.2925751
pubmed: 2925751
Rommens PM, Hofmann A (2013) Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 44(12):1733–1744. https://doi.org/10.1016/j.injury.2013.06.023
doi: 10.1016/j.injury.2013.06.023
pubmed: 23871193
Timmer RA, Verhage SM, Krijnen P, Meylaerts SAG, Schipper IB (2022) Indications for surgical fixation of low-energy pelvic ring fractures in elderly: a systematic review. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04438-w
Kim CH, Kim JW (2020) Plate versus sacroiliac screw fixation for treating posterior pelvic ring fracture: a Systematic review and meta-analysis. Injury 51(10):2259–2266. https://doi.org/10.1016/j.injury.2020.07.003
doi: 10.1016/j.injury.2020.07.003
pubmed: 32646648