The Outcome of Internal Fixation by Anterior Pelvic Plating & Posterior Percutaneous Iliosacral Screw in Tile Type-C Pelvic Ring Fracture

Md. Ashiqur Rahman *

Department of Orthopaedic Surgery, Ad-Din Sakina Women's Medical College Hospital, Jashore, Bangladesh.

Md. Shah Alam

Department of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh.

Saidul Islam

Department of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh.

Shahidul Islam

Department of Orthopedics and Spine Surgery, Addin Women’s Medical College Hospital, Dhaka, Bangladesh.

Shariful Islam

NITOR, Dhaka, Bangladesh.

Shahidul Islam Chowdhury

Department of Orthopaedic Surgery, Noakhali Medical College Hospital, Noakhali, Bangladesh.

Anwar Ahmed Miajee

Department of Orthopaedic Surgery, Popular Medical College Hospital, Dhaka, Bangladesh.

S. Ripon Kumar Ghosh

Department of Orthopaedics & Traumatology, Ad-Din Women's Medical College Hospital, Dhaka, Bangladesh.

*Author to whom correspondence should be addressed.


Abstract

Background: Pelvic fractures constitute one of the most severe orthopaedic injuries causing significant mortality & morbidity. Unstable pelvic ring disruptions result from high-energy trauma and are associated with multiple concomitant injuries. Many patients suffered from complications like prolonged hospital stay & immobilization, mal-union, chronic pain, limb length discrepancies, sitting problem & impaired gait due to inadequate treatment. Effective emergency medical services & proper definitive management must be ensured to save lives & reduce long-term complications. 

Objectives: To evaluate the outcome of internal fixation by anterior pelvic plating & posterior percutaneous iliosacral screw in tile Type-C pelvic ring fracture. 

Materials and Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery, Dhaka Medical College & Hospital, Dhaka, for two years from July 2019 to June 2021. Patients of diagnosed Tile Type-C pelvic ring fractures were the study population. A total of 22 patients aged (18 to 60) years presenting within three weeks of injury were included in the study. Radiological & functional outcomes were evaluated six months after surgery according to Matta radiographic criteria and Majeed score, respectively. Data included demography of the patients, mechanism of injuries, associated injuries, emergency interventions, fracture types, post-operative complications & length of hospital stay. 

Results: In this study, the highest number of patients, 08(36.36%), was observed in the third decade, and the lowest number, 01(4.55%), was observed in the second decade. The mean age was 37.82±14.82, ranging from 18 to 60 years. The majority of the patients are male workers. According to Matta radiographic criteria, 6 months after surgery 11(50%) patients had excellent, 8(36.36%) patients had good, 3(13.64%) had fair radiological outcome. According to Majeed score grading, the overall functional outcome of the study population revealed that 18 patients (81.82%) belonged to good (excellent + good), and four patients (18.18%) belonged to unsatisfactory (poor + fair) outcomes. Only 02 patients (9.09%) patients had wound infection, 02 patients (9.09%) had erectile dysfunction, 02 patients (9.09%) had urinary tract infection, 01 patient (4.55%) had implant loosening & 14 patients (63.63%) patients had no post-operative complications. 

Conclusion: It is concluded that internal fixation of Tile type – C pelvic ring fractures by anterior pelvic plating and posterior per-cutaneous iliosacral screw are a satisfactory and effective management method for early mobilization and rehabilitation of the patients.

Keywords: Outcome, internal fixation, anterior pelvic plating, posterior percutaneous, iliosacral screw, type-c pelvic ring fracture


How to Cite

Rahman , M. A., Alam , M. S., Islam , S., Islam , S., Islam , S., Chowdhury , S. I., Miajee , A. A., & Ghosh , S. R. K. (2023). The Outcome of Internal Fixation by Anterior Pelvic Plating & Posterior Percutaneous Iliosacral Screw in Tile Type-C Pelvic Ring Fracture. Asian Journal of Orthopaedic Research, 6(1), 36–44. Retrieved from https://journalajorr.com/index.php/AJORR/article/view/166

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References

Hossain A, Islam S, Qasem MF, Eskander SM, Hasan MT, Nahar M. Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka, Bangladesh. Journal of clinical orthopaedics and trauma. 2020 Nov 1;11(6):1162-7.

Hasankhani EG, Omidi-Kashani F. Treatment outcomes of open pelvic fractures associated with extensive perineal injuries. Clinics in orthopedic surgery. 2013 Dec 1;5(4):263-8.

Spanjersberg WR, Knops SP, Schep NW, van Lieshout EM, Patka P, Schipper IB. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury. 2009 Oct 1;40(10):1031-5.

Black SR, Sathy AK, Jo C, Wiley MR, Minei JP, Starr AJ. Improved survival after pelvic fracture: 13-year experience at a single trauma center using a multidisciplinary institutional protocol. Journal of orthopaedic trauma. 2016 Jan 1;30(1):22-8.

Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management?. Orthopaedics & Traumatology: Surgery & Research. 2013 Apr 1;99(2):175-82.

Marmor M, El Naga AN, Barker J, Matz J, Stergiadou S, Miclau T. Management of pelvic ring injury patients with hemodynamic instability. Frontiers in Surgery. 2020 Nov 12;7:588845.

Van Vugt AB, Van Kampen A. An unstable pelvic ring: the killing fracture. The Journal of Bone and Joint Surgery. British volume. 2006 Apr;88(4):427-33.

Oh HK, Choo SK, Kim JJ, Lee M. Stoppa approach for anterior plate fixation in unstable pelvic ring injury. Clinics in orthopedic surgery. 2016 Sep 1;8(3):243-8.

Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta orthopaedica. 2005 Jan 1;76(5):667-78.

Choy WS, Kim KJ, Lee SK, Park HJ. Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries. Yonsei medical journal. 2012 Mar 1;53(2):422-6.

MATTA JM, SAUCEDO T. Internal fixation of pelvic ring fractures. Clinical Orthopaedics and Related Research®. 1989 May 1;242:83-97.

Moon DH, Kim NK, Won JS, Choi JS, Kim DH. Outcome of surgical treatment of AO type C pelvic ring injury. Hip & Pelvis. 2014 Dec 1;26(4):269-74.

Mardanpour K, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. Journal of injury and violence research. 2013 Jun;5(2): 77.

Kokubo Y, Oki H, Sugita D, Takeno K, Miyazaki T, Negoro K, Nakajima H. Functional outcome of patients with unstable pelvic ring fracture: Comparison of short-and long-term prognostic factors. Journal of Orthopaedic Surgery. 2017 Jan 31;25(1): 2309499016684322.

Mohammed M. Unstable pelvic ring injuries. Outcome and timing of surgical treatment by internal fixation.

Mardanpour K, Rahbar M. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation. Medical Journal of The Islamic Republic of Iran (MJIRI). 2011 Jul 10;25(2):87-93.

Vidyarthi DA, Nayak D. Study of incidence and prevalence of pelvic fractures in Central India. J Med Sci Clin Res; 2018.

Wu S, Chen J, Yang Y, Chen W, Luo R, Fang Y. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. Journal of Orthopaedic Surgery and Research. 2021 Dec;16(1):1-0.

Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics, E-Book. Elsevier Health Sciences; 2020 Dec 23.

Portela R. Outcome of Unstable Pelvic Fractures after Internal Fixation: Our Experience. Ann Orthop Musculoskelet Disord. 2019;2(1):1023.

Halawi MJ. Pelvic ring injuries: Surgical management and long-term outcomes. Journal of clinical orthopaedics and trauma. 2016 Jan 1;7(1):1-6.

Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta orthopaedica. 2005 Jan 1;76(5):667-78.