Percutaneous Iliosacral Screw Fixation: Early Treatment for Unstable Posterior Pelvic Ring Disruptions
OBJECTIVE Open reduction and internal fixation of unstable posterior pelvic ring injury provides better bony stability and less long term morbidity than nonoperative treatment. However, open reduction and internal fixation of the posterior pelvis may involve substantial intraoperative blood loss, re...
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Veröffentlicht in: | The Journal of Trauma: Injury, Infection, and Critical Care Infection, and Critical Care, 1995-03, Vol.38 (3), p.453-458 |
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creator | Shuler, Thomas E. Boone, Darrell C. Gruen, Gary S. Peitzman, Andrew B. |
description | OBJECTIVE Open reduction and internal fixation of unstable posterior pelvic ring injury provides better bony stability and less long term morbidity than nonoperative treatment. However, open reduction and internal fixation of the posterior pelvis may involve substantial intraoperative blood loss, reported infection rates of 6 to 25%, and wound complications in 25%. Our hypothesis was that percutaneous cannulated iliosacral screws placed by fluoroscopic control would provide early, rapid, definitive stabilization with minimal blood loss, infection, and wound complications.
DESIGN A retrospective medical record and radiographic study.Materials, Methods, Measurements and Main ResultsTwenty consecutive patients with an unstable posterior pelvic ring injury treated by percutaneous fixation (41 screws) under fluoroscopic guidance were reviewed. Average patient age was 34 years, trauma score was 14.4 +/- 3.3, and Injury Severity Score was 22.9 +/- 10.6. Mechanisms were motor vehicle collisions (11), falls (3), crush injury (3), and pedestrian/auto (3). Pelvic injuries were classified as Tile B (5) or Tile C (15). Associated injuries were present in 80%. Seventy-five percent of patients underwent pelvic fixation less than 72 hours after injury with closed percutaneous screw placement achieved in 60%, assisted by open reduction in 25% or aided by anterior external fixation in 15%. Mean operative time was 52 minutes for patients requiring percutaneous screws only (7 of 20 patients, 35%), whereas average blood loss was 233 mL for all cases (including open anterior and posterior procedures). No loss of fixation or wound complications occurred during 9.6 months follow-up.
CONCLUSIONS Percutaneous iliosacral screw fixation for unstable posterior pelvic disruption provided early fixation with minimal operative time, minimal blood loss, and wound-related morbidity. |
doi_str_mv | 10.1097/00005373-199503000-00031 |
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DESIGN A retrospective medical record and radiographic study.Materials, Methods, Measurements and Main ResultsTwenty consecutive patients with an unstable posterior pelvic ring injury treated by percutaneous fixation (41 screws) under fluoroscopic guidance were reviewed. Average patient age was 34 years, trauma score was 14.4 +/- 3.3, and Injury Severity Score was 22.9 +/- 10.6. Mechanisms were motor vehicle collisions (11), falls (3), crush injury (3), and pedestrian/auto (3). Pelvic injuries were classified as Tile B (5) or Tile C (15). Associated injuries were present in 80%. Seventy-five percent of patients underwent pelvic fixation less than 72 hours after injury with closed percutaneous screw placement achieved in 60%, assisted by open reduction in 25% or aided by anterior external fixation in 15%. Mean operative time was 52 minutes for patients requiring percutaneous screws only (7 of 20 patients, 35%), whereas average blood loss was 233 mL for all cases (including open anterior and posterior procedures). No loss of fixation or wound complications occurred during 9.6 months follow-up.
CONCLUSIONS Percutaneous iliosacral screw fixation for unstable posterior pelvic disruption provided early fixation with minimal operative time, minimal blood loss, and wound-related morbidity.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/00005373-199503000-00031</identifier><identifier>PMID: 7897737</identifier><identifier>CODEN: JOTRA5</identifier><language>eng</language><publisher>Baltimore, MD: Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Blood Loss, Surgical ; Blood Volume ; Bone Screws ; Female ; Fracture Fixation, Internal - instrumentation ; Fracture Fixation, Internal - methods ; Humans ; Male ; Medical sciences ; Middle Aged ; Orthopedic surgery ; Pelvic Bones - injuries ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><ispartof>The Journal of Trauma: Injury, Infection, and Critical Care, 1995-03, Vol.38 (3), p.453-458</ispartof><rights>Williams & Wilkins 1995. All Rights Reserved.</rights><rights>1995 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4241-f4f6abc117734365cca5af43a20a196d459523c43c0d0b38606e5a7c1da325ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3505861$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7897737$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shuler, Thomas E.</creatorcontrib><creatorcontrib>Boone, Darrell C.</creatorcontrib><creatorcontrib>Gruen, Gary S.</creatorcontrib><creatorcontrib>Peitzman, Andrew B.</creatorcontrib><title>Percutaneous Iliosacral Screw Fixation: Early Treatment for Unstable Posterior Pelvic Ring Disruptions</title><title>The Journal of Trauma: Injury, Infection, and Critical Care</title><addtitle>J Trauma</addtitle><description>OBJECTIVE Open reduction and internal fixation of unstable posterior pelvic ring injury provides better bony stability and less long term morbidity than nonoperative treatment. However, open reduction and internal fixation of the posterior pelvis may involve substantial intraoperative blood loss, reported infection rates of 6 to 25%, and wound complications in 25%. Our hypothesis was that percutaneous cannulated iliosacral screws placed by fluoroscopic control would provide early, rapid, definitive stabilization with minimal blood loss, infection, and wound complications.
DESIGN A retrospective medical record and radiographic study.Materials, Methods, Measurements and Main ResultsTwenty consecutive patients with an unstable posterior pelvic ring injury treated by percutaneous fixation (41 screws) under fluoroscopic guidance were reviewed. Average patient age was 34 years, trauma score was 14.4 +/- 3.3, and Injury Severity Score was 22.9 +/- 10.6. Mechanisms were motor vehicle collisions (11), falls (3), crush injury (3), and pedestrian/auto (3). Pelvic injuries were classified as Tile B (5) or Tile C (15). Associated injuries were present in 80%. Seventy-five percent of patients underwent pelvic fixation less than 72 hours after injury with closed percutaneous screw placement achieved in 60%, assisted by open reduction in 25% or aided by anterior external fixation in 15%. Mean operative time was 52 minutes for patients requiring percutaneous screws only (7 of 20 patients, 35%), whereas average blood loss was 233 mL for all cases (including open anterior and posterior procedures). No loss of fixation or wound complications occurred during 9.6 months follow-up.
CONCLUSIONS Percutaneous iliosacral screw fixation for unstable posterior pelvic disruption provided early fixation with minimal operative time, minimal blood loss, and wound-related morbidity.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical</subject><subject>Blood Volume</subject><subject>Bone Screws</subject><subject>Female</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Pelvic Bones - injuries</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdtuGyEQhlGUKrHSPEIkLqLebcNhWSB3UQ5tpEi1crhGs3i2QcW7LuzGzdsXx67vioTQMP8_M3wQQjn7ypnVF6wsJbWsuLWKyRJVZUt-QGZcCVsZw-whmTEmRKWEEcfkNOfQFo1Q2gpzRI60sVpLPSPdHJOfRuhxmDK9j2HI4BNE-uQTruld-ANjGPpLegspvtPnhDAusR9pNyT60ucR2oh0PuQRUyhXc4xvwdPH0P-kNyGnabWx58_kUwcx4-nuPCEvd7fP19-rhx_f7q-vHipfi5pXXd010HrOy3C1bJT3oKCrJQgG3DaLWlklpK-lZwvWStOwBhVozxcghQKUJ-TLtu4qDb8nzKNbhuwxxu0DndbcGGVNEZqt0Kch54SdW6WwhPTuOHMbyu4fZben7D4oF-vZrsfULnGxN-6Ylvz5Lg_ZQ-wS9D7kvUwqpkyzKVNvZeshFnj5V5zWmNwrQhxf3f_-WP4FZ_uUvQ</recordid><startdate>199503</startdate><enddate>199503</enddate><creator>Shuler, Thomas E.</creator><creator>Boone, Darrell C.</creator><creator>Gruen, Gary S.</creator><creator>Peitzman, Andrew B.</creator><general>Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199503</creationdate><title>Percutaneous Iliosacral Screw Fixation: Early Treatment for Unstable Posterior Pelvic Ring Disruptions</title><author>Shuler, Thomas E. ; Boone, Darrell C. ; Gruen, Gary S. ; Peitzman, Andrew B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4241-f4f6abc117734365cca5af43a20a196d459523c43c0d0b38606e5a7c1da325ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood Loss, Surgical</topic><topic>Blood Volume</topic><topic>Bone Screws</topic><topic>Female</topic><topic>Fracture Fixation, Internal - instrumentation</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Pelvic Bones - injuries</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><toplevel>online_resources</toplevel><creatorcontrib>Shuler, Thomas E.</creatorcontrib><creatorcontrib>Boone, Darrell C.</creatorcontrib><creatorcontrib>Gruen, Gary S.</creatorcontrib><creatorcontrib>Peitzman, Andrew B.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of Trauma: Injury, Infection, and Critical Care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shuler, Thomas E.</au><au>Boone, Darrell C.</au><au>Gruen, Gary S.</au><au>Peitzman, Andrew B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous Iliosacral Screw Fixation: Early Treatment for Unstable Posterior Pelvic Ring Disruptions</atitle><jtitle>The Journal of Trauma: Injury, Infection, and Critical Care</jtitle><addtitle>J Trauma</addtitle><date>1995-03</date><risdate>1995</risdate><volume>38</volume><issue>3</issue><spage>453</spage><epage>458</epage><pages>453-458</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><coden>JOTRA5</coden><abstract>OBJECTIVE Open reduction and internal fixation of unstable posterior pelvic ring injury provides better bony stability and less long term morbidity than nonoperative treatment. However, open reduction and internal fixation of the posterior pelvis may involve substantial intraoperative blood loss, reported infection rates of 6 to 25%, and wound complications in 25%. Our hypothesis was that percutaneous cannulated iliosacral screws placed by fluoroscopic control would provide early, rapid, definitive stabilization with minimal blood loss, infection, and wound complications.
DESIGN A retrospective medical record and radiographic study.Materials, Methods, Measurements and Main ResultsTwenty consecutive patients with an unstable posterior pelvic ring injury treated by percutaneous fixation (41 screws) under fluoroscopic guidance were reviewed. Average patient age was 34 years, trauma score was 14.4 +/- 3.3, and Injury Severity Score was 22.9 +/- 10.6. Mechanisms were motor vehicle collisions (11), falls (3), crush injury (3), and pedestrian/auto (3). Pelvic injuries were classified as Tile B (5) or Tile C (15). Associated injuries were present in 80%. Seventy-five percent of patients underwent pelvic fixation less than 72 hours after injury with closed percutaneous screw placement achieved in 60%, assisted by open reduction in 25% or aided by anterior external fixation in 15%. Mean operative time was 52 minutes for patients requiring percutaneous screws only (7 of 20 patients, 35%), whereas average blood loss was 233 mL for all cases (including open anterior and posterior procedures). No loss of fixation or wound complications occurred during 9.6 months follow-up.
CONCLUSIONS Percutaneous iliosacral screw fixation for unstable posterior pelvic disruption provided early fixation with minimal operative time, minimal blood loss, and wound-related morbidity.</abstract><cop>Baltimore, MD</cop><pub>Williams & Wilkins</pub><pmid>7897737</pmid><doi>10.1097/00005373-199503000-00031</doi><tpages>6</tpages></addata></record> |
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subjects | Adolescent Adult Aged Biological and medical sciences Blood Loss, Surgical Blood Volume Bone Screws Female Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Humans Male Medical sciences Middle Aged Orthopedic surgery Pelvic Bones - injuries Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases |
title | Percutaneous Iliosacral Screw Fixation: Early Treatment for Unstable Posterior Pelvic Ring Disruptions |
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