Treatment of Day type <b>Ⅱ</b> pelvic crescent fracture by using percutaneous cannulated screw fixation technique _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUAN Yi ¹ , WANG Tao ² , YUAN Jun ¹ , QU Gangbo ¹ , HAO Pandeng ¹ , ZENG Zhijiang ¹ , LUO Bing ¹ ,  YANG Jiafu ¹

1. Department of Orthopaedics, Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Orthopaedics, Zhenxiong County People’s Hospital, Zhenxiong Yunnan, 657200, P.R.China;

Corresponding author：

YANG Jiafu, Email: 283811046@qq.com

Keywords：

Percutaneous; cannulated screw; internal fixation; pelvic crescent fracture

DOI：

10.7507/1002-1892.2201709002

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ObjectiveTo evaluate the feasibility and effectiveness of percutaneous cannulated screw fixation for the treatment of Day type Ⅱ pelvic crescent fracture.MethodsThe clinical data of 14 patients with Day type Ⅱ pelvic crescent fractures underwent closed reduction and percutaneous cannulated screw fixation between January 2009 and July 2016 were retrospectively analysed. There were 9 males and 5 females, aged 17-65 years (mean, 38 years). The causes of injury included traffic accident in 8 cases, falling from height in 3 cases, bruise injury in 3 cases; all were closed fractures. According to Tile classification, there were 8 cases of type B, 6 cases of type C. There were 13 cases combined with fracture of the anterior pelvic ring, including 8 cases of superior and inferior ramus of pubis fracture, 1 case of superior ramus of pubis fracture with symphysis separation, and 4 cases of symphysis separation. The interval of injury and admission was 1- 72 hours (mean, 16 hours), and the interval of injury and operation was 3-8 days (mean, 5 days). After operation, the reduction of fracture was evaluated by the Matta evaluation criteria, the clinical function was assessed by Majeed function assessment.ResultsThe operation time was 35-95 minutes (mean, 55 minutes), cumulative C-arm fluoroscopy time was 3-8 minutes (mean, 5 minutes), no iatrogenic vascular injury and pelvic organ damage occurred. Postoperative X-ray films at 2 days indicated that 2 cases of vertical shift and 2 cases of mild rotation were not completely corrected. Postoperative CT examination at 3 days indicated that 2 pubic joint screws broke through the obturator bone cortex. None of the pubic ramus screws entered into the acetabulum, but a screw of superior pubic branch broke through the posterior cortical of superior pubic branch, a screw of posterior ilium column broke through the medial bone cortex of the ilium, and no clinical symptom was observed. One patient suffered from wound infection in the pubic symphysis, then healed after 2 weeks of wound drainage, the other wounds healed by first intention. According to Matta criterion for fracture reduction, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case with an excellent and good rate of 92.9%. All patients were followed up 8-24 months (mean, 14 months). All fractures healed at 4 months and restored to the normal walking at 6 months after operation, 3 patients suffered from slight pain in the sacroiliac joints and slight claudication when they were tired or walked for a long time and unnecessary for special treatment. One patient felt pain in the back of the iliac spine when he was lying down. During the follow-up, no screw loosening or other internal fixation failure occurred. At last follow-up, according to Majeed functional evaluation criteria, the results were excellent in 7 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 85.7%.ConclusionThe percutaneous cannulated screw fixation is a safe treatment for Day type Ⅱ pelvic crescent fracture, which has a reliable fixation and good effectiveness.

Citation： YUAN Yi, WANG Tao, YUAN Jun, QU Gangbo, HAO Pandeng, ZENG Zhijiang, LUO Bing, YANG Jiafu. Treatment of Day type Ⅱ pelvic crescent fracture by using percutaneous cannulated screw fixation technique . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 139-144. doi: 10.7507/1002-1892.2201709002 Copy

1.	Hasenboehler EA, Stahel PF, Williams A, et al. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement. Patient Saf Surg, 2011, 5(1): 8.
2.	Wu T, Chen W, Zhang Q, et al. Biomechanical comparison of two kinds of internal fixation in a type C Zone Ⅱ pelvic fracture model. Chin Med J (Engl), 2015, 128(17): 2312-2317.
3.	Wagner D, Ossendorf C, Gruszka D, et al. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg, 2015, 41(4): 349-362.
4.	Spain K, Holt T. Surgical Revision after Sacroiliac Joint Fixation or Fusion. Int J Spine Surg, 2017, 11: 5.
5.	Polly DW, Swofford J, Whang PG, et al. Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-Surgical management for sacroiliac joint dysfunction. Int J Spine Surg, 2016, 10: 28.
6.	刘宗超, 马川, 石厚银. 经皮空心螺钉固定技术治疗垂直旋转不稳定骨盆骨折的疗效评价. 中国骨与关节损伤杂志, 2011, 26(8): 694-696.
7.	苑芳昌, 周东生. 经皮髂骨拉力螺钉固定术治疗髂骨后部骨折钉道角度的影像学研究. 山东医药, 2008, 48(17): 17-18.
8.	刘斌, 张立岩, 王济纬, 等. 不同路径髂骨钉钉道的 CT 影像学研究. 中国骨伤, 2011, 24(2): 141-144.
9.	桑锡光, 张立平, 刘海春, 等. 腰椎-髂骨固定的临床解剖学研究. 中国临床解剖学杂志, 2007, 25(2): 156-159, 165.
10.	Borrelli J, Koval KJ, Helfet DL. Operative stabilization of fracture dislocations of the sacroiliac joint. Clin Orthop Relat Res, 1996, (329): 141-146.
11.	Shui X, Ying X, Mao C, et al. Percutaneous screw fixation of crescent Fracture-Dislocation of the sacroiliac joint. Orthopedics, 2015, 38(11): e976-982.
12.	Zong Z, Chen S, Jia M, et al. Posterior iliac crescent fracture-dislocation: is it only rotationally unstable? Orthopedics, 2014, 37(5): e435-440.
13.	Park SE, Lee SW, Kim WY, et al. Atypical pelvic crescent fracture caused by vertical shear force. Hip Pelvis, 2014, 26(3):194-197.
14.	Trikha V, Singh V, Kumar VS. Anterior fracture dislocation of sacroiliac joint: A rare type of crescent fracture. Indian J Orthop, 2015, 49(2): 255-259.
15.	Day AC, Kinmont C, Bircher MD, et al. Crescent fracture-dislocation of the sacroiliac joint: a functional classification. J Bone Joint Surg (Br), 2007, 89(5): 651-658.
16.	谭振, 黄仲, 李亮, 等. 骶髂关节脱位的分型方法及手术治疗方案. 四川大学学报(医学版), 2017, 48(5): 661-667.
17.	蔡鸿敏, 刘又文, 李红军. 骨盆髂嵴外固定架 Schanz 钉置钉区域的影像学研究. 中国骨伤, 2015, 28(7):617-621.
18.	秦晖, 安智全, 姜朝来. 经前侧入路手术治疗骨盆新月型骨折. 中国修复重建外科杂志, 2011, 25(7): 816-820.

1. Hasenboehler EA, Stahel PF, Williams A, et al. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement. Patient Saf Surg, 2011, 5(1): 8.
2. Wu T, Chen W, Zhang Q, et al. Biomechanical comparison of two kinds of internal fixation in a type C Zone Ⅱ pelvic fracture model. Chin Med J (Engl), 2015, 128(17): 2312-2317.
3. Wagner D, Ossendorf C, Gruszka D, et al. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg, 2015, 41(4): 349-362.
4. Spain K, Holt T. Surgical Revision after Sacroiliac Joint Fixation or Fusion. Int J Spine Surg, 2017, 11: 5.
5. Polly DW, Swofford J, Whang PG, et al. Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-Surgical management for sacroiliac joint dysfunction. Int J Spine Surg, 2016, 10: 28.
6. 刘宗超, 马川, 石厚银. 经皮空心螺钉固定技术治疗垂直旋转不稳定骨盆骨折的疗效评价. 中国骨与关节损伤杂志, 2011, 26(8): 694-696.
7. 苑芳昌, 周东生. 经皮髂骨拉力螺钉固定术治疗髂骨后部骨折钉道角度的影像学研究. 山东医药, 2008, 48(17): 17-18.
8. 刘斌, 张立岩, 王济纬, 等. 不同路径髂骨钉钉道的 CT 影像学研究. 中国骨伤, 2011, 24(2): 141-144.
9. 桑锡光, 张立平, 刘海春, 等. 腰椎-髂骨固定的临床解剖学研究. 中国临床解剖学杂志, 2007, 25(2): 156-159, 165.
10. Borrelli J, Koval KJ, Helfet DL. Operative stabilization of fracture dislocations of the sacroiliac joint. Clin Orthop Relat Res, 1996, (329): 141-146.
11. Shui X, Ying X, Mao C, et al. Percutaneous screw fixation of crescent Fracture-Dislocation of the sacroiliac joint. Orthopedics, 2015, 38(11): e976-982.
12. Zong Z, Chen S, Jia M, et al. Posterior iliac crescent fracture-dislocation: is it only rotationally unstable? Orthopedics, 2014, 37(5): e435-440.
13. Park SE, Lee SW, Kim WY, et al. Atypical pelvic crescent fracture caused by vertical shear force. Hip Pelvis, 2014, 26(3):194-197.
14. Trikha V, Singh V, Kumar VS. Anterior fracture dislocation of sacroiliac joint: A rare type of crescent fracture. Indian J Orthop, 2015, 49(2): 255-259.
15. Day AC, Kinmont C, Bircher MD, et al. Crescent fracture-dislocation of the sacroiliac joint: a functional classification. J Bone Joint Surg (Br), 2007, 89(5): 651-658.
16. 谭振, 黄仲, 李亮, 等. 骶髂关节脱位的分型方法及手术治疗方案. 四川大学学报(医学版), 2017, 48(5): 661-667.
17. 蔡鸿敏, 刘又文, 李红军. 骨盆髂嵴外固定架 Schanz 钉置钉区域的影像学研究. 中国骨伤, 2015, 28(7):617-621.
18. 秦晖, 安智全, 姜朝来. 经前侧入路手术治疗骨盆新月型骨折. 中国修复重建外科杂志, 2011, 25(7): 816-820.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of Day type Ⅱ pelvic crescent fracture by using percutaneous cannulated screw fixation technique

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