Causes and solutions for failed anterior ring fixation for unstable pelvic fractures
10.3760/cma.j.cn115530-20191112-00403
- VernacularTitle:不稳定型骨盆骨折前环固定失效的原因分析与处理
- Author:
Huagui MO
1
;
Yuanqiao HUANG
;
Yuanzhuang CHEN
;
Gunshao MA
;
Qin XU
;
Yuqiang LUO
;
Jiahui CHEN
Author Information
1. 广东省江门市中心医院四肢关节骨科 529030
- From:
Chinese Journal of Orthopaedic Trauma
2020;22(6):495-500
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discuss the causes and solutions for failed anterior ring fixation for unstable pelvic fractures.Methods:A retrospective analysis was conducted of the 84 patients who had been admitted to Department of Orthopedics and Joint Surgery, Jiangmen Central Hospital for unstable pelvic fractures from January 2009 to March 2019. They were 56 males and 28 females, aged from 19 to 64 years (mean, 42.5 years). By the Tile classification, 22 cases were type B1, 16 type B2, 10 type B3, 22 type C1, 6 type C2 and 8 type C3. Simple anterior ring fixation was performed for 21 cases and combined anterior and posterior ring fixation for 63 ones. The Matta's criteria were applied for the evaluation of fracture reduction. The cases of failed anterior ring fixation and their solutions were recorded and analyzed.Results:All patients were followed up for 6 to 36 months (average, 13.5 months). Failed anterior ring fixation was observed in 7 cases (8.3%) at 3 to 75 days after operation (average, 29.1 days). The failure was attributed to improper operation timing and unstable anterior ring fixation in 2 cases, mere unstable anterior ring fixation in one, wrong choice of anterior ring fixators and improper rehabilitation in 2 cases, poor intraoperative reduction in one and unstable posterior ring fixation in one. In the 2 failed cases that had been treated by external fixators, one underwent revision and the other conservative treatment. In the 5 cases that had been treated by plating, 4 underwent revision and one conservative treatment. By the Majeed criteria, the pelvic function was evaluated at the final follow-up as excellent in 2, good in 2 and fair in one in the 5 cases of revision who obtained follow-up from 11 to 24 months(average, 17.2 months) after revision; malunion was observed in the 2 cases of conservative treatment.Conclusions:Failed anterior ring fixation for unstable pelvic fracture may be caused by improper operation timing, wrong choice of anterior ring fixators, intraoperative malreduction, unstable pelvic ring fixation and improper rehabilitation. The key solution to failed anterior ring fixation is to find the specific causes. Plate revision may lead to fine therapeutic efficacy.
