Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption

Abstract

Little information is provided in the literature describing an efficient reduction technique for pelvic ring disruption. The aim of this study is to assess the use of the transcondylar traction as a closed reduction technique for vertically unstable fracture-dislocations of the sacro-iliac joint. Twenty-four pelvic ring disruptions were treated with attempted closed reduction followed by percutaneous screw fixation. Transcondylar traction was used as a closed reduction technique. Closed reduction to within 1 cm of residual displacement was obtained in all cases. No incidence of infection, digestive, cutaneous, or vascular complications occurred. We observed secondary displacement in three patients. Correction of the vertical displacement is better achieved when performed within 8 days after the trauma. Two posterior screws and a complementary anterior fixation is typically required to avoid further displacement in case of sacral fractures. However, an open approach should be preferred in both cases of crescent iliac fracture-sacroiliac dislocation and transforaminal fracture associated with peripheral neurological deficit. A vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.

Fig. 1

Reduction technique by transcondylar traction. The contralateral foot is blocked with a distal foot rest. Above the thigh, a U inverse rest prevents knee flexion. When the contralateral leg is firmly fixed to the table, the trunk must be immobilised with two thoracic rests on each side. The only mobile part should be the ipsilateral lower limb under the pelvic fracture. Hip and knee flexion is helpful in obtaining reduction of the fracture

Fig. 2

Measurements technique. Using an anteroposterior view for the vertical displacement (a) and an inlet view for the posterior displacement (b), right and left landmarks were measured from a central line, determined from the spine axis, and reported in millimeters of displacement on the preoperative, postoperative, and the last follow-up evaluation. The landmarks were the iliac crests, sacro-iliac feet, U radiological feet. The differences in height between the right and left sides for the three landmarks were averaged and compared

Fig. 3

Pre-operative, postoperative and last follow-up vertical displacement measured on AP views. Values are means + standard deviations

Fig. 4

Variation of post-operative vertical displacement (mm) compared to the variation of surgical delay (days) using the linear regression model. The procedure is dependent on early operative intervention, especially in patients with severe posterior pelvic deformities. Early operative intervention improves the reduction accuracy

Fig. 5

Variation of functional outcome (Mageed score) compared to the variation of the last follow-up vertical displacement (in mm) using the linear regression model. The functional outcome decreased with the amount of vertical displacement at the last follow-up