Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

Abstract

Objective: To be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS).

Methods: A retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post-surgical reduction quality was evaluated using Matta scoring criteria and patient lower-extremity functional outcome was evaluated using Majeed functional scoring criteria.

Results: When used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post-surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra-acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients' lower-extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow-up at an average of 41.6 months postoperatively.

Conclusion: With excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS-assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.

Keywords: Closed reduction; Pelvic fracture; Screw fixation.

Fig. 1

This figure shows the improved pelvic reduction system used in this study.

Fig. 2

This figure is a computer tomography 3D reconstruction of a recruited patients' initial injury (A), post‐operative reduction quality of transcondylar traction (B), and complete anatomical reduction after receiving unlocking closed reduction technique (C).

Fig. 3

This figure demonstrates the design of this retrospective cohort study. AP, anteroposterior radiograph; Inlet, inlet radiograph (40 degrees caudad); Outlet, outlet radiograph (40 degrees cephalad); CS, corridor screw; PCRS, pelvic close reduction system; UCRT, unlocking closed reduction technique.

Fig. 4

This figure demonstrates and compares the dimensions of the modified Starr frame (A) used in this study and the Starr frame (B).

Fig. 5

This figure demonstrates and compares the dimensions of FBURD (A) used in this study and the T‐handle (B).

Fig. 6

This figure indicates the drilling locations of two transverse supra‐acetabular pins (1, 2), 2 LC‐2 pins (3, 4), and the traction pin (5). This figure also indicates the placement of the connecting rod (6) and FRURD (7), which is connected to the transverse supra‐acetabular pin (2) for unlocking the iliosacral joint dislocation. The red star stands for the dislocated iliosacral joint of the left side of the pelvis.