Evolution of the reduction technique for unstable pelvic ring fractures: a narrative review

Abstract

Unstable pelvic ring fractures are associated with high mortality and morbidity, and the quality of reduction is critical to the prognosis. While previous reviews have examined general fracture reduction techniques, there is limited focus on the specific advancements and challenges in the reduction technique of unstable pelvic ring fractures. The pelvic fracture reduction technique has undergone a four-stage evolution: open reduction, conventional closed reduction, navigation-assisted closed reduction, and robot-assisted automatic closed reduction. This review discusses and compares the features, effectiveness, and safety of each reduction technique. Open reduction improves clinical outcomes compared to nonsurgical management; however, it is no longer commonly practiced due to its association with extensive soft tissue damage. Although conventional closed reduction is minimally invasive and reduces intraoperative blood loss, surgical duration, and the length of hospital stay, frequent fluoroscopy is required to assess the reduction position, imposing a high risk of radiation exposure. Computer-aided navigation technology has advanced closed reduction techniques by allowing better visualization of the fracture site and surgical instruments, thereby enhancing the quality of pelvic fracture reduction and reducing radiation exposure. The recently developed robot-assisted automatic reduction technique relieves the burden on orthopedic surgeons and further reduces intraoperative radiation exposure. Future advancements in the pelvic reduction technique may involve big data-based intelligent reduction to enable broader indications such as bilateral pelvic fractures.

Keywords: Effectiveness; Reduction technique; Safety; Unstable pelvic ring fracture.

Fig. 1

Pelvic anatomy. a Osseous anatomy of the pelvic ring. b Interosseous ligaments maintaining pelvic stability

Fig. 2

Reduction frames. a Matta’s frame (diagram adopted from the literature [35]. b Starr frame (diagram adopted from the manufacture’s website https://www.starrframe.com/products/starr-frame/)