Treatment OF OPEN TILE TYPE C PELVIC FRACTURES BY OPEN REDUCTION AND INTERNAL FIXATION THROUGH ANTERIOR AND POSTERIOR APPROACHES AT EARLY STAGE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIBaichuan

No.5 Ward of Orthopedics, the 4th Affiliated Hospital of Guangxi Medical University, Liuzhou Guangxi, 545005, P. R. China;

Corresponding?author：

LIBaichuan, Email: libaichuan001@sina.com

Keywords：

Open pelvic fracture; Internal fixation; Damage control orthopedics; Vacuum sealing drainage

DOI：

10.7507/1002-1892.20140124

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Objective To explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage. Methods Between January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type Ⅱ and 7 as Gustilo type Ⅲ. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed. Results Delayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2. Conclusion Early internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.

Citation： LIBaichuan. Treatment OF OPEN TILE TYPE C PELVIC FRACTURES BY OPEN REDUCTION AND INTERNAL FIXATION THROUGH ANTERIOR AND POSTERIOR APPROACHES AT EARLY STAGE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 554-557. doi: 10.7507/1002-1892.20140124 Copy

1.	張英澤. 骨盆骨折救治的幾點建議. 中華骨科雜志, 2011, 31(11):1183-1184.
2.	McMurtry R, Walton D, Dickinson D, et al. Pelvic disruption in the polytraumatized patient:a management protocol. Clin Orthop Relat Res, 1980, (151):22-30.
3.	Tile M. Pelvic ring fractures:should they be fixed? J Bone Joint Surg (Br), 1988, 70(1):1-12.
4.	Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:retrospective and prospective analysis. J Bone Joint Surg (Am), 1976, 58(4):453-458.
5.	霍雷, 張厚慶, 徐步靖, 等. 經皮骶髂關節螺釘固定治療骨盆骨折. 中國微創外科雜志, 2013, 13(4):339-342.
6.	Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329):129-140.
7.	Majeed SA. Crading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2):304-306.
8.	陳明, 謝鳴, 勘武生, 等. 不穩定型骨盆骨折的手術方式探討. 中華創傷骨科雜志, 2013, 15(5):445-447.
9.	劉磊, 陳偉, 孫家元, 等. 損傷控制骨科在不穩定骨盆骨折治療中的應用. 中華創傷雜志, 2013, 29(1):6-9.
10.	Vécsei V, Negrin LL, Hajdu S. Today's role of external fixation in unstable and complex pelvic fractures. Eur J Trauma Emerg Surg, 2010, 36:100-106.
11.	Rommens PM, Hessmann MH. Staged reconstructon of pelvic ring disruption:differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma, 2002, 16(2):92-98.
12.	張奇, 陳偉, 樊新云, 等. 選擇性動脈造影與栓塞在血流動力學不穩定骨盆骨折診治中的應用. 中華創傷骨科雜志, 2009, 11(7):609-613.
13.	黎清波, 王欣, 鄒艷麗, 等. 負壓封閉引流減少創面毒素再損傷的臨床觀察. 中華創傷骨科雜志, 201l, 13(1):47-50.
14.	林愛華, 孫海軍. 封閉負壓吸引治療重度多發傷合并盆腔嚴重感染. 中華急診醫學雜志, 2013, 22(6):581-582.
15.	陳戈, 李濤, 陳仲, 等. 開放性骨盆骨折會陰撕裂感染的治療. 中華骨科雜志, 2011, 31(11):1213-1217.
16.	Phieffer LS, Lundberg WP, Templeman DC. Instability of the posterior pelvic ring complicated with disruption of the pubic symphysis. Orthop Clin North Am, 2004, 35(4):445-449.
17.	Tile M. Acute pelvic fractures:I. Causation and classification. J Am Acad Orthop Surg, 1996, 4(3):143-151.
18.	Lindahl J, Hirvensalo E. Outcome of operatively treated type C injuries of the pelvic ring. Acta Orthop, 2005, 76(5):667-678.
19.	Sagi HC, Lindvall EM. Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy. J Orthop Trauma, 2005, 19(2):130-133.

1. 張英澤. 骨盆骨折救治的幾點建議. 中華骨科雜志, 2011, 31(11):1183-1184.
2. McMurtry R, Walton D, Dickinson D, et al. Pelvic disruption in the polytraumatized patient:a management protocol. Clin Orthop Relat Res, 1980, (151):22-30.
3. Tile M. Pelvic ring fractures:should they be fixed? J Bone Joint Surg (Br), 1988, 70(1):1-12.
4. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:retrospective and prospective analysis. J Bone Joint Surg (Am), 1976, 58(4):453-458.
5. 霍雷, 張厚慶, 徐步靖, 等. 經皮骶髂關節螺釘固定治療骨盆骨折. 中國微創外科雜志, 2013, 13(4):339-342.
6. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329):129-140.
7. Majeed SA. Crading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2):304-306.
8. 陳明, 謝鳴, 勘武生, 等. 不穩定型骨盆骨折的手術方式探討. 中華創傷骨科雜志, 2013, 15(5):445-447.
9. 劉磊, 陳偉, 孫家元, 等. 損傷控制骨科在不穩定骨盆骨折治療中的應用. 中華創傷雜志, 2013, 29(1):6-9.
10. Vécsei V, Negrin LL, Hajdu S. Today's role of external fixation in unstable and complex pelvic fractures. Eur J Trauma Emerg Surg, 2010, 36:100-106.
11. Rommens PM, Hessmann MH. Staged reconstructon of pelvic ring disruption:differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma, 2002, 16(2):92-98.
12. 張奇, 陳偉, 樊新云, 等. 選擇性動脈造影與栓塞在血流動力學不穩定骨盆骨折診治中的應用. 中華創傷骨科雜志, 2009, 11(7):609-613.
13. 黎清波, 王欣, 鄒艷麗, 等. 負壓封閉引流減少創面毒素再損傷的臨床觀察. 中華創傷骨科雜志, 201l, 13(1):47-50.
14. 林愛華, 孫海軍. 封閉負壓吸引治療重度多發傷合并盆腔嚴重感染. 中華急診醫學雜志, 2013, 22(6):581-582.
15. 陳戈, 李濤, 陳仲, 等. 開放性骨盆骨折會陰撕裂感染的治療. 中華骨科雜志, 2011, 31(11):1213-1217.
16. Phieffer LS, Lundberg WP, Templeman DC. Instability of the posterior pelvic ring complicated with disruption of the pubic symphysis. Orthop Clin North Am, 2004, 35(4):445-449.
17. Tile M. Acute pelvic fractures:I. Causation and classification. J Am Acad Orthop Surg, 1996, 4(3):143-151.
18. Lindahl J, Hirvensalo E. Outcome of operatively treated type C injuries of the pelvic ring. Acta Orthop, 2005, 76(5):667-678.
19. Sagi HC, Lindvall EM. Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy. J Orthop Trauma, 2005, 19(2):130-133.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment OF OPEN TILE TYPE C PELVIC FRACTURES BY OPEN REDUCTION AND INTERNAL FIXATION THROUGH ANTERIOR AND POSTERIOR APPROACHES AT EARLY STAGE

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