nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

01.05.2020 | Original Article

Achievable pin spanning angulation in anterosuperior pelvic external fixation

verfasst von: Benjamin Young, Drayton Daily, Clarence Kee, Kevin Perry, Massimo Max Morandi, R. Shane Barton, Giovanni F. Solitro

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Pelvic external fixation using anterosuperior pins provides a quick method of stabilization without necessitating fluoroscopic guidance. Various locations, depths, and inclinations have been cited for external fixator pins; however, the existing literature lacks clear indications for the angular difference between pins. Thus, we aimed to determine the greatest degree of sagittal pin spanning angulation (SPSA) between two iliac crest pins and how intraosseous depth (ID) affects these angulations.

Materials and methods

A newly developed computer algorithm produced cross sections of 3D pelvic reconstructions in the sagittal plane in 5° increments. Computer-generated pins with IDs of 60, 75, and 90 mm were positioned in 5° increments transversely. Pins were assessed for cortical containment to define values for SPSA and transverse pin spanning angulation (TPSA).

Results

A bimodal distribution revealed varying degrees of insertion frequency and SPSA, cranially and caudally. The caudal distribution exhibited greater cortical containment with larger values for SPSA and TPSA. The highest insertion frequency (85.7%) and largest SPSA (155°) were observed for the 60-mm ID. Increasing ID resulted in further bony penetration and smaller values for SPSA and TPSA.

Conclusions

Expanding the degree of SPSA between inserted pins in anterosuperior pelvic external fixation can be challenging due to the thinning of the iliac wing, which affords a narrow corridor for intraosseous pin containment. An ID of 60 mm allows larger degrees of SPSA while maintaining higher rates of cortical pin containment when compared to pins with greater IDs.

Nelson JT, Coleman JR, Carmichael H et al (2020) High rate of fibrinolytic shutdown and venous thromboembolism in patients with severe pelvic fracture. J Surg Res 246:182–189. https://doi.org/10.1016/j.jss.2019.09.012CrossRefPubMed

Scaglione M, Parchi P, Digrandi G et al (2010) External fixation in pelvic fractures. Musculoskelet Surg 94:63–70. https://doi.org/10.1007/s12306-010-0084-5CrossRefPubMed

Poenaru DV, Popescu M, Anglitoiu B et al (2015) Emergency pelvic stabilization in patients with pelvic posttraumatic instability. Int Orthop 39:961–965. https://doi.org/10.1007/s00264-015-2727-5CrossRefPubMed

Ohmori T, Kitamura T, Nishida T et al (2018) The impact of external fixation on mortality in patients with an unstable pelvic ring fracture: a propensity-matched cohort study. Bone Jt J 100B:233–241. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0852.R1CrossRef

Apostolov P (2011) Methods and techniques of percutaneous external fixation in pelvic fractures. J IMAB Annu Proc (Scientific Pap) 17(1):166–171. https://doi.org/10.5272/jimab.2011171.166CrossRef

Mitchell PM, Corrigan CM, Patel NA et al (2016) 13-Year experience in external fixation of the pelvis: complications, reduction and removal. Eur J Trauma Emerg Surg 42:91–96. https://doi.org/10.1007/s00068-015-0499-7CrossRefPubMed

Wojahn RD, Gardner MJ (2019) Fixation of anterior pelvic ring injuries. J Am Acad Orthop Surg 27:667–676. https://doi.org/10.5435/jaaos-d-17-00839CrossRefPubMed

Queipo-De-Llano A, Perez-Blanca A, Ezquerro F, Luna-González F (2013) Simultaneous anterior and posterior compression of the pelvic ring with external fixation using a pre-tensed curved bar: a biomechanical study. Injury 44:1787–1792. https://doi.org/10.1016/j.injury.2013.08.016CrossRefPubMed

Solomon LB, Pohl AP, Chehade MJ et al (2008) Surgical anatomy for pelvic external fixation. Clin Anat 21:674–682. https://doi.org/10.1002/ca.20697CrossRefPubMed

10.

Solomon LB, Pohl AP, Sukthankar A, Chehade MJ (2009) The subcristal pelvic external fixator: technique, results, and rationale. J Orthop Trauma 23:365–369. https://doi.org/10.1097/BOT.0b013e3181a2aec3CrossRefPubMed

11.

Simon P (2006) Progress report in 2005 about pelvic ring bifocal lesions: roundtable under the direction of Patrick Simon, Sotest, Nancy, 27 June 2005. Eur J Orthop Surg Traumatol 16:304–314. https://doi.org/10.1007/s00590-006-0172-2CrossRef

12.

Tosounidis TH, Mauffrey C, Giannoudis PV (2018) Optimization of technique for insertion of implants at the supra-acetabular corridor in pelvis and acetabular surgery. Eur J Orthop Surg Traumatol 28:29–35. https://doi.org/10.1007/s00590-017-2007-8CrossRefPubMed

13.

Stewart R, Kieser DC, Scholze M et al (2018) Preliminary biomechanical results of a novel pin configuration for external fixation of vertical shear pelvic fractures. ANZ J Surg 88:1051–1055. https://doi.org/10.1111/ans.14822CrossRefPubMed

14.

Stahel PF, Mauffrey C, Smith WR et al (2013) External fixation for acute pelvic ring injuries: decision making and technical options. J Trauma Acute Care Surg 75:882–887. https://doi.org/10.1097/TA.0b013e3182a9005fCrossRefPubMed

15.

Mohanty K, Musso D, Powell JN et al (2005) Emergent management of pelvic ring injuries: an update. Can J Surg 48:49–56PubMedPubMedCentral

16.

Kim WY, Hearn TC, Seleem O et al (1999) Effect of pin location on stability of pelvic external fixation. Clin Orthop Relat Res 361:237–244CrossRef

17.

Lee C, Sciadini M (2018) The use of external fixation for the management of the unstable anterior pelvic ring. J Orthop Trauma 32:S14–S17. https://doi.org/10.1097/bot.0000000000001251CrossRefPubMed

18.

Bircher MD (1996) Indications and techniques of external fixation of the injured pelvis. Injury 27:3–19. https://doi.org/10.1016/S0002-9378(15)33148-3CrossRef

19.

Tang P, Meredick R, Prayson MJ, Gruen GS (2002) External fixation of the pelvis. Tech Orthop 17:228–238. https://doi.org/10.1097/00013611-200206000-00012CrossRef

20.

Rubel IF, Kloen P, Borens O, Helfet DL (2002) External fixation for pelvic ring injuries. Tech Orthop 17:221–227. https://doi.org/10.1097/00013611-200206000-00011CrossRef

21.

Tucker MC, Nork SE, Simonian PT, Chip Routt ML (2000) Simple anterior pelvic external fixation. J Trauma Inj Infect Crit Care 49:989–994. https://doi.org/10.1097/00005373-200012000-00002CrossRef

22.

Archdeacon MT, Arebi S, Le TT et al (2009) Orthogonal pin construct versus parallel uniplanar pin constructs for pelvic external fixation: a biomechanical assessment of stiffness and strength. J Orthop Trauma 23:100–105. https://doi.org/10.1097/BOT.0b013e3181962e0eCrossRefPubMed

23.

McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC (2010) Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis 68:281–291PubMed

24.

Slafer GA, Satorre EH, Andrade FH (1994) Slicer PDF. Genet Improv F Crop 30:1–68. https://doi.org/10.1016/j.mri.2012.05.001.3DCrossRef

25.

Morandi M, Daily D, Kee C et al (2019) Safe supra-acetabular pin insertion in relation to intraosseous depth. J Orthop Res 37:1790–1797. https://doi.org/10.1002/jor.24323CrossRefPubMed

26.

Waikakul S, Kojaranon N, Vanadurongwan V, Harnroongroj T (1998) An aiming device for pin fixation at the iliac crest for external fixation in unstable pelvic fracture. Injury 29:757–762. https://doi.org/10.1016/S0020-1383(98)00180-6CrossRefPubMed

27.

Chen H, Tang P, Yao Y et al (2015) Anatomical study of anterior column screw tunnels through virtual three-dimensional models of the pelvis. Eur J Orthop Surg Traumatol 25:105–110. https://doi.org/10.1007/s00590-013-1410-zCrossRefPubMed

28.

Chon CS, Jeong JH, Kang B et al (2018) Computational simulation study on ilio-sacral screw fixations for pelvic ring injuries and implications in Asian sacrum. Eur J Orthop Surg Traumatol 28:439–444. https://doi.org/10.1007/s00590-017-2061-2CrossRefPubMed

29.

Dhakshyani R, Nukman Y, Abu Osman NA (2012) Rapid prototyping models for dysplastic hip surgeries in Malaysia. Eur J Orthop Surg Traumatol 22:41–46. https://doi.org/10.1007/s00590-011-0778-xCrossRef

30.

Ponsen KJ, Joosse P, Van Dijke GAH, Snijders CJ (2007) External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins. Acta Orthop 78:648–653. https://doi.org/10.1080/17453670710014347CrossRefPubMed

Titel: Achievable pin spanning angulation in anterosuperior pelvic external fixation
verfasst von: Benjamin Young
Drayton Daily
Clarence Kee
Kevin Perry
Massimo Max Morandi
R. Shane Barton
Giovanni F. Solitro
Publikationsdatum: 01.05.2020
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 7/2020
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02684-5

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2020

Correction to: Management of early ankle osteoarthritis through anterior joint-preserving surgery: a retrospective evaluation at mid- to long-term follow-up

Clinical and ultrasonographical follow-up after standard removal of distal radius volar plates positioned distal to the watershed line

Sarcopenia in distal radius fractures: systematic review of the literature and current findings

Results after the application of tranexamic acid intravenous or intra-articular in the control of postsurgical bleeding after total hip arthroplasty: a randomized controlled trial

Locked wires fixator for fractures of the distal third of the radius and ulna in children