Closed Reduction and Minimally Invasive Fixation for the Treatment of Bilateral Displaced Posterior Pelvic Ring Disruption.

Abstract

Objective: Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures. However, the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon. In this study, we describe in detail a novel unlocking closed reduction technique (UCRT) frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes.

Methods: We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions (AO/OTA 61-C2 and C3) who were initially treated with this technique between July 2017 and July 2022. According to the AO/OTA classification, there were 9 cases (28.12%) of 61-C2, and 23 cases (71.88%) of 61-C3. There were 11 males, 21 females, with an average age of 38.1 years. The interval from injury to operation was 4-27 days, with a cut-off of 12.5 days (receiver operating characteristic curve). Operative time, blood loss, and postoperative radiographic findings were recorded. The functional outcomes and complications were followed.

Results: A total of 30 (93.8%) patients achieved successful closed reduction, whereas 2 required open reduction. The successful closed reduction rate was 95.5% (21/22) in patients whose injury-to-operation time was less than 12.5 days. The vertical displacement percent correction of the obviously displaced hemipelvis was 70.20% ± 16.79% on average. The average degree of pelvic deformity correction was 64.86% ± 17.71%. Thirty patients were followed up for at least 12 months (12-36 months), and no complications of nonunion or redisplacement were observed. The Matta-Tornetta scoring standard revealed that the excellent (25/30) and good (4/30) rate was 96.7%. The Majeed clinical efficacy score revealed that the overall excellent and good rate was 100%. One patient had INFIX-related infection, and 2 reported numbness in the lateral thigh. The numbness was improved after INFIX removal.

Conclusions: This study presents an updated technique for closed reduction using a UCRT frame for bilateral posterior pelvic ring disruption, which has been shown to be effective, as indicated by excellent surgical and functional outcomes.