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The application of lateral-rectus approach on toddlers’ unstable pelvic fractures

BACKGROUND: Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpos...

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Autores principales: Liu, Yuancheng, Zhan, Xiaorui, Huang, Fuming, Wen, Xiangyuan, Chen, Yuhui, Yang, Cheng, Fan, Shicai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057593/
https://www.ncbi.nlm.nih.gov/pubmed/32131792
http://dx.doi.org/10.1186/s12891-020-3172-1
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author Liu, Yuancheng
Zhan, Xiaorui
Huang, Fuming
Wen, Xiangyuan
Chen, Yuhui
Yang, Cheng
Fan, Shicai
author_facet Liu, Yuancheng
Zhan, Xiaorui
Huang, Fuming
Wen, Xiangyuan
Chen, Yuhui
Yang, Cheng
Fan, Shicai
author_sort Liu, Yuancheng
collection PubMed
description BACKGROUND: Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. METHODS: We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients’ characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes. RESULTS: Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months. CONCLUSIONS: Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.
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spelling pubmed-70575932020-03-10 The application of lateral-rectus approach on toddlers’ unstable pelvic fractures Liu, Yuancheng Zhan, Xiaorui Huang, Fuming Wen, Xiangyuan Chen, Yuhui Yang, Cheng Fan, Shicai BMC Musculoskelet Disord Research Article BACKGROUND: Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. METHODS: We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients’ characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes. RESULTS: Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months. CONCLUSIONS: Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome. BioMed Central 2020-03-04 /pmc/articles/PMC7057593/ /pubmed/32131792 http://dx.doi.org/10.1186/s12891-020-3172-1 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Liu, Yuancheng
Zhan, Xiaorui
Huang, Fuming
Wen, Xiangyuan
Chen, Yuhui
Yang, Cheng
Fan, Shicai
The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title_full The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title_fullStr The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title_full_unstemmed The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title_short The application of lateral-rectus approach on toddlers’ unstable pelvic fractures
title_sort application of lateral-rectus approach on toddlers’ unstable pelvic fractures
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057593/
https://www.ncbi.nlm.nih.gov/pubmed/32131792
http://dx.doi.org/10.1186/s12891-020-3172-1
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