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Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure?
OBJECTIVES: To determine the frequency of fixation failure after transsacral-transiliac (TS) screw fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of failure of TS screws. DESIGN: Retrospective cohort study. SETTING: Level 1 academic trauma center. PA...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016598/ https://www.ncbi.nlm.nih.gov/pubmed/33937707 http://dx.doi.org/10.1097/OI9.0000000000000084 |
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author | Tisano, Breann K. Kelly, Drew P. Starr, Adam J. Sathy, Ashoke K. |
author_facet | Tisano, Breann K. Kelly, Drew P. Starr, Adam J. Sathy, Ashoke K. |
author_sort | Tisano, Breann K. |
collection | PubMed |
description | OBJECTIVES: To determine the frequency of fixation failure after transsacral-transiliac (TS) screw fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of failure of TS screws. DESIGN: Retrospective cohort study. SETTING: Level 1 academic trauma center. PATIENTS/PARTICIPANTS: Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). INTERVENTION: Operative treatment with at least one TS screw. MAIN OUTCOME MEASUREMENTS: Radiographic failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. RESULTS: Radiographic failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior fixation was comprised of a single TS screw in 3 of these 4 failures. The dominant mechanism of screw failure was bending. All of these failures occurred early in the postoperative period. No fixation failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. CONCLUSIONS: This is the first study to describe the mechanism of failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. LEVEL OF EVIDENCE: Level IV. |
format | Online Article Text |
id | pubmed-8016598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-80165982021-04-29 Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? Tisano, Breann K. Kelly, Drew P. Starr, Adam J. Sathy, Ashoke K. OTA Int Clinical/Basic Science Research Article OBJECTIVES: To determine the frequency of fixation failure after transsacral-transiliac (TS) screw fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of failure of TS screws. DESIGN: Retrospective cohort study. SETTING: Level 1 academic trauma center. PATIENTS/PARTICIPANTS: Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). INTERVENTION: Operative treatment with at least one TS screw. MAIN OUTCOME MEASUREMENTS: Radiographic failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. RESULTS: Radiographic failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior fixation was comprised of a single TS screw in 3 of these 4 failures. The dominant mechanism of screw failure was bending. All of these failures occurred early in the postoperative period. No fixation failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. CONCLUSIONS: This is the first study to describe the mechanism of failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. LEVEL OF EVIDENCE: Level IV. Wolters Kluwer Health 2020-07-10 /pmc/articles/PMC8016598/ /pubmed/33937707 http://dx.doi.org/10.1097/OI9.0000000000000084 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Clinical/Basic Science Research Article Tisano, Breann K. Kelly, Drew P. Starr, Adam J. Sathy, Ashoke K. Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title | Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title_full | Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title_fullStr | Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title_full_unstemmed | Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title_short | Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
title_sort | vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure? |
topic | Clinical/Basic Science Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016598/ https://www.ncbi.nlm.nih.gov/pubmed/33937707 http://dx.doi.org/10.1097/OI9.0000000000000084 |
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