The Application Of Two Different Ways In Unstable Anterior Pelvic Ring Fracture

Background and objectivePelvic fracture, commonly occurs with injury accidents like traffic accidents or falling accidents. Nowadays, as the traffic develops, the morbidity of pelvic is seeing a trend of growth, meanwhile, the traditional therapies, including traction, manual reduction, cast immobilization, pelvic suspension, etc, which cannot always give the unstable pelvic fracture patients a perfect reduction, is causing malunion instead, damaging the physiological structure to pelvic, even resulting in serious sequelae, e.g. shortening deformity of extremity, limb pain, or disuse atrophy. Compared with the traditional ways, the new method which named ORIF (open reduction and internal fixation) can brings a better reduction and satisfaction to the patients. ORIF reflects a series positive changes, containing a better cure to pelvic anatomical position, more stable fixation, pelvic capacity recovery, less complication, a possibility to the patients for whom they can initiate physical activities as well as functional exercise in a earlier stage, which dramatically decrease the disability and mortality. Therefore, that for patients without operation contraindication, a surgery of open reduction and internal fixation shall be performed has been reached a consensus. It is common to see a anterior pelvic fracture among the patients of pelvic fracture. The anterior pelvic refers to a cyclic structure which constitute by the symphysis who connect with bilateral pubic ramus and ramus of ischium. It is the weaknesses of the pelvic, In the past, we used to chose the operative approach of ilioinguinal to treat the unstable fracture in anterior pelvic, but because the fracture is too deep to finish the operate of manifest, restoration, and fixation. And many important vessels and nerves serves all around, which are easy to be damaged. Therefore, that how to give the recover pelvic safe, effective, shortcut, and in smaller trauma is a aim for every surgeon. Both internal fixation with modified Stoppa approach and internal fixation with cannulated screw through a small incision are newly operation method, and isn’t popular in china. This article mainly involves in discussion of therapeutic effect and application of internal screw fixation in small incision and open reduction internal fixation through modified Stoppa respectively applying in treatments of anterior ring bone fracture.Objects and methodsFrom June2007to February2013,22cases with pelvic ring fractures were treated with either internal fixation with modified Stoppa approach or internal fixation with cannulated screw through a small incision. With9male and13female,in the age29-59,41.9±9.1in average. According to the Tile classification,1cases were type A2,11cases were B2,7cases were type B3,and3cases were type C3. Patients were divided into two groups. In group A,9patients received internal fixation with modified Stoppa approach and in group B,13patients were treated with internal fixation with cannulated screw through a small incision. Majeed criterion was used for evaluation of fracture reduction, and the postoperative functions were evaluated as well.ResultsThe average length of incision was9.2±1.7cm (range,8cm-12cm)in group A and4.7±0.9cm(range,4-6cm) in group B. The average operative time was55.5±8.8minutes (range,45-75minutes) in group A and69.6±13.1minutes(range,55-90minutes)in group B. The average blood loss was115.5±61.0ml (range,50-250ml)in group A and28.4±14.0ml(range,10-50ml)in group B. According to Majeed criterion, the results were excellent in all patients. The duration of follow up was from6months to24months (in average15±4.3months), and Bony union was achieved in all fractures.Conclusions1.Both internal fixation with modified Stoppa approach and internal fixation with cannulated screw through a small incision is the safe,effective ways to teat the unstable fracture in anterior pelvic ring.2.Internal fixation with modified Stoppa approach can suitable polytype of unstable unstable fracture in anterior pelvic ring.3.Internal fixation with cannulated screw through a small incision can make a smaller trauma,but it has a narrow range in the unstable unstable fracture in anterior pelvic ring.and it has more radiate trauma to both surgeon and patient,as well.