Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial
Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the bo...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Chinese Journal of Traumatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1008127522000633 |
| _version_ | 1811170567720534016 |
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| author | Islam Sayed Moussa Ahmed Mohammed Sallam Amr Khairy Mahmoud Elzaher Hassan Elzaher Amr Mohammed Nagy Ahmed Salem Eid |
| author_facet | Islam Sayed Moussa Ahmed Mohammed Sallam Amr Khairy Mahmoud Elzaher Hassan Elzaher Amr Mohammed Nagy Ahmed Salem Eid |
| author_sort | Islam Sayed Moussa |
| collection | DOAJ |
| description | Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries. Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant. Results: The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up. Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection). |
| first_indexed | 2024-04-10T16:58:45Z |
| format | Article |
| id | doaj.art-a6a90fa70a8545abb420acdb0ed326df |
| institution | Directory Open Access Journal |
| issn | 1008-1275 |
| language | English |
| last_indexed | 2024-04-10T16:58:45Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Chinese Journal of Traumatology |
| spelling | doaj.art-a6a90fa70a8545abb420acdb0ed326df2023-02-07T04:21:24ZengElsevierChinese Journal of Traumatology1008-12752023-01-012614859Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trialIslam Sayed Moussa0Ahmed Mohammed Sallam1Amr Khairy Mahmoud2Elzaher Hassan Elzaher3Amr Mohammed Nagy4Ahmed Salem Eid5Corresponding author.; Department of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, 11522, EgyptPurpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries. Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant. Results: The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up. Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection).http://www.sciencedirect.com/science/article/pii/S1008127522000633Tile B2 and C1 injuriesPercutaneous sacroiliac screwPosterior ring fixationRadiological outcomeMajeed pelvic score |
| spellingShingle | Islam Sayed Moussa Ahmed Mohammed Sallam Amr Khairy Mahmoud Elzaher Hassan Elzaher Amr Mohammed Nagy Ahmed Salem Eid Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial Chinese Journal of Traumatology Tile B2 and C1 injuries Percutaneous sacroiliac screw Posterior ring fixation Radiological outcome Majeed pelvic score |
| title | Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial |
| title_full | Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial |
| title_fullStr | Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial |
| title_full_unstemmed | Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial |
| title_short | Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial |
| title_sort | combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable tile b and c pelvic ring injuries a randomized controlled trial |
| topic | Tile B2 and C1 injuries Percutaneous sacroiliac screw Posterior ring fixation Radiological outcome Majeed pelvic score |
| url | http://www.sciencedirect.com/science/article/pii/S1008127522000633 |
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