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Is Closed Reduction and Percutaneous Fixation of Unstable Posterior Ring Injuries as Accurate as Open Reduction and Internal Fixation?

Lindsay, Adam MD*; Tornetta, Paul III MD; Diwan, Amna MD; Templeman, David MD

Journal of Orthopaedic Trauma: January 2016 - Volume 30 - Issue 1 - p 29–33
doi: 10.1097/BOT.0000000000000418
Original Article: OTA Highlight Paper

Objectives: The objective of this retrospective review was to determine whether a closed reduction technique for unstable pelvic ring injuries is as accurate as an open technique.

Design: Retrospective review.

Setting: Two academic Level 1 trauma centers.

Patients/Participants: We reviewed the records of 113 patients who had unilateral unstable pelvic ring injuries (Bucholz type 3, OTA type 61-C1) treated with closed reduction and percutaneous fixation (CRPF) or open reduction with internal fixation (ORIF).

Intervention: Sixty patients were treated at one institution with open reduction and percutaneous iliosacral screw fixation. This involved prone positioning and a gluteus maximus sparing approach for direct visualization and reduction of the fracture. A second cohort of 53 patients was treated at a separate institution with closed reduction and percutaneous iliosacral screw fixation. This involved supine positioning and skeletal traction.

Main Outcome Measures: Preoperative and postoperative plain radiographs of the pelvis were reviewed and standardized measurements were made to compare quality of reduction.

Results: We were able to measure displacement within 0.1 mm. Overall reduction quality was slightly better for the CRPF group. The largest average difference in postoperative displacement was seen at the iliac wing height on anteroposterior pelvis radiographs with 6.3 mm (range 0–19.6) in the ORIF group versus 1.9 mm (range 0–4.7) in the CRPF group.

Conclusions: The closed reduction technique described here is as effective as the ORIF technique in obtaining reduction of unstable pelvic ring injuries (Bucholz type 3, OTA type 61-C1).

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedics, UC Irvine Medical Center, University of California Irvine, Orange, CA;

Department of Orthopaedics, Boston University Medical Center, Boston, MA; and

Department of Orthopaedics, Hennepin County Medical Center, Minneapolis, MN.

Reprints: Adam Lindsay, MD, Department of Orthopaedics, UC Irvine Medical Center, University of California Irvine, 101 The City Drive South, Pavillion III, Building 29A, Orange, CA 92868 (e-mail: alindsay2009@gmail.com).

Presented as a podium presentation at the Annual Meeting of the Orthopaedic Trauma Association, October 5, 2012, Minneapolis, MN, and at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 21, 2013, Chicago, IL.

P. Tornetta is a consultant for Smith & Nephew. D. Templeman has received royalties from Zimmer Orthopaedics. The remaining authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Accepted July 27, 2015

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