Surgical correction of the pelvis after malunited pelvic fracture.
DOI:
https://doi.org/10.15674/0030-598720221-285-92Abstract
Mal-union and non-union of the pelvic bones is a complication
of the treatment of its injuries, which mostly occur with 61C fractures
according to the AO/OTA classification. Objective. To analyze
the results of surgical treatment of a female patient with a pelvic fracture
that has healed with residual deformity (shortening, posterior
displacement, internal rotation to the right and external rotation to
the left) and to demonstrate the importance of careful planning with
the involvement of 3D modeling in cases of reconstructive surgery
after a pelvic fracture. Methods. The study has the form of a clinical
case description. The results of the treatment were evaluated according
to the IPS score. During the examination, multiple fractures
of the pelvic bones and dislocations corresponding to type 61 C3 according
to the AO/OTA classification were revealed. After a CT scan
of the pelvis with 3D reconstruction, a 3-stage surgical intervention
was planned and performed. The first stage: 2 K-wires were percutaneously
inserted through the left sacroiliac joint at the SI-SII level to
the area of the planned osteotomy of the sacrum; through a paramedian
access, a longitudinal osteotomy of the sacrum was performed
on the right through the area of the previous fracture with mobilization
of the lateral fragment. The second: transection of the symphysis,
osteotomy of the pubic bone at the site of improper fusion, repositioning,
fixation with a simulated reconstructive plate and standard
screws; reposition of the right pelvic semiring. The third: adequate
closure of the posterior wound. For control, a CT scan of the pelvis
and a comparative evaluation of the main projections and images on
3D reconstruction and frontal sections were performed. 4 months after
the operation, the patient carries out a full axial load with no pain
syndrome and continues rehabilitation aimed at returning the correct
stereotype of gait. The functional result was estimated at 90 points
on the IPS scale. Conclusions. Late surgical correction is difficult
to perform and is associated with a large number of possible severe
complications. Careful preoperative planning is the key for the pelvic
fractures treatment and their consequences. The best method of prevention
of late reconstructions is the correct initial definitive treatment.
This requires the presence of specialized medical centers with
experts specializing in the treatment of pelvic fractures, the necessary
equipment and a defined protocol
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