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Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results

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Abstract

Purpose

Fragility fractures of the pelvis (FFPs) type IIIa in the Rommens classification include unilateral iliac fractures as well as pubic rami fractures. We devised a new, less-invasive fixation technique to achieve increased stability for FFPs type IIIa. The aim of this study was to describe this procedure and report the preliminary clinical results.

Methods

A total of 14 geriatric patients (> 60 years old) who sustained FFP type IIIa caused by low-energy trauma were surgically treated with interdigitating screw fixation including a trans-pubic screw in a retrograde manner and two trans-iliac screws from the anterior inferior iliac spine toward the posterior inferior iliac spine. All iliac fractures were displaced with external rotation, and closed reduction was performed. Percutaneous screw fixation, in which fully threaded screws were in contact with each other, provided stable fixation allowing early mobilization.

Results

A median decrease in pain levels by post-operative day two was 4.5 compared with pre-operatively using a numerical rating scale. While full weight-bearing was allowed from four weeks post-operatively in the initial five patients, immediate full weight-bearing was instructed as tolerated for the subsequent nine patients. No complications were encountered during the peri-operative period. At the final follow-up, all fractures were united without fixation loss, screw dislodgment, or hardware failure.

Conclusions

This procedure of closed reduction and interdigitating screw fixation for FFP type IIIa appears to represent a safe, reliable technique. Our experience suggests that interdigitating fixation for FFP type IIIa is effective for relieving pain and promoting early mobilization in elderly patients.

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Authors and Affiliations

  1. Trauma and Reconstruction Center, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan

    Yuhei Nakayama, Takashi Suzuki, Akifumi Honda, Shinnosuke Yamashita, Kentaro Matsui, Keisuke Ishii, Taketo Kurozumi & Yoshinobu Watanabe

  2. Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan

    Hirotaka Kawano

Authors
  1. Yuhei Nakayama
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  2. Takashi Suzuki
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  3. Akifumi Honda
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  4. Shinnosuke Yamashita
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  5. Kentaro Matsui
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  6. Keisuke Ishii
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  7. Taketo Kurozumi
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  8. Yoshinobu Watanabe
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  9. Hirotaka Kawano
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Corresponding author

Correspondence to Takashi Suzuki.

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Ethical approval

This retrospective cohort study was conducted in compliance with the Declaration of Helsinki and was approved by our institutional review board at our hospital. The need to obtain informed consent from the involved patients was waived by the institutional review board.

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The authors declare that they have no conflict of interest.

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Nakayama, Y., Suzuki, T., Honda, A. et al. Interdigitating percutaneous screw fixation for Rommens type IIIa fragility fractures of the pelvis: technical notes and preliminary clinical results. International Orthopaedics (SICOT) 44, 2431–2436 (2020). https://doi.org/10.1007/s00264-020-04664-0

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  • DOI: https://doi.org/10.1007/s00264-020-04664-0

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