Dataset Information

Bilateral pelvic discontinuity: a unique condition characterized by high failure rates of current treatment.

ABSTRACT:

Background

Bilateral pelvic discontinuity is characterized by complete dissociation of the superior and inferior pelvis secondary to bone loss or fracture. The end result is a freely mobile inferior pelvis at the level of each discontinuity which presents a significant reconstruction challenge. This clinical entity has not been described previously, and the results of surgical treatment are not known.

Methods

We retrospectively reviewed all identified cases of pelvic discontinuity (PD) treated with revision THA at one institution. We identified 133 pelvic discontinuities. Within this group, 6 patients had bilateral simultaneous PDs. Preoperative, intraoperative, and postoperative data and radiographic imaging were reviewed preoperatively and postoperatively for the characteristics of the dissociation and assessing PD healing and fixation of components after surgery.

Results

There were no preoperative factors that could distinguish these patients from the rest of the group of discontinuities (3 rheumatoid arthritis, 2 osteonecrosis of the femoral head, 1 developmental dysplasia). The reconstructions performed included 2 cup/cage, 5 posterior plating and uncemented cup, 3 cage alone, and 2 cups only. Ten of 12 hips had at least 1 complication postoperatively. At final follow-up, only 1 patient (17%) had radiographic evidence that both discontinuities had healed (posterior plate with uncemented cup).

Conclusions

Bilateral pelvic discontinuity is rare but presents the surgeon with a major reconstructive challenge. Only 1 patient went on to radiographic healing with current treatment strategies. Continued motion of the contralateral pelvic dissociation may account for the high failure rates. Surgeons should be aware of the challenges presented by this diagnosis and develop strategies to improve outcomes.

SUBMITTER: Martin JR

PROVIDER: S-EPMC5247510 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Publications

Bilateral pelvic discontinuity: a unique condition characterized by high failure rates of current treatment.

Martin John R JR Barrett Ian I Sierra Rafael J RJ Lewallen David G DG Berry Daniel J DJ

Arthroplasty today 20160201 4

<h4>Background</h4>Bilateral pelvic discontinuity is characterized by complete dissociation of the superior and inferior pelvis secondary to bone loss or fracture. The end result is a freely mobile inferior pelvis at the level of each discontinuity which presents a significant reconstruction challenge. This clinical entity has not been described previously, and the results of surgical treatment are not known.<h4>Methods</h4>We retrospectively reviewed all identified cases of pelvic discontinuity ...[more]

PMID: 28326425

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Project description:ObjectiveTo evaluate the clinical outcomes of traumatic spino-pelvic dissociation (TSD) treated with modified bilateral triangular fixation.MethodsEighteen consecutive patients of TSD were included in the study from March 2011 to March 2015, and the medical records of patients were reviewed retrospectively. There were 14 men and 4 women with an average age of 33.1 ± 1.4 years (range, 18-55 years). A total of 16 cases were caused by falling, and 2 cases were caused by traffic accident. All sacral fractures had associated injuries. According to the morphology of sacral fracture, U-shaped fractures were present in 10 cases, H-shaped fractures in 6 cases, and Y-shaped fractures in 2 cases. According to Roy-Camille classification, there were 12 cases of type II and 6 cases of type III. All patients received surgical treatment with modified bilateral triangular fixation, and the sacral plexus decompression was performed simultaneously on 6 cases whose scores were more than 2 according to Gibbons classification and were found having traumatic canal stenosis or sacral nerve compression detected by preoperative imaging examination. Mears' radiological evaluation criterion was applied to evaluate the reduction quality of fractures; Gibbons score was applied as the index of neurological deficiency healing, and the clinical outcome of fracture was evaluated with Majeed function assessment at last follow-up.ResultsAll patients were followed up continuously within an average of 32.4 ± 3.6 months (range, 22-48 months). All sacral fractures were healed in an average time of 11.3 ± 2.8 months (range, 8-28 months). According to the Majeed function evaluation, 12 cases were classified as excellent, 4 cases as good, and 2 cases as fair. Meanwhile, the anatomical reduction was obtained in 11 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in 1 case according to Mears' radiological evaluation criterion. The average Gibbons score changed from 2.5 ± 0.2 preoperatively to 1.4 ± 0.5 24 months postoperatively, which had a significant difference (t = 2.15, P < 0.05).ConclusionModified triangular fixation combined with internal fixations shows satisfactory clinical outcomes in the treatment of TSD, which is recommended as an effective and advanced surgical choice.

Dataset Information

Bilateral pelvic discontinuity: a unique condition characterized by high failure rates of current treatment.

Background

Methods

Results

Conclusions

Publications

Bilateral pelvic discontinuity: a unique condition characterized by high failure rates of current treatment.

Similar Datasets

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