Intramedullary screw and plate combination technique for stabilization of anterior pelvic ring: when and how? - A technical note and case series.

BACKGROUND

Posterior pelvic ring restoration and stabilization are widely recognized as the primary goal in managing pelvic ring injuries. However, anterior pelvic ring (APR) stabilization is also essential in certain cases. Traditional methods, including open plating or intramedullary screw fixation alone, may be insufficient for addressing several challenging situations. The intramedullary screw and plate combination (SPC) technique for APR stabilization offers a feasible solution for these complex cases while achieving favorable clinical outcomes. Therefore, the present study aimed to introduce the SPC technique for APR stabilization and evaluate its clinical and radiological outcomes.

METHODS

This retrospective study analyzed the data of patients who underwent APR stabilization with the SPC technique at two urban university hospitals. The indications for the SPC technique included straddle fractures involving Nakatani zone III, symphysis pubis diastasis with ramus fractures, segmental ramus fractures, and cases requiring construct length augmentation. The radiologic and functional outcomes, including bone union, pelvic displacement index (PDI), symphysis pubis width (SPW), Matta and Tornetta grading, and Majeed scores, were assessed.

RESULTS

Altogether, 17 patients were included in the present study. Bone union was achieved in 94.12 % of the patients, with a mean union time of 3.88 ± 1.34 months. The PDI significantly improved from 1.10 ± 0.08 preoperatively to 1.05 ± 0.07 postoperatively (p = 0.015) and remained stable at the last follow-up. SPW showed a significant reduction postoperatively (p = 0.041) and remained stable at the last follow-up. According to the Matta and Tornetta grading system, 82.35 % of the patients demonstrated good or excellent outcomes, and the mean Majeed score was 93.19 ± 8.91. No implant-related complication was observed.

CONCLUSION

The SPC technique is a feasible and effective approach for stabilizing challenging APR injuries, offering favorable clinical and radiologic outcomes while minimizing the risks associated with traditional plating.