الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Reduction of pelvic ring deformities can be accomplished using closed or open techniques. Closed reduction and percutaneous fixation can be performed urgently, even during the initial resuscitation of the patient, thereby diminishing pelvic bleeding. Stable percutaneous pelvic fixation also decreases operative blood loss and time, is associated with a very low wound complication rate, and allows comfortable mobilization of the patient. An additional benefit was that these percutaneous techniques did not decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage.
Early and accurate closed reduction in conjunction with stable fixation using percutaneous insertion techniques could be ideal treatment for certain pelvic ring disruptions, especially in patients with polytrauma.
This was a prospective study of forty patients with unstable posterior pelvic ring injuries Tile type C (completely unstable). All cases were treated in Menoufia and Tanta University Hospitals during the period from March 2012 to February 2017.Two methods of fixation were used percutaneous fixation after closed reduction (group I included twenty patients) or open reduction and internal fixation (group II included twenty patients). Implants used were large set cannulated screws and small set dynamic compression plates. The age of the patients ranged from 20 – 50 years with a mean age (34.6 years group I & 37.25 years in group II) there were 31 males and 9 females. The left side was affected in 22 patients and the right side in 18 patients.
It was found that unstable pelvic ring injuries were more common in males than females, affect active adult age group than elderly and
motor car accidents were the most common causative trauma in both groups of patients to a similar degree.
In this study, intraoperative blood loss was minimal in percutaneous group of patients in contrast to amount of blood loss recorded in patients of open group. In group I no blood transfusion was needed with haemoglobin concentration of more than 10 mg/dl postoperatively. In contrast to group II patients where four patients needed blood transfusion intraoperatively according to amount of blood loss.
Posterior operative time and hospital stay were statistically highly significant shorter in percutaneous group than open group. Also healing duration was significantly shorter in percutaneous group.
For most cases, partial weight-bearing was started after 4-6 weeks and progressed gradually to full weight-bearing after 8-10 weeks guided clinically and by radiological healing. The clinical results of both groups were assessed by Lindahl et al.’s modification of the Majeed score and radiological evaluation was according to the maximal anterior or posterior displacement reached at the end of the follow up periods of each patient by way of constructing horizontal reference lines through bony landmarks.
Satisfactory radiological and functional results of percutaneous group I (75% and 85% respectively) compared to satisfactory radiological and functional results of open group II (85% and 70%) pay attention towards the effectiveness of percutaneous iliosacral screws in management of unstable posterior pelvic ring instabilities
It was found that better reduction of posterior pelvic ring injuries was associated better final outcome, better postoperative function, less pain and better return to previous job. Postoperative residual posterior displacement of more than 1 cm was associated with
increased long-term pain and disability. Statistical analysis showed significant relation between radiological and clinical results that means satisfactory reduction of posterior pelvic ring injuries was associated with satisfactory clinical results in both groups of patients
Although overall functional results of percutaneous group were better than open group it was statistically insignificant. Postoperative residual posterior pelvic pain, sitting affection and gait affection were mainly responsible for the functional results of both groups of patients at the final follow up period.
In this study insignificant high incidence of complications were more in open group such as infection and nerve root affection while backing out of iliosacral screws without loss of posterior fixation was noticed in percutaneous group.
Open reduction and internal fixation of posterior pelvic injuries in particular, were associated with high wound complication rate. Early and accurate closed reduction in conjunction with stable fixation using percutaneous insertion techniques should be ideal treatment for certain pelvic ring disruptions, especially in patients with polytrauma.
Percutaneous fixation compared to open technique of posterior pelvic ring injuries offers safe, short operative time technique, less complication, with better results, short hospital stay, early healing and should be the standard way for pelvic ring fractures fixation. High quality pre-operative and intra-operative imaging, image-guidance, are essential for an equally high quality of surgical results.