| ВХОД ДЛЯ ПАЦИЕНТОВ
|Re: застарелое повреждение таза
послал Adam Starr 28 Март 2003, 17:25
|Thanks for the link to the plain films and CT images.
I think this is just a pelvic ring disruption that has gone on to a non-union. The arrow is pointing to the inferior ramus non-union, and
the sup ramus is a high "root" fracture, right near the pecten. The sup ramus fracture enters the tab - you could call it an acetabular
fracture - but down here in Dallas we treat these acutely as stable pelvic ring injuries. The fracture in the anterior portion of the
acetabulum is so low it doesn't seem to cause much trouble.
His R sacroiliac joint is opened anteriorly a little bit - the "unreduced posterior lesion" Alex mentioned in his first post. My earlier post about plating, bone grafting, etc., is all wrong.
What you have is a pelvic fracture that hasn't healed after 4 months or so, with a minimal deformity.
I think what I would offer the guy is a percutaneous iliosacral screw to stabilize and improve the SI joint alignment, coupled with a perc anterior column screw to stabilize the high ramus fx. These screws aren't easy to place, and have a host of potential problems and complications. But, I think they would work.
The open treatment options carry more morbidity, in my opinion, but they could achieve the same result. It's possible to do an ilioinguinal
approach and stabilize both fractures. Bone grafting of each site (you would probably aim for a fusion of the SI joint if you chose the open route) and plate fixation would likely lead to union.
The perc screw method would also likely lead to union, but with less surgical dissection. The problem with the perc method is that it
requires an expert fluoroscopy technician, and a surgeon who understands the anatomy, as seen on fluoro. It's hard to do.
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