Minimally Invasive Surgery for Pelvic Fractures with Long and Short Screws - Part I

By Xueqi Zhao, Shengfen Liu

Affiliations

1. Department of Orthopaedics, Gansu Provincial Hospital, Lanzhou, China

doi: 10.29271/jcpsp.2025.10.1361

Sir,         

Pelvic ring fractures are most commonly seen in the context of high-impact trauma and are often associated with other fractures or injuries elsewhere in the body. Certain pelvic fractures do not disrupt the pelvic ring, such as iliac wing fractures, and are usually managed without surgical intervention. Similarly, acetabular fractures occur frequently, particularly in older adults with high-energy trauma, hip dislocations, and falls.¹ Traumatic injuries can range from minor wounds to severe, complex injuries that may lead to shock and multisystem organ dysfunction. Pelvic fractures often damage blood vessels, nerves, genitourinary organs, and the rectum, and haemorrhage from pelvic fracture is a leading cause of complications and death.² Treatment of pelvic fractures includes both conservative treatment and surgical treatment. Conservative treatment may lead to uncorrectable pelvic deformity, as well as many other serious complications. Currently, surgical treatment can immobilise the pelvis to restore fracture stability and improve the patient's prognosis.³ Traditional open surgical treatment of pelvic fractures has a number of drawbacks, such as a large incision, long operative time, major bleeding, greater damage to soft tissues and surrounding organs, slow postoperative recovery, and increased postoperative complications. In the following case, minimally invasive surgery for pelvic fracture, using long and short screws for fixation, clearly addressed the shortcomings  of  traditional  surgery.

A 36-year male patient presented with traumatic pain and discomfort in the right hip and pubic symphysis for 2 hours. Vital signs were stable, and symptomatic treatment was given. Physical examination showed a positive pelvic com- pression and separation test. Three-dimensional reconstruction showed that the right ilium was fractured and the pubic symphysis  was  separated  (Figure 1A, B).

After admission, under general anaesthesia, pelvic fracture reduction and internal fixation was performed. First, the patient was placed in the left lateral position, and the right fractured ilium was repositioned by manoeuvre. X-ray confirmed good alignment. Subsequently, the fracture was fixed with one long and one short screw, and follow-up x-ray again showed proper screw positioning and fixation (Figure 1C, D). In the second step, the patient was placed in the supine position, and the separated pubic symphysis was repositioned using bone-holding forceps. X-ray confirmed well repositioned. The pubic symphysis was then fixed with two short screws, and a follow-up x-ray confirmed proper repositioning with good position of the screws (Figure 1E-G). In the third step, the pubic symphysis was sutured layer by layer through a small surgical incision (Figure 1H). Postoperative follow-up of the patient showed good recovery. The patient was able to gradually walk one week after the operation, and showed significant improvement by one month after the operation.

Figure 1: (A, B) Three-dimensional reconstruction showed that the right ilium was fractured, and the pubic symphysis was separated. (C, D) Good alignment on x-ray, and the fracture was fixed with one long and one short screw, showing proper fixation with optimal position of the screws. (E-G) Proper repositioning on x-ray, and the pubic symphysis is fixed with two short screws, showing proper repositioning with good position of the screws. (H) The pubic symphysis was sutured layer by layer through a small surgical incision.

In conclusion, minimally invasive surgery for fixation of pelvic fractures using long and short screws offers outstanding advantages, including a small surgical incision, shorter operation time, minimal postoperative complications, and rapid recovery, ultimately improving the patients’ quality of life.

PATIENT’S  CONSENT:
Publication of data related to this case has been approved with the patient's informed consent.

COMPETING  INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’  CONTRIBUTION:
XZ: Drafted, revised, and edited the manuscript.
SL: Conducted to data collection, analysis, and interpre- tation.
Both authors approved the final version of the manuscript to be published.
 

REFERENCES

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