Reduction And Internal Fixation Of Acetabular And Pelvic Fractures Using MIPO Technique

Objective: To compare clinical results of MIPO technique and ilioin- guinal approach in the treatment of acetabular and pelvic fractures.Methods: A total of 23 cases(17 males and 6 females, aged 25~62 years, with a mean age of 44.17±9.69 years) with acetabular or pelvic fractures were retrospectively evaluated before and after the surgery in our department, the Third Hospital of Hebei Medical University from January 2012 to December 2014. Causes of Injury included traffic injuries(n=15), fall injury(n=6) and crush injury(n=2). Of all 23 patients, some were accompanied by multiple injuries(n=10), and some were combined with posteror ring fracture(n=8), limb fracture(n=4), chest and abdominal organ injury(n=3), urethral injury(n=2) and traumatic brain injury(n=2). The duration from injury to surgery was 3-15 days, with an average of(8.50±3.64) days. These 23 cases were divided into two groups, group A and group B. In group A, 11 cases(9 males and 2 females, aged 33~61 years, with a mean age of 42.82±8.17 years) were treated using MIPO. According to Young-Burgess classification, 4 cases suffered pelvic fracture, including 1 case with type APC Ⅲand 3 with type LCⅡ. Based on Judet-Letournel classification, 7 patients had acetabular fracture, involving 4 patients with double column fracture, 2 with T-shape fracture and 2 with transverse fracture. Treatment: An incision was made at the ilium and ipsilateral pubic bone respectively. The displaced ilium and anterior column of the acetabulum were reduced and fixed temporarily with Kirschner wires or screws.The steel plate was then inserted beneath iliopsoas and iliac vessels via the incision at the ilium and came out from the incision above the pubic bone(or inserted at the incision above the pubic bone, penetrating beneath iliopsoas and iliac vessels, and came out from the incision of the iliac bone). Then the pelvic and acetabular fractures were fixed. Of 7 cases with acetabular fracture, 3 patients were treated combining Kocher-Langenbeck approach for reduction and fixation of posterior column of the acetabular bone In group B, 12 patients(8 males and 4 females, aged 25~62 years, with a mean age of 45.42±11.13 years) were treated using ilioinguinal approach. According to Young-Burgess classification, 4 patients suffering pelvic fractures were divided into type APC Ⅲ(1 case), type LCⅡ(1 case) and type LCⅢ(2 cases). Based on Judet-Letournel classification, 8 patients with acetabular fracture were divided into double column fracture(4 cases), T-shape fracture(4 cases) and transverse fracture(1 case). Treatment: By means of classic ilioinguinal approach, iliopsoas, iliac vessels and the spermatic cord(round ligament of the uterus) were separated to expose the “three windows” for fracture reduction. Afterwards, the steel plate was inserted beneath iliopsoas and iliac vessels and came out from the incision at the pubic symphysis, for fixation of pelvic fracture and fracture of anterior column of the acetabulum. Of 8 cases with acetabular fracture, 4 patients were treated combining Kocher-Langenbeck approach for reduction and fixation of posterior column of the acetabulum The operation time, intra-operative blood loss, as well as postoperative drainage, function and complications were all recorded. The quality of fracture reduction in pelvic and acetabular fracture was evaluated using the Matta scheme. At the latest follow-up, hit joint function was evaluated using a modified Merle D’Aubigne –Postel scoring system.Results:(1) Operation time: 90~360min in group A(excluding the time for fixing posterior ring fracture and other fractures), with an average time of(171±81.6) min and 180~480min in group B, with an average time of(293.4±96) min. The operative time in group A was shorter than that in group B, and the difference was statistically significant(P<0.05);(2) Intra-operative blood loss: 270~2000ml(excluding the time for fracture fixation in other parts) in group A, with an average of(128.33±44.38) ml and 400~3000ml in group B, with an average of(501.82±177.36) ml. Less intra-operative blood loss was found in group A compared with group B, and the difference was statistically significant(P<0.05);(3) Postoperative drainage: 20~150ml(excluding the fracture fixation of other parts) in group A, with an average of(51.82±43.09) ml, and 30~200ml in group B with an average of(105.83±47.19) ml. Postoperative drainage was less in group A than that in group B, and there was statistically significant difference(P<0.05);(4) Quality of fracture reduction: Four patients were satisfied with fracture reduction and none were unsatisfied in group A. of pelvic fracture; 3 cases underwent anatomical reduction, 4 cases had good reduction and none had poor reduction in group B. Three patients were satisfied with fracture reduction and 1 was unsatisfied in group B, while 5 had good anatomical reduction, 2 had good fracture reduction and 1 had poor reduction;(5) Scores of hip joint function: The scores in group A were classified into being excellent(n=3), fair(n=6), good(n=2) and poor(n=0), while excellent(n=3), fair(n=7), good(n=1) and poor(n=1) were obtained in group B. The quality of fracture reduction and hip joint function at the latest follow-up in both groups showed no significant difference(P>0.05). In group A, 1 case suffered superficial infection and 1 suffered lateral femoral nerve palsy, while there were 2 cases with lateral femoral nerve palsy, 1 with urinary tract infection, 2 with superficial infection, 1 with deep vein thrombosis and 1 with heterotopic ossification in group B; No postoperative complication was observed, such as nonunion and acetabulum infection. Compared with group B, fewer postoperative complications were observed in group A, which was statistically significant(P<0.05).Conclusion: MIPO Technique is preferable in the treatment of pelvic and acetabular fracture for the following reasons, such as less trauma and bleeding, shorter operative time and excellent safety without femoral vessels and nerve exposure.