Palisade Technique — the New Method for Open Reduction of Pelvic Fractures

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Abstract

Background. Restoration of the pelvic bones and acetabulum anatomy after fracture is an important criterion for functional outcome. Often, the reduction of flat pelvic bones is not an easy task. The authors proposed a method of reduction using a special support site of two or three 3.5 mm cortical screws for Matta bone forceps.

The aim of the study was to demonstrate a new way of pelvic bones fragments reduction.

Method. Three clinical situations are presented when a new method was used: 1) reduction of a pointed fragment of the acetabulum posterior column transverse fracture; 2) reduction of the acetabulum quadrilateral plate fragments with medial displacement and 3) reduction the rupture of the pelvic bones in the sacroiliac joint with the vertical displacement. Previously, a support site was created in one of the fragments from two or three not fully twisted 3.5 mm cortical screws. One of the Matta bone forceps branches was placed on the formed site, and the second on another fragment and the displacement was eliminated. Then the final osteosynthesis was performed with pelvic plates and/or cannulated screws according to the surgical plan. Before closing the wound the support site was removed.

Conclusions. The proposed method has shown its effectiveness during the reduction of the flat bones fragments, as it allows you to compress the spongy bones of the pelvis with a thin cortical layer stronger, compared with existing methods during which fragments splitting and «pulling out» anchor screws in the branches of reduction forceps can occur. The developed method of reduction demonstrated convenience and reliability.

About the authors

Nikita N. Zadneprovskiy

Sklifosovsky Clinical and Research Institute for Emergency Care

Author for correspondence.
Email: zacuta2011@gmail.com
ORCID iD: 0000-0002-4432-9022

Cand. Sci. (Med.)

Russian Federation, Moscow

Pavel A. Ivanov

Sklifosovsky Clinical and Research Institute for Emergency Care

Email: ipamailbox@gmail.com
ORCID iD: 0000-0002-2954-6985

Dr. Sci. (Med.)

Russian Federation, Moscow

Alexander V. Nevedrov

Sklifosovsky Clinical and Research Institute for Emergency Care

Email: alexnev1985@yandex.ru
ORCID iD: 0000-0002-1560-6000

Cand. Sci. (Med.)

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Position of the Matta forceps in case of the acetabulum fracture on a plastic model of the pelvis:a — appearance of the support site for one of the Matta bone forceps;b — the position of the Matta forceps during the reduction of the posterior column of the acetabulum fracture on a plastic model of the pelvis

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3. Fig. 2. Transverse juxtatectal fracture of the right acetabulum with displacement (AO/OTA 62B1.2):a — CT 3D–reconstruction of the pelvis; b — postoperative X-ray of the right acetabulum in the oblique iliac Judet view

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4. Fig. 3. Position of the Matta forceps branch in case of the acetabulum fracture on a plastic model of the pelvis:a — view of the support screws for reduction with two Matta forceps:b — the position of the Matta forceps branches during the reduction of the acetabulum quadrilateral plate fracture

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5. Fig. 4. Two–column fracture of the right acetabulum (AO/OTA 62C1e):a — CT 3D–reconstruction of the pelvis in inlet view;b — postoperative X-ray of the pelvis in the AP view

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6. Fig. 5. Position of the Matta forceps branch in case of rupture of the left SIJ on a plastic model of the pelvis:a — before reduction;b — view after reduction of the left SIJ

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7. Fig. 6. Rupture of the left SIJ with displacement of the left half of the pelvis posteriorly and cranially:a — X-ray performed during the reduction of the left SIJ by the developed method;b — after reduction the left SIJ and fixing it with a cannulated screw

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Copyright (c) 2021 Zadneprovskiy N.N., Ivanov P.A., Nevedrov A.V.

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