Yanagisawa Yohei, Matsumoto Yukei, Hoshino Tetsuya, Inoue Yoshiaki, Yamazaki Masashi
Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan; Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
Int J Surg Case Rep. 2020;71:230-234. doi: 10.1016/j.ijscr.2020.04.093. Epub 2020 May 12.
There are no universally accepted treatment strategies for fragility fractures of the pelvis (FFPs). The incidence of delayed union or non-union of Type IIIa FFP is still unknown.
We describe a case of delayed union of a Type IIIa FFP. A 96-year-old female patient who lives independently accidentally fell when exiting a car. The diagnosis of Type IIIa FFP with displaced left ilium and left pubic rami fracture. Surgical repair was performed using an anterior intrapelvic approach with constructs made using two reconstruction contoured plates to bridge the medial edge and middle part of the fracture. This case was revealed delayed union. The periodic CT examinations were performed to determine the progress of bone union. The patient returned to most social activities including living independently and the Modified Majeed score was 94 at 12 months post-operation.
For the case of TypeⅢa FFP, soft tissue is spread over a wide area. When the fracture site of ilium was exposed, the cortical bone was found to be thin with poor blood flow. There is a possibility that the blood flow was hindered by subperiosteal elevation of the iliacus muscle from the internal iliac fossa in this case.
Non-union of the iliac wings is relatively rare following high-energy pelvic ring fractures. The incidence of delayed union or non-union of Type IIIa FFP remains unknown; therefore, careful follow-up of patients who undergo treatment is necessary to reduce the risk of delayed union.
骨盆脆性骨折（FFP）尚无普遍接受的治疗策略。IIIa型FFP延迟愈合或不愈合的发生率仍不清楚。
我们描述一例IIIa型FFP延迟愈合的病例。一名96岁独立生活的女性患者下车时意外摔倒。诊断为IIIa型FFP，伴有左侧髂骨和左侧耻骨支骨折移位。采用骨盆前路入路，使用两块重建塑形钢板构建内固定，以桥接骨折的内侧边缘和中部，进行手术修复。该病例出现延迟愈合。定期进行CT检查以确定骨愈合进展。患者恢复了包括独立生活在内的大部分社交活动，术后12个月改良马吉德评分为94分。
对于IIIa型FFP病例，软组织广泛分布。暴露髂骨骨折部位时，发现皮质骨薄且血流差。在本病例中，髂腰肌从髂窝骨膜下抬高可能阻碍了血流。
高能骨盆环骨折后髂骨翼不愈合相对少见。IIIa型FFP延迟愈合或不愈合的发生率仍不清楚；因此，对接受治疗的患者进行仔细随访对于降低延迟愈合风险是必要的。
