Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
Department of Orthopaedic Surgery, Ajou University School of Medicine, 164, World Cupro, Yeongtong-gu, Suwon-si, 16499, Gyeonggi-do, Republic of Korea.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3303-3311. doi: 10.1007/s00402-024-05463-7. Epub 2024 Aug 6.
Superior and inferior ramus fractures, termed straddle fractures, are high-energy fractures often accompanied by unstable pelvic ring injuries. However, consensus is lacking regarding indications for surgical treatment or fixation methods. We aimed to compare clinical and radiological outcomes of unilateral ramus fixation (URF) and bilateral ramus fixation (BRF) for straddle fractures with unilateral posterior pelvic ring injuries.
We enrolled 118 patients (73 males, 45 females; mean age, 47 years) diagnosed with straddle fractures between March 2015 and December 2021 with > 1 year of follow-up. Patients were divided into URF (n = 60) and BRF (n = 58) groups based on the anterior pelvic ring fixation method. Preoperative factors including body mass index, diabetes, smoking, injury mechanism, injury severity score, American Society of Anesthesiologists classification system, Tile classification, and Young and Burgess classification were compared. Intraoperative blood loss, operation time, postoperative bone union rate, complications, and the need for additional surgeries were analyzed.
There were no statistically significant preoperative differences between the two groups. However, the URF group showed a significantly lower mean operative time and blood transfusion requirement (63 min and 2 units, respectively) than the BRF group (104 min and 3 units, respectively) (both p < 0.001). Postoperatively, bone union was achieved in 57 (95.0%) and 56 (96.6%) patients in the URF and BRF groups, respectively. Complications occurred in 17 (28.3%) and 14 (24.1%) patients in the URF and BRF groups, respectively, with additional surgeries needed in 3 (5.0%) patients in the URF group and 2 (3.4%) patients in the BRF group.
Unilateral anterior fixation can provide sufficient stability and clinical effectiveness in the surgical treatment of straddle fractures in areas with posterior pelvic ring injuries. Compared with bilateral anterior fixation, unilateral fixation significantly reduces operation time and blood loss, making it a viable fixation method for straddle fractures.
上下支骨折，又称跨骑骨折，是一种高能量骨折，常伴有不稳定的骨盆环损伤。然而，对于手术治疗的适应证和固定方法尚缺乏共识。我们旨在比较单侧支固定（URF）和双侧支固定（BRF）治疗单侧后骨盆环损伤的跨骑骨折的临床和影像学结果。
我们招募了 118 名（73 名男性，45 名女性；平均年龄 47 岁）被诊断为跨骑骨折的患者，这些患者于 2015 年 3 月至 2021 年 12 月接受了随访> 1 年。根据前骨盆环固定方法，患者被分为 URF（n = 60）和 BRF（n = 58）组。比较了术前因素，包括体重指数、糖尿病、吸烟、损伤机制、损伤严重程度评分、美国麻醉师协会分类系统、Tile 分类和 Young 和 Burgess 分类。分析了术中失血量、手术时间、术后骨愈合率、并发症和是否需要额外手术。
两组患者术前无统计学差异。然而，URF 组的平均手术时间和输血需求明显低于 BRF 组（分别为 63 分钟和 2 单位，104 分钟和 3 单位；均 P < 0.001）。术后，URF 组和 BRF 组分别有 57 例（95.0%）和 56 例（96.6%）患者实现了骨愈合。URF 组和 BRF 组分别有 17 例（28.3%）和 14 例（24.1%）患者发生并发症，URF 组有 3 例（5.0%）和 BRF 组有 2 例（3.4%）患者需要额外手术。
单侧前固定在治疗后骨盆环损伤的跨骑骨折中可以提供足够的稳定性和临床效果。与双侧前固定相比，单侧固定显著减少了手术时间和失血量，是治疗跨骑骨折的一种可行的固定方法。
