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Objective To evaluate the clinical efficacy of the Rossum Robot in assisting full-process closed reduction and internal fixation for low-energy osteoporotic unstable pelvic fractures in elderly patients. Methods We performed a retrospective analysis of the clinical data of 37 patients with osteoporotic unstable pelvic fractures due to low-energy trauma, who underwent robotic reduction and internal fixation surgery between October 2023 and May 2024. Eighteen patients underwent Rossum Robot-assisted full-process closed reduction and internal fixation (RoRobot group), while 19 patients underwent percutaneous screw fixation with TiRobot assistance (TiRobot group). We compared the excellent and good rate of fracture reduction (EGR), the accuracy of screw placement (ASP), and the degree of fracture healing between the two groups. Efficacy indicators included changes in the Visual Analogue Scale (VAS) for pain and the Majeed score at preoperative, 1-week, 1-month, 3-month, and 6-month follow-ups. Statistical correlations were assessed using independent t-tests, chi-square tests, and non-parametric tests. Result The EGR in the RoRobot assistance group was significantly higher than that in the control group ( P  = 0.019). No significant difference was observed in fracture healing between the two groups post-surgery ( P  = 0.157). No significant difference was found in ASP between the RoRobot and TiRobot assistant groups ( P  = 0.619). No significant difference was observed in the preoperative VAS and Majeed scores between the two groups ( P  = 0.611, P  = 0.939). Both groups showed significant improvement in VAS scores post-surgery. One week and one month after surgery, the VAS score in the RoRobot assisted group was significantly lower than in the TiRobot assisted group ( P  = 0.000, P  = 0.001). Majeed scores significantly increased in both groups post-surgery, and during multiple follow-ups within six months, the RoRobot assisted group showed significantly higher Majeed scores than the TiRobot assisted group. Conclusion In elderly patients with osteoporotic unstable pelvic fractures resulting from low-energy injuries, Rossum robot-assisted pelvic fracture closed reduction and internal fixation surgery leads to less tissue damage, more effective fracture reduction, better postoperative pain relief, and faster recovery compared to TiRobot-assisted internal fixation surgery.

Background Iliosacral screw fixation is a popular method for the management of posterior pelvic ring fractures or dislocations, providing adequate biomechanical stability. Our aim in this study was to describe the use of a new patient-specific external template to guide the insertion of iliosacral screws and to evaluate the efficacy and safety of this technique compared with the conventional fluoroscopy-guided technique. Methods This was a retrospective study of patients with incomplete or complete posterior pelvic ring disruptions who required iliosacral screw fixation. For analysis, patients were divided into two groups: the external template group (37 screws in 22 patients) and the conventional group (28 screws in 18 patients). The operative time per screw, radiation exposure time and the rate of screw perforation (accuracy) were compared between groups. In the external template group, the difference between the actual and planned iliosacral screw position was also compared. Results In the conventional group, the average operative time per screw was 39.7 ± 10.6 min, with an average radiation exposure dose of 1904.0 ± 844.5 cGy/cm 2 , with 4 cases of screw perforation. In the external template group, the average operative time per screw was 17.9 ± 4.7 min, with an average radiation exposure dose of 742.8 ± 230.6 cGy/cm 2 and 1 case of screw perforation. In the template group, the mean deviation distance between the actual and planned screw position was 2.75 ± 1.0 mm at the tip, 1.83 ± 0.67 mm in the nerve root tunnel zone and 1.52 ± 0.48 mm at the entry point, with a mean deviation angle of 1.73 ± 0.80°. Conclusions The external template provides an accurate and safe navigation tool for percutaneous iliosacral screw insertion that could decrease the operative time and radiation exposure.

Open pelvic fractures are life-threatening injuries. Preperitoneal pelvic packing (PPP) has been suggested to be ineffective for hemorrhage control in open pelvic fractures. We hypothesize that PPP is effective at hemorrhage control in patients with open pelvic fractures and reduces mortality. Patients undergoing PPP from 2005 to 2015 were analyzed. Patients with open pelvic fractures were defined as direct communication of the bony injury with overlying soft tissue, vagina, or rectum. During the 10-year study, 126 patients underwent PPP; 14 (11%) sustained an open pelvic fracture. After PPP, 1 patient (7%) underwent angioembolization with a documented arterial blush. PPP controlled pelvic hemorrhage in all patients. Overall mortality rate was 7% with one death due to traumatic brain injury. PPP is effective for hemorrhage control in patients with open pelvic fractures. PPP should be used in a standard protocol for hemodynamically unstable patients with pelvic fractures regardless of associated perineal injuries.

Background Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. Methods We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients’ characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes. Results Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months. Conclusions Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.

Iliosacral screw osteosynthesis is a widely recognized technique for stabilizing unstable posterior pelvic ring injuries, offering notable advantages, including enhanced mechanical stability, minimal invasiveness, reduced blood loss, and lower infection rates. However, the procedure presents technical challenges due to the complex anatomy of the sacrum and the proximity of critical neurovascular structures. While conventional fluoroscopy remains the primary method for intraoperative guidance, precise preoperative planning using multiplanar reconstructions and three-dimensional volume rendering is crucial for ensuring accurate placement of iliosacral or transsacral screws. Particular attention must be given to the preoperative evaluation of both the iliosacral and transsacral corridors, as anatomical variations may restrict the available space for screw insertion. This review aims to highlight the essential aspects of sacroiliac osteosynthesis, with a focus on the critical role of thorough preoperative planning and its impact on achieving successful surgical outcomes.

Objectives . The purpose of this study was to compare the reduction effect and clinical outcomes of anterior subcutaneous internal fixation (INFIX) and steel plate-screw internal fixation in the treatment of anterior ring injury in Tile C pelvic fractures. Methods . In this retrospective study, the clinical outcomes of 46 patients treated using INFIX and 44 patients treated with steel plate-screw internal fixation were analyzed and compared. All patients underwent anterior and posterior fixation. The Matta imaging scoring system was used to evaluate the postoperative reduction accuracy; the Majeed scoring system was applied to obtain functional outcomes in clinical follow-up. All potential complications were identified and evaluated accordingly. Results Both groups of patients were followed up for a period of 13–36 months, with an average of 27 months. The procedure time and blood loss in the INFIX group were significantly lower than those in the plate group(t = − 2.327, P  = 0.023;t = − 4.053, P  = 0.000; there was no statistically significant difference in the Majeed score and Matta score between the two groups after surgery ( P  > 0.05). Conclusions . INFIX treatment for anterior ring injury in Tile C pelvic fractures can achieve good therapeutic effects. Compared to internal fixation with plates and screws, it has advantages such as shorter surgical time and less blood loss. INFIX may be more suitable for obese patients, young women of childbearing age, or patients with urinary system injuries.

Background Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture. Methods One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group ( n  = 65) and control group ( n  = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment. Results There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group ( p  < 0.01), i.e., 58.6 vs. 72.3 min and 29.3 vs. 37 min, respectively. Using the Matta radiological scoring systems, the reduction was scored excellent in 21/65 cases (32.3%) and good in 30/65 cases (46.2%) for the 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group, respectively. This suggests no significant difference between these two groups about the function outcomes. Conclusion Full reduction and proper fixation of the pelvic ring and reconstruction of anatomical morphology are of great significance to patients’ early functional exercise and for the reduction of long-term complications. This retrospective study has demonstrated the 3D printing technology as a potential approach for improving the diagnosis and treatment of pelvic fractures. Trial registration The study was retrospectively registered at the Chinese Clinical Trial Registry, number: ChiCTR-TRC-17012798, trial registration date: 26 Sept. 2017.

IntroductionClassification and management of osteoporotic pelvic ring injuries (OPRI) continue to pose a considerable challenge to orthopaedic traumatologists. The currently used fragility fractures of the pelvis (FFP) classification of OPRI has recently been shown to have significant weaknesses. The aim of this study therefore was to propose a new, simple, yet comprehensive alphanumeric classification (ANC) of OPRI and to assess its intra- and interobserver reliability. Furthermore, its potential advantages over the FFP classification are discussed.Materials and methodsOne hundred consecutive CT scans from patients with OPRI were evaluated by three orthopaedic traumatologists with varying levels of experience and one musculoskeletal radiologist. Intra- and interobserver reliability of the proposed classification system was assessed using weighted kappa (κ) statistics and percentage agreement. In addition, the Fleiss’ kappa statistic was computed to assess interobserver agreement among all four raters.ResultsOverall intraobserver reliability of the proposed ANC was substantial [κ ranging from 0.71 to 0.80; percentage agreement: 70% (range, 67–76%)]. Overall interobserver reliability between pairs of raters was substantial as well [κ ranging from 0.61 to 0.68; percentage agreement: 58% (range, 53–61%)]. For ANC types, groups and subgroups, intra- and interobserver reliability were substantial to almost perfect. Interobserver agreement among all four raters was moderate to substantial, with Fleiss’ kappa values of 0.48, 0.69, 0.71 and 0.52 for ANC overall, types, groups and subgroups, respectively.ConclusionThe proposed ANC of OPRI demonstrated overall reliability comparable to that of the FFP classification. The ANC, however, is simple, more comprehensive, and consistently relates to injury severity.

The success of robot‐assisted pelvic fracture reduction surgery heavily relies on the accuracy of 3D/3D feature‐based registration. This process involves extracting anatomical feature points from pre‐operative 3D images which can be challenging because of the complex and variable structure of the pelvis. PointMLP_RegNet, a modified PointMLP, was introduced to address this issue. It retains the feature extraction module of PointMLP but replaces the classification layer with a regression layer to predict the coordinates of feature points instead of conducting regular classification. A flowchart for an automatic feature points extraction method was presented, and a series of experiments was conducted on a clinical pelvic dataset to confirm the accuracy and effectiveness of the method. PointMLP_RegNet extracted feature points more accurately, with 8 out of 10 points showing less than 4 mm errors and the remaining two less than 5 mm. Compared to PointNet++ and PointNet, it exhibited higher accuracy, robustness and space efficiency. The proposed method will improve the accuracy of anatomical feature points extraction, enhance intra‐operative registration precision and facilitate the widespread clinical application of robot‐assisted pelvic fracture reduction.

Background An option for emergency control of pelvic hemorrhage is Extra-peritoneal Pelvic Packing (EPP), which addresses the retroperitoneal source of exsanguination in pelvic fractures. The aim of this study was to demonstrate the efficacy of early EPP in reducing mortality due to hemorrhage from pelvic fractures, and to evaluate the impact of packing on transfusion requirements within the first 24 h and ICU length of stay (ICU-LOS). All data pertaining trauma patients admitted from October 2002 and December 2103 with hemodynamic instability and pelvic fractures were selected from the Hospital Trauma Registry. Patients with severe brain injury and bleeding from extra-pelvic sources were excluded. Patient population was divided into two groups: EPP group, including patients admitted from 2009 to 2013, with EPP as part of the treatment algorithm, and NO-EPP group, from 2002 to 2008, without EPP as atherapeutic option. Descriptive statistical analysis was performed on allpatients. Twenty-five patients of each group with similar features were matched using Propensity Score Analysis (PSA). Results Six hundred eighty out of 4659 major trauma (14.6 %) presented a pelvic fracture. In 78 hemodynamically unstable patients (30 in EPP group,48 in NO-EPP group) the major source of bleeding was the pelvis. Among patients selected by PSA early mortality was significantly reduced in EPP group (20 vs 52 %, p  = .03) compared to NO-EPP, notwithstanding similar hemodynamic impairment. No difference was observed in transfusion requirements and ICU-LOS. Conclusions The EPP is a safe and quick procedure, able to improve hemodynamic stabilization and to reduce acute mortality due to hemorrhage in patients with pelvic fracture, in combination with optimized transfusion protocol. EPP may be useful as a bridge for time-consuming procedures, such as angio-embolization.