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Radiostereometric Analysis Allows Assessment of the Stability and Inducible Displacement of Pelvic Ring Disruptions during Healing: A Case Series

Andreas Ladurner, Stuart A Callary, Aniruddha Mitra, Mark Rickman, Dominic Thewlis & Lucian B Solomon

abstract There is currently no accurate data on fracture displacement during the rehabilitation of pelvic ring injuries. This study investigated the use of radiostereometric analysis (RSA) in assessing the stability of C1 pelvic ring injuries stabilised with a posterior plate and an anterior external fixator. Six patients, instructed to weight-bear as tolerated after surgery, were reviewed at 2, 4, 6, 12, 26, 52 and 104 weeks. The external fixators were removed at 6 weeks. Outcomes, including the Iowa Pelvic Score (IPS), and complications were recorded. Fracture stability was assessed using measurements on plain radiographs and RSA. All patients progressed to full weight-bearing without support within 6 weeks. At 104 weeks, the IPS was excellent in four patients, good in one patient and fair in one patient. Plain radiographs showed that all fractures were well reduced, and no loss of reduction occurred over time. By contrast, RSA measurements identified displacement in all cases. The maximum three-dimensional (3D) displacement at any time point in each patient ranged from 2 to 10 mm. Two patients with the largest displacement over time had the lowest IPS. RSA also demonstrated displacements above the currently defined normal threshold through the 'un-injured' sacroiliac joint in the same two patients, suggesting a subtle C2 injury, missed at initial assessment. This study demonstrates the limitations of plain radiographs in assessing pelvic fracture stability and displacement during healing, and the potential of RSA to monitor more accurately the effects of stabilisation and weight-bearing on fracture stability.
   
citation Ladurner A, Callary S A, Mitra A, Rickman M, Thewlis D, Solomon L B. Radiostereometric Analysis Allows Assessment of the Stability and Inducible Displacement of Pelvic Ring Disruptions during Healing: A Case Series. J Clin Med 2020; 9:.
   
type journal paper/review (English)
date of publishing 24-10-2020
journal title J Clin Med (9/11)
ISSN print 2077-0383
PubMed 33114372
DOI 10.3390/jcm9113411