Biniamtadesse¹, Ararso Gonfa¹, Teshome Eshetu¹ and Habtewold Mulat²*

¹Orthopedic and Trauma Surgery Residents at St. Paul Millennium Medical College, Aabet Hospital, Addis Ababa, Ethiopia
²Assistant Professor, Orthopedic and trauma surgeon at St. Paul Millennium Medical Collage, Aabet Hospital, Addis Ababa, Ethiopia and Member of College of Surgeons in Central, East and South Africa

*Corresponding Author: Habtewold Mulat, Assistant Professor, Orthopedic and trauma surgeon at St. Paul Millennium Medical Collage, Aabet Hospital, Addis Ababa, Ethiopia and Member of College of Surgeons in Central, East and South Africa.

Received: November 02, 2021; Published: April 30, 2025

Abstract

Aim: Aim of this case report is to evaluate the efficacy of percutaneous screw fixation technique in displaced low anterior column acetabular fractures ( superior pubic Rami fractures) – A novel and indigenous technique.

Objective:

• To assess clinical outcome of the patient ( Decrease in pain and early rehabilitation in post period)
• To assess radiological outcome of the patient ( X- ray and CT scan in post op period)

Method

• In this prospective case report, we included 2 patients with displaced superior pubic fractures with severe co morbities.
• The patients were operated in February 2025 at Yashoda Superspeciality Hospital, Nehru Nagar and Vasundhra, Ghaziabad.

Results

• Of the 2 patients operated both became pain free immediately in the post op period, early mobilisation (bed side sitting and wheel chair mobilisation) was done very next day.
• Radiologically post op x-rays ,CT scan was done to check for adequate reduction of the fracture, screw backout, loosening and mal-positioning.

Conclusion

• This novel indigenous technique gives us very good result in polytrauma patients, where open surgery can’t be performed, because of the poor general condition of the patients.
• With percutaneous fixation technique in displaced low anterior column fractures, the patient becomes pain free very next morning, there is no requirement of blood transfusion, less chances of infection, short hospital stay with very fast recovery.
• Limitation of this case report- Number of patients included are very few and follow up is there for 1 month only. So we need a bigger study with a long follow up to make this procedure standardised world wide.
• Inclusion criteria
• Polytrauma patients with liver lacerations, renal injury, vascular injury, where open reduction is contraindicated because of poor general condition.
• Communited and displaced ( unilateral or bilateral) superior pubic Rami fractures
• Old age
• severe osteoporosis.

Exclusion criteria

• Central fracture dislocation of acetabulum.
• Fracture involving quadrilateral plate.
• Pubic symphysis diasthesis.

 Keywords: Indigenous Technique; Pubic Rami Fractures; Low Anterior; Percutaneous Screws

References

1. A Laird and JF Keating. “Acetabular fractures. A 16-year prospective epidemiological study”. Journal of Bone and Joint Surgery7 (2005): 969-973.
2. BG Ochs., et al. “Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU)”. Injury8 (2010): 839-851.
3. US Renal Data System. “USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End Stage Renal Disease in the United States”. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md,USA (2011).
4. G Benoit. “Surgical technics of kidney transplantation”. Progresen Urologie4 (1996): 594-604.
5. R Judet., et al. “Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report”. The Journal of Bone and Joint Surgery 46 (1964): 1615-1646.
6. DC Mears. “Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone”. The Journal of the American Academy of Orthopaedic Surgeons2 (1999): 128-141.
7. MLC Routt Jr. “Iliosacral screw fixation: early complications of the percutaneous technique”. Journal of Orthopaedic Trauma8 (1997): 584-589.
8. MLC Routt., et al. “A rational approach to pelvic trauma: resuscitation and early definitive stabilization”. Clinical Orthopaedics and Related Research 318 (1995): 61-74.
9. S Tseng and P Tornetta III. “Percutaneous management of Morel-Lavallee lesions”. Journal of Bone and Joint Surgery1 (2006): 92-96.
10. ML Routt., et al. “The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique”. Journal of Orthopaedic Trauma1 (1995): 35-44.
11. AJ Starr., et al. “Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum”. Injury1 (2001): 45-50.
12. PV Giannoudis., et al. “Percutaneous fixation of the pelvic ring”. Journal of Bone and Joint Surgery2 (2007): 145-154.
13. AC Crowl and DM Kahler. “Closed reduction and percutaneous fixation of anterior column acetabular fractures”. Computer Aided Surgery3 (2002): 169-178.
14. N Kazemi and MT Archdeacon. “Immediate full weightbearing after percutaneous fixation of anterior column acetabulum fractures”. Journal of Orthopaedic Trauma2 (2012): 73-79.
15. YC Lin., et al. “Percutaneous antegrade screwing for anterior column fracture of acetabulum with fluoroscopic-based computerized navigation”. Archives of Orthopaedic and Trauma Surgery2 (2008): 223-226.

Citation

Citation: Rahul Kakran., et al. “A Novel Latest and Indigenous Technique Developed for Fixing Displaced Superior Pubic Rami Fractures (Low Anterior Column Acetabulum Fracture) using Percutaneous Screws: A Case Report".Acta Scientific Orthopaedics 8.5 (2025): 14-18.

Copyright

Copyright: © 2025 Rahul Kakran., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.