Z Orthop Unfall 2019; 157(01): 22-28
DOI: 10.1055/a-0621-9570
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Approach to the Quadrilateral Plate (EAQUAL): a New Endoscopic Approach for Plate Osteosynthesis of the Pelvic Ring and Acetabulum – a Cadaver Study

Article in several languages: English | deutsch
Alexander Trulson
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Markus Alexander Küper
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Inga Maria Trulson
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Christian Minarski
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Leonard Grünwald
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Bernhard Hirt
2   Institut für Klinische Anatomie und Zellanalytik, Eberhard-Karls-Universität Tübingen, Tübingen
,
Ulrich Stöckle
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
,
Fabian Stuby
1   Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik, Tübingen
› Author Affiliations
Further Information

Publication History

Publication Date:
14 June 2018 (online)

Abstract

Background Dislocated pelvic fractures which require surgical repair are usually operated on via open surgery. Approach-related morbidity is reported with a frequency of up to 30%. The aim of this anatomical study was to prove the feasibility of endoscopic visualisation of the relevant anatomical structures in pelvic surgery and to perform completely endoscopic plate osteosynthesis of the acetabulum with available standard laparoscopic instruments.

Method In four human cadavers, we established an endoscopic preparation of the complete pelvic ring, from the symphysis to the iliosacral joint, including the quadrilateral plate and the sciatic nerve, and performed endoscopic plate osteosynthesis along the iliopectineal line.

Results The endoscopic preparation of the complete pelvic ring and the quadrilateral plate was demonstrated step-by-step, followed by completely endoscopic plate osteosynthesis along the pelvic brim. Endoscopic, radiographic, and schematic pictures are used to illustrate the technique.

Conclusion The completely endoscopic preparation of the pelvic brim and the quadrilateral plate is feasible with available standard laparoscopic instruments. Moreover, plate osteosynthesis could be performed endoscopically. Further research on reduction techniques is necessary when planning to implement this technique into a clinical scenario.

 
  • References/Literatur

  • 1 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013; 44: 1733-1744
  • 2 Wagner D, Ossendorf C, Gruszka D. et al. Fragility fractures of the sacrum: how to identify and when to treat surgically?. Eur J Trauma Emerg Surg 2015; 41: 349-362
  • 3 Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury 2015; 46: 320-326
  • 4 Ma K, Luan F, Wang X. et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics 2013; 36: e1307-e1315
  • 5 Elmadag M, Guzel Y, Acar MA. et al. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res 2014; 100: 675-680
  • 6 Küper MA, Eisner F, Königsrainer A. et al. Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence. World J Gastroenterol 2014; 20: 4883-4891
  • 7 Chen K, Cao G, Chen B. et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality Nonrandomized Studies in the last 5 years. Int J Surg 2017; 39: 1-10
  • 8 Lacy AM, García-Valdecasas JC, Delgado S. et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359: 2224-2229
  • 9 Schwenk W, Böhm B, Müller JM. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc 1998; 12: 1131-1136
  • 10 Schäffler A, König B, Feinauer B. et al. [Effects of a pelvic ring injury on earning capacity]. Z Orthop Unfall 2017; 155: 67-71
  • 11 Mosheiff R, Khoury A, Weil Y. et al. First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma 2004; 18: 106-111
  • 12 Acklin YP, Zderic I, Grechenig S. et al. Are two retrograde 3.5 mm screws superior to one 7.3 mm screw for anterior pelvic ring fixation in bones with low bone mineral density?. Bone Joint Res 2017; 6: 8-13
  • 13 Stevenson AJ, Swartman B, Bucknill AT. Percutaneous internal fixation of pelvic fractures. Unfallchirurg 2017; 120 (Suppl. 01) S10-S18
  • 14 Ochs BG, Gonser C, Shiozawa T. et al. Computer-assisted periacetabular screw placement: comparison of different fluoroscopy-based navigation procedures with conventional technique. Injury 2010; 41: 1297-1305
  • 15 Gras F, Marintschev I, Wilharm A. et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries–a case series. BMC Musculoskelet Disord 2010; 11: 153
  • 16 Ismail HD, Djaja YP, Fiolin J. Minimally invasive plate osteosynthesis on anterior pelvic ring injury and anterior column acetabular fracture. J Clin Orthop Trauma 2017; 8: 232-240
  • 17 Keel MJ, Ecker TM, Cullmann JL. et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br 2012; 94: 405-411
  • 18 Küper MA, Trulson A, Trulson IM. et al. EASY (endoscopic approach to the symphysis): a new minimally invasive approach for the plate-osteosynthesis of the symphysis and the anterior pelvic ring – a cadaver study and first clinical results. Eur J Trauma Emerg Surg 2018; DOI: 10.1007/s00068-018-0928-5.
  • 19 Biere SS, van Berge Henegouwen MI, Maas KW. et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379: 1887-1892
  • 20 Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS 2013; 17: 188-193
  • 21 Fang C, Alabdulrahman H, Pape HC. Complications after percutaneous internal fixator for anterior pelvic ring injuries. Int Orthop 2017; 41: 1785-1790
  • 22 Rubel IF, Seligson D, Mudd L. et al. Endoscopy for anterior pelvis fixation. J Orthop Trauma 2002; 16: 507-514
  • 23 Zobrist R, Messmer P, Levin LS. et al. Endoscopic-assisted, minimally invasive anterior pelvic ring stabilization: a new technique and case report. J Orthop Trauma 2002; 16: 515-519
  • 24 Mauffrey C, Hake M, Kim FJ. Flexible 3D laparoscopic assisted reduction and percutaneous fixation of acetabular fractures: introduction to a new surgical option. Injury 2016; 47: 2203-2211