The use of the transpedicular spinal system and titanium mesh cage in surgical treatment of post‑traumatic pelvic deformity: a case study and a brief literature review

Abstract

Introduction The problem of treating chronic unstable pelvic injuries is characterized by the complexity of delayed one-step or staged reduction, difficulties in choosing the technology and treatment options, complexity of selecting criteria for evaluating planning along with the effectiveness of treatment. The use of spinal systems to perform reduction manipulations and fixation of the pelvis is described in few clinical observations. Therefore, the assessment of the effectiveness of the sequential use of various fixation systems in one patient was regarded by the authors as a rare opportunity and determined the purpose of the study. Purpose Demonstration of the possibilities of various osteosynthesis methods and their combination in reconstructive surgery of the pelvis in a case of its severe chronic injury. Materials and methods We present a clinical case and a brief analysis of the literature. This is a case of a patient with posttraumatic pelvic deformity and imbalance syndrome as a leading component of pelvic ring deformity. The effectiveness of reconstruction options, including those with the use of spinal systems, was analyzed. The treatment was assessed with radiological study methods (X-ray and CT) with balance evaluation on a digital platform and functional scores for the quality of life. Results Correction of frontal deformity of the pelvis was achieved with compensation for a relative shortening of the left lower extremity, restoration of the center of rotation of the hip joints, and relief of pain in the lumbar region. The functional state according to the Majeed score system and clear radiological signs of stabilization of the pelvic ring while maintaining the position of the acetabulum in the frontal plane prove the effectiveness of hybrid osteosynthesis with the use of spinal fixation systems. Conclusion The leading syndromic complexes are instability with clinical manifestations of non-union and pain along with an imbalance syndrome, manifested by a gross deformation of the pelvic ring. Syndromic evaluation determines the tactics of surgical treatment while a detailed planning of the sequence of intervention, choice of the level of osteotomy, combination of osteosynthesis options using spinal fixation systems provide the solution of reconstructive pelvic surgery tasks in one session.