Two-step method combined with pelvic unlocking reduction frame for minimally invasive treatment of Tile C3 pelvic fractures

Li Yifei; Xiang Penghui; Wang Zhen; He Li; Gu Meiqi; Xu Zhe; Li Tianyu; Zhang Rui; Yin Enzhi; Bai Xiangjun; Yi Chengla

doi:10.3969/j.issn.1009-4237.2025.08.004

Abstract：Objective To investigate the surgical methods and clinical efficacy of a two-step method com-bined with pelvic unlocking reduction frame for minimally invasive treatment of Tile C3 pelvic fractures.Methods The retrospective data of 26 patients with Tile C3 pelvic fractures treated with the two-step method were collected from our trauma center from Jul.2017 to Jul.2023.Among the 26 cases,there were 11 males and 15 females aged 18-57(mean 37.7)years,with the time from injury to surgery being 4-27(mean 10.2)d.There were 6 cases of C3.1,4 cases of C3.2,and 16 cases of C3.3.All patients were treated with the two-step method for closed reduction and minimal internal fixation.The first step involves manual traction of the relatively stable or minor displaced side of the pelvis for initial reduction,temporarily fixed with a 7.3 mm hollow screw or fixation pin as a reference.The significantly vertically displaced side is reduced by using the reduction frame and stabilized with sacroiliac screws.In the second step,using the reduced and stabilized side as a reference,the temporarily fixed side is readjusted for optimal reduction to ultimately complete the bilateral pelvic fixation.The anterior ring is fixed according to the injury condition using Infix,anterior column screws,or pubic symphysis plates.Surgical time,blood loss,fluoroscopy re-sults,and postoperative complications were recorded.Follow-up included fracture healing time,reduction quality e-valuated using the Matta criteria,and clinical efficacy assessed by Majeed scoring.Results All the 26 cases expe-rienced successful surgeries,with intraoperative fluoroscopy results showing good screw placement.The average sur-gical time was 90-270(mean 161.2)min,and the average intraoperative blood loss was 30-150(mean 76.1)mL.Matta reduction criteria revealed 16 excellent,7 good,and 3 acceptable results,with a satisfactory rate of 88.5％.Three cases experienced symptoms of lateral femoral cutaneous nerve injury,whose symptoms were relieved after re-moval of the Infix;one case with Infix fixation developed superficial subcutaneous infection,which was improved af-ter debridement;no other surgical-related complications occurred.Follow-up for 1-3 years showed that all fractures healed,with a healing time of 3-5(mean 3.7)months,and no complications such as loss of reduction or failure of internal fixation.The Majeed clinical efficacy scores showed 18 excellent and 8 good results,yielding a total satisfac-tory rate of 100％.Conclusion The two-step pelvic unlocking reduction frame technique can effectively achieve closed reduction of Tile C3 pelvic fractures,characterized by its simplicity,minimal damage,and good outcomes.It is worthy of clinical promotion and application.