Endoscopic-assisted anterior pelvic ring osteosynthesis for pelvic ring injuries: a technical report

In the surgical treatment of pelvic ring injuries (PRIs), there is an increasing adoption of minimally invasive techniques to improve surgical outcomes. Since the introduction of endoscopic-assisted osteosynthesis for PRIs in 2019, various surgical challenges have been identified. To improve surgical and clinical outcomes, we modified the existing procedures and aimed to present the surgical outcomes of patients with pelvic fractures who underwent endoscopic-assisted surgery.

We conducted a retrospective analysis of patients with PRIs treated with endoscopic technique over a 15-month period. All patients were diagnosed with diastatic symphysis, superior pubic ramus fracture, or both. The postoperative radiological and functional outcomes were assessed and reported. Details of the preoperative planning and surgical procedures were reviewed.

Thirteen patients with PRIs were enrolled: 10 patients for diastatic pubic symphysis (three of whom received superior ramus screw fixation) and three for isolated superior pubic ramus fractures. All surgeries were completed with endoscopic assistance, without the need for conversion to open surgery. The average surgical duration was 204.1 min, the endoscopy time was 103.7 min, and the volume of blood loss was 185.0 ml. Excellent reduction was achieved in all patients according to the Matta/Tornetta criteria and in nine patients according to the Lefaivre criteria. The mean Majeed scores were 71 and 82 and the mean Merle d'Aubigné scores 11 and 15 at 3 and 6 months postoperatively, respectively.

Endoscopic-assisted pelvic surgery is a safe and effective treatment alternative for PRIs, particularly when focusing on the anterior pelvic ring. The advantages of this approach, including small incisions and preservation of abdominal and pelvic floor muscle integrity, contribute to improved patient recovery. Future research should focus on comparative studies of this technique with other minimally invasive techniques and open surgery.