[The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture].

Objective: To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.

Methods: The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference ( >0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.

Results: The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A ( <0.05); there was no significant difference in screw length between the two groups ( =0.793, =0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups ( =-1.068, =0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant ( =2.104, =0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation ( >0.05).

Conclusion: Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.