Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2025; 16(7): 107087
Published online Jul 18, 2025. doi: 10.5312/wjo.v16.i7.107087
Novel handheld pelvic alignment guide for hollow screw fixation in osteoporotic pelvic fragility fractures
Yuan Wang, Zhen-Yu Tan, Jie-Ming He, Yue-Xia Shu, Zhen Pan, De-Gang Zhu, Jia Wang
Yuan Wang, Jie-Ming He, Yue-Xia Shu, Zhen Pan, De-Gang Zhu, Jia Wang, Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
Yuan Wang, Yue-Xia Shu, Zhen Pan, Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
Zhen-Yu Tan, Department of Pathology, Tongji Hospital, Tongji University, Shanghai 200065, China
Co-corresponding authors: De-Gang Zhu and Jia Wang.
Author contributions: Wang Y and Wang J conceptualized the study and drafted the manuscript; Tan ZY and Shu YX collected the clinical data; Pan Z and He JM conducted statistical analyses; Wang Y, He JM, Zhu DG, and Wang J performed the surgeries and completed patient follow-up. All authors reviewed and approved the final version of the manuscript. We propose designating Wang J and Zhu DG as co-corresponding authors based on their respective and complementary contributions to this study. Wang J was responsible for the clinical conception, patient enrollment, surgical protocol design, and overall project coordination. Zhu DG contributed extensively to the biomechanical methodology, data interpretation, and manuscript revision. Given the multidisciplinary nature of this research, which involves both orthopedic clinical application and implant engineering optimization, having two corresponding authors ensures accurate representation and response across all domains. This designation enhances the manuscript’s academic integrity and facilitates efficient communication during the editorial and post-publication process.
Supported by Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, No. TRYJ2024 LC16; the National Natural Science Foundation of China, No. 82102577; and the Laboratory Open Fund of Key Technology and Materials in Minimally Invasive Spine Surgery, No. 2024JZWC-YBA05.
Institutional review board statement: The study protocol was approved by the institutional ethics committee of Tongren Hospital (Approval No. K2024-006-001).
Informed consent statement: All patients provided written informed consent prior to participation in the study.
Conflict-of-interest statement: The authors declare no competing interests for this article.
Data sharing statement: The original data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia Wang, Professor, Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China. wangjia2990@163.com
Received: March 16, 2025
Revised: April 12, 2025
Accepted: May 28, 2025
Published online: July 18, 2025
Processing time: 124 Days and 18 Hours
Abstract
BACKGROUND

Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment. The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.

AIM

To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide (HPAG) in combination with a 6.0 mm hollow screw, aiming to enhance the accuracy, efficiency, and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.

METHODS

The HPAG and 6.0 mm hollow screw were employed during surgical treatment. A 2.0-3.0 cm incision was made to expose the optimal screw entry point. Intraoperative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion. Clinical outcomes and fracture reduction quality were evaluated using Matta, visual analog scale, and Majeed scores during follow-ups. A representative case is presented to demonstrate the surgical procedure in detail.

RESULTS

No perioperative complications were observed. The mean operative time was 35.2 ± 6.97 minutes, with a screw insertion time of 7.25 ± 1.86 minutes, an average incision length of 2.8 ± 0.67 cm, and mean blood loss of 43.25 ± 15.64 mL. At one-year follow-up, seven patients achieved excellent Majeed scores and three achieved good scores.

CONCLUSION

The HPAG technique significantly shortens operative time, minimizes surgical trauma, and facilitates accurate screw placement. It presents a promising and efficient approach for managing fragility fractures of the pelvis, especially in osteoporotic patients.

Keywords: Pelvic fragility fractures; Anterior pelvic ring; Osteoporosis; Hollow screw; Minimally invasive

Core Tip: This technical report introduces a novel handheld pelvic alignment guide (HPAG) combined with 6.0 mm hollow screws, specifically designed for accurate and minimally invasive retrograde pubic ramus screw insertion in osteoporotic pelvic fragility fractures. The technique reduces operative time, incision size, and intraoperative fluoroscopy, minimizing surgical trauma. HPAG simplifies a technically demanding procedure, enables wider adoption, and demonstrates excellent clinical outcomes, highlighting its potential as a standard surgical approach in osteoporotic anterior pelvic ring injuries.