Pu-Lock - Nikita's Nail

Nikita's Nail
Pu-Lock™
Interlocking intramedullary nailing for pubic rami fractures

Interlocking intramedullary nailing for pubic rami fractures
‣Nikita's Nail (Pu-Lock™)
‣ the mean duration of osteosynthesis - 37.6 ± 17.3
minutes
‣ the mean intraoperative blood loss - 8.6 ± 3.2 mL.
‣ sufficient biomechanical stability, allowing full
weight bearing on the affected limb immediately
after the surgery.
‣ do not increase the risk of inflammatory
complications in patients after colostomy,
cystostomy and abdominal draining

THE URGENCY OF THE PROBLEM
The annual rate of pubic rami fractures is 699 206

‣ The overall incidence is 6.9/100,000/year in the total population and 25.6/100,000/year in individuals aged over 60 years.
https://www.ncbi.nlm.nih.gov/pubmed/11764428
‣ Epidemiologic analysis of pelvic ring fractures in the United States. Between 1990 and 2007, the population-adjusted incidence of
pelvic ring fractures increased from 27.24 to 34.30 per 100 000 capita.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748159/
‣ Pelvic fractures in the Netherlands. Annual incidence of pelvic fractures in older versus younger population was 57.9 versus 6.4 per
100,000 persons.
https://www.ncbi.nlm.nih.gov/pubmed/28993913
‣ Epidemiology of Pelvic Fractures in Germany. The purpose of this study was to estimate incidence rates of pelvic fractures in the
German population aged 60 years or older, based on outpatient and inpatient data. Age and sex-specific incidence rates of first
fractures between 2008 and 2011 were calculated. The total number of patients with a first pelvic fracture corresponded to 8,041 and
during the study period 5,978 insured persons needed inpatient treatment.
‣ Epidemiology of Hospitalized Traumatic Pelvic Fractures and Their Combined Injuries in Taiwan. During 2000–2011, the hospitalized
incidence of pelvic fractures in Taiwan ranged from 17.17 to 19.42 per 100,000, and an increasing trend with age was observed.

Pelvic fractures are still a challenge to trauma surgeons because they are often associated with life-
threatening hemorrhage, deformity, and associated internal injuries. The success of treatment depends on
the reliable fixation of the pelvic ring fractures.
20-40 years old young working people are most suffer due to high-energy trauma. The reconstruction of
the anatomy of this area leads to normal urination recovery, restoration of fertility in women and erectile
function in men and reduce the number of people with disabilities.
In elderly patients, isolated pubic bone fractures are more common. These fractures are usually low-energy
injuries; however, they are often accompanied by severe pain, loss of weight bearing, and severe mobility
impairment. Moreover, conservative treatment with a long-term bed rest in these patients is often
associated with hypostatic pneumonia, pressure sores, and thromboembolic complications.
Pu-Lock™

We believe that surgical fixation of anterior pelvic ring
fractures plays a crucial role in the stability of the
pelvic ring. This is supported by several studies which
demonstrated that reliable stabilization of the anterior
pelvic ring significantly increases the mechanical
stiffness of the entire pelvic ring in patients with fixed
posterior pelvic ring fractures, which in turn helps to
reduce pain, allows earlier patient activation, and
prevents complications associated with prolonged bed
rest.
However, currently applied techniques of anterior
pelvic ring fixation have some significant
disadvantages. Pelvic external fixation system devices
do not provide proper reduction and sufficient stability
of bone fragments, may cause inflammation of the soft
tissues around the Schanz screws, and may also be
associated with discomfort and inconvenience during
diagnostic and therapeutic procedures. The use of
bone plates requires prolonged surgical approaches
and is associated with high risk of a major vessel
injury and infectious complications in the
postoperative period.

The minimally invasive methods of screw
osteosynthesis are associated with high risk of implant
migration and secondary displacement in addition to
the complexity of the surgical procedure.
Consequently, most clinicians often tend to avoid the
risks of surgical anterior pelvic ring fixation and apply
conservative treatment with long-term bed rest
instead.

To address the challenge we developed our novel, minimally invasive surgical
technique for anterior pelvic ring fractures treatment by intramedullary interlocking
nails.

THE ADVANTAGES OF THIS TECHNIQUE
‣The proposed technique of osteosynthesis for pubic rami
fractures is a minimally invasive procedure that is associated
with minimum blood loss and low risk of inflammation in the
postoperative period.
‣Treatment of pubic rami fractures with this technique is
similar to that in conventional techniques, and rapid
achievement of good functional results could be expected.
Fixation with this technique is characterized by sufficient
biomechanical stability, allowing full weight bearing on the
affected limb immediately after the surgery.
‣Using an interlocking nail, retrograde osteosynthesis of pubic
rami fractures in all Nakatani zones with one incision and
without the risk of damage to the hip joint is possible.
‣Moreover, the novel surgical technique could be used in
patients with anterior abdominal wall wounds.
‣Interlocking nailing for pubic rami fractures is a fixation
method that does not require mandatory removal of the
fixator after confirmation of union.

‣ We could endlessly write about the advantages of the technique, but the most important thing is a
feedback directly from the surgeons.
Miguel Oransky (Italy)
https://www.facebook.com/YaroslavBeryozkin/posts/623966634702135
Reiner Schnettler (Germany)
Marco Altamirano (Mexico)
https://www.facebook.com/PelvicFractures/posts/2341681765865752
Bachir Zerrouki (France)
https://www.facebook.com/PelvicFractures/posts/2158422644191666
Abdallah Attia (Egypt)
https://www.facebook.com/watch/?v=184200842495045
Alberto Garcia Abad (Spain)
https://www.facebook.com/groups/DOCTIVE/permalink/2517893941612081/
Andreas A. Kurth (Germany)
Yuan Ta Li (Taiwan)

‣ We could endlessly write about the advantages of the technique, but the most important thing is a
feedback directly from the surgeons.
Hoàng Khánh’ (Vietnam)
Tarek Ibrahim (Saudi Arabia)
Malek Abualnadi (Jordan)
Martin Alett Oliva (Mexico)
Ravi Shankar Kirubanandan (India)
Livan Meneses-Turino (South Africa)
Khaled Jabr (Saudi German Hospital Group)
https://www.facebook.com/pg/PelvicFractures/photos/?tab=album&album_id=19644606635878
66

CLINICAL CASES
Case report 1. Intramedullary nailing of a Nakatani
zone I pubic ramus fracture
A female patient, 83 years old. She had a ground-level fall on
the right side.
Admission diagnosis: isolated unstable pelvic fracture
AO/OTA 61B1.1a (right Nakatani I), fracture of the right
lateral part of sacrum AO/OTA 54B2.
Concomitant diseases: an organic psychotic disorder caused
by somatic diseases and/or brain dysfunction of mixed origin
with affective fluctuations and signs of severe cognitive
disorder.
The patient complained of pain and crepitus in the pubic
symphysis on turning in the bed, loss of the body weight
bearing ability, and frequent urination.

CLINICAL CASES
Closed internal fixation of the right pubic bone with a Nikita's
Nail(Pu-Lock™) and percutaneous sacroiliac screw fixation in
the S1 segment with a 6.5 mm cannulated screw were
performed on day 2 after the injury.
A link to the video rendered from a series of intraoperative
radiographs from an image intensifier:
https://youtu.be/s-aH6OubENM

CLINICAL CASES
On day 2 after surgery, the patient was encouraged to sit and bear full weight on both
lower limbs using a walker and therapeutic exercise.

CLINICAL CASES
zone II pubic ramus fracture
A 19-year old female patient. She sustained injuries in a road
traffic accident (a motorbike passenger). First aid was
provided in another healthcare facility. She was transferred
to our hospital on day 7.
Admission diagnosis: polytrauma (ISS 12): closed chest injury,
left hydrothorax, pelvic fracture AO/OTA 61A2.3 (right and
left Nakatani II), left ankle contusion.
Chief complaint: pain in the symphysis at rest and on
movements, loss of the body weight bearing ability.

CLINICAL CASES
On day 3 after admission, closed fixation of both pubic bones
with Nikita's Nail(Pu-Lock™) was performed. The estimated
blood loss was minimal. Duration of surgery 60 minutes.
https://youtu.be/8va_R0srjEY
Surgical access area on day 8

CLINICAL CASES
The postoperative period was clear. The pain was relieved.
On day 2 after surgery, the patient was encouraged to sit and bear full weight on both
lower limbs without support and therapeutic exercise.
Photos demonstrating the
ability of the patient to
bear the vertical load on
day 8 post-surgery.

CLINICAL CASES
zone III pubic ramus fracture
A male patient, 64 years of age. He sustained a fall from the
roof of a house (~ 7 meters high). First aid was provided in
another healthcare facility. He was transferred to our
hospital on day 4.
Admission diagnosis: polytrauma (ISS 29): closed chest injury,
right-sided 2–12 rib fracture, left-sided 6–7 rib fracture, right
pneumothorax, bilateral hydrothorax. L1–L4 transverse
process fracture. Displaced fracture of the right pubic bone
and ischium, posterior fracture of the right ilium (crescent
fracture), non-displaced fracture of the left ilium, right
sacroiliac joint disruption. Pelvic fracture AO/OTA 61B3.3b
(right Nakatani III).
Concomitant diseases: chronic kidney failure
(decompensation), type 2 diabetes, grade 3 obesity.

CLINICAL CASES
On admission, a pelvic external fixator (PEF) was applied in
order to stabilize the unstable pelvic ring fracture. Owing to
excess abdominal fat, a subcristal PEF was applied.
While in ICU, the patient was ventilated, received
hemodialysis sessions and resuscitation therapy.

CLINICAL CASES
After stabilization of the patient on day 10, minimally
invasive sacroiliac screw fixation with a cannulated screw on
the right side and fixation of the pubic fracture with a Nikita's
Nail(Pu-Lock™) were performed. The estimated blood loss
was minimal (less than 10 mL). Duration of surgery 60
minutes.
This strategy enabled the patient to start rehabilitation
immediately right in the ICU with active movements in lower
limbs and turns to the side and on the stomach.
A link to the video showing therapeutic exercises:
https://youtu.be/ogr2fx2Lhzs

CLINICAL CASES
Pelvic radiograph 6 months after surgery. Functional outcome 6 months after surgery.

CLINICAL CASES
Case report 4. Closed reduction using PEF
A 46-year-old female patient. She sustained a fall on the back
from a staircase ~ 4.5 meters high.
Admission diagnosis: multiple injuries: rotationally unstable
pelvic fracture AO/OTA 61B2.3b (right Nakatani II, left non-
displaced Nakatani III), disruption of the right sacroiliac joint
(SIJ).
Chief complaint: severe pain, abnormal mobility of the right
part of the pelvis on turns, and loss of the body weight
bearing ability.
On admission, the pelvic ring was stabilized with a
supraacetabular PEF.

CLINICAL CASES
After stabilization of the patient on day 8, closed internal
fixation of the right pubic bone with a Nikita's Nail(Pu-Lock™)
and percutaneous sacroiliac screw fixation in the right S1
segment with a 6.5 mm cannulated screw were performed.
A link to the video showing closed reduction of the anterior
pelvic arch with PEF and subsequent internal fixation:
https://youtu.be/-PesVBy5ISA

CLINICAL CASES
A photo demonstrating the patient’s ability to sit in the bed and
stand with a full load on the lower extremities on day 2 after
surgery.

CLINICAL CASES
An excellent functional outcome (Majeed score 80) 12 months after surgery. Pubic bone union was diagnosed. The patient
reported no pain and resumed an active life.

CLINICAL CASES
Case report 5. Closed reduction using a nail
A 60-year-old female patient. She sustained injuries in a road
traffic accident (was hit by a car).
Admission diagnosis: polytrauma (ISS 32) including unstable
pelvic fracture AO/OTA 61C1.3be (right Nakatani I and III, left
Nakatani II), 54B3 (right Denis II).
Chief complaint: severe pain in the pelvis on turns, crepitus
in the symphysis, and loss of the body weight bearing ability.
Significant mobility of the pelvis was noted on lateral
compression.
A link to the video showing pelvic instability on the
provocative test preoperatively.
https://youtu.be/aLikYvNIZPA

CLINICAL CASES
On admission, the pelvic ring was stabilized with PEF (a
rectangular frame with 4 Schanz screws). After stabilization
of the patient on day 18, PEF rods were disassembled and
two Schanz screws were removed. Two remaining
supraacetabular screws were used as levers to achieve closed
reduction of the pelvic ring fractures.
After the frame was disassembled, closed fixation of both
pubic bones with Pu-Lock™ nails and right closed sacroiliac
screw fixation in the S1 segment using a 6.5 mm cannulated
screw with a washer were performed.
The fixation was stable and the patient was encouraged to
bear full weight on the left lower limb and partial weight
(50%) on the right lower limb, to sit and turn on the side.
A link to the video showing the provocative test after
surgery:
https://youtu.be/2Ocn9dlzsC8
The trajectory of the nail within
the right pubic bone ends is
marked in yellow.

CLINICAL CASES
Case report 6. Closed reduction using a one-tooth
hook
A male patient, 42 years old. He sustained injuries in a road
traffic accident (a motorbike driver).
Admission diagnosis: isolated pelvic fracture AO/OTA
61B2.3b (right Nakatani II, left Nakatani II), floating pubic
symphysis, disruption of the right SCJ.
Chief complaint: pelvic pain on movements and rotations,
loss of the body weight bearing ability.
A link to the video showing closed reduction of the anterior
pelvic arch with a one-tooth hook and subsequent
intramedullary nailing:
https://youtu.be/BBe8KXUKRsI

CLINICAL CASES
We believe that it is safe to manipulate the hook within
~5 cm from the symphysis. If the hook is advanced farther,
there is a risk of injury to the vascular anastomosis between
the obturator artery/vein and inferior epigastric artery
referred to as the “corona mortis.”
After successful reduction, close fixation of both pubic bones
was performed using Nikita's Nail(Pu-Lock™) which were
locked in a standard fashion.
We rejected right sacroiliac screw fixation since the
provocative test did not show posterior pelvic instability.

CLINICAL CASES
The postoperative period was uneventful. The pain was relieved. Full weight bearing on both lower limbs was allowed on day
2 after surgery.

CLINICAL CASES
Case report 7. Open reduction with a bone
holding forceps
A 19-year old female patient. She fell down from the 5th
floor. On the day of injury, she was taken to another
healthcare institution. She was transferred to our hospital on
day 14 after the injury.
Admission diagnosis: polytrauma (ISS 19) including unstable
pelvic fracture AO/OTA 61C3.3b (right displaced Nakatani II,
left non-displaced Nakatani II), AO/OTA 54С3N2M3 (left
Denis II, right Denis II, displaced H-type sacral fracture).
A link to the video showing the provocative test for pelvic
instability preoperatively:
https://youtu.be/wL8FKXjogvE

CLINICAL CASES
Neurological examination revealed saddle anesthesia of the
perineum and pelvic floor dysfunction.
On admission, the pelvic ring was stabilized with a
supraacetabular PEF.
After her condition became stable, the PEF was removed and
closed reduction of the right pubic bone using a nail was
attempted.

CLINICAL CASES
Closed reduction failed, and we decided to proceed with
open reduction through a right pararectal mini-incision 4 cm
long. The revision through the incision revealed the
interposition of periosteum between pubic bone fragments.
The interposed tissues were dissected, open reduction was
accomplished and bone ends were temporarily fixed with a
small beak-shaped bone holding forceps. Then, a standard
fixation of the pubic bone with a Nikita's Nail(Pu-Lock™) was
performed.
Links to the video rendered from consequent series of
radiographs from x-ray image intensifier:
https://youtu.be/wL0k4x8aXNo

CLINICAL CASES
Following this, the patient was rolled toward the prone position, and a neurosurgical team performed iliolumbar fixation of
the posterior pelvic arch using a transpedicular system and S2–S3 laminectomy with revision of the cauda equina.

CLINICAL CASES
The postoperative period was uneventful. Full weight bearing
on both legs was encouraged. Neurological examination
showed no changes.
Good functional outcome (Majeed score 74) 12 months after
surgery. Neurological examination showed slight
improvement with persisting saddle anesthesia of the
perineum. The pelvic floor function restored.
A link to the video of the patient 12 months after surgery:
https://youtu.be/9M4w2LLwTnY

CLINICAL CASES
Case report 8. Fixation of pubic fractures during
laparotomy
A 32-year-old male patient. He sustained injuries in a road
traffic accident (was hit by a car). On the day of injury, he
was admitted to a healthcare institution in another region.
Admission diagnosis: polytrauma (ISS 19): contusion of the
anterior abdominal wall and liver rupture which was
managed with exploratory laparotomy and liver suturing.
Chief complaint: severe pain in the pelvis on movements. The
patient could not sit or turn on his side. All wound dressing
changes were performed under general anesthesia. The
patient was subfebrile.

CLINICAL CASES
Further diagnostic workup showed rotationally unstable
pelvic fracture AO/OTA 61B2.3b with disruption of the right
SIJ, bilateral vertical comminuted fractures of pubic and iliac
bones (Nakatani II) (floating pubic symphysis). Status post-
laparotomy and liver suturing (postoperative wound
infection with the fibrinous discharge and purulent material),
crush injury of the scrotum (necrotic soft tissues covering
fibrinous drainage with purulent material), contaminated
extensive abrasions on the back (~18%), and multiple
abrasions on the upper and lower extremities.
The distraction test showed a rotationally unstable pelvis
with abnormal mobility of the right pelvis and severe pain.

CLINICAL CASES
After stabilization of the patient on day 12 post-injury, closed
intramedullary fixation of both pubic bones with Nikita's
Nail(Pu-Lock™) and minimally invasive sacroiliac screw
fixation in the right S1 segment with a 6.5 mm cannulated
screw were performed.
https://youtu.be/erGIXsdBAjI

CLINICAL CASES
The early postoperative period was uncomplicated and the
wounds healed. On day 2 after surgery, the patient reported
no pelvic pain and was able to sit and ambulate with a
walker.
Links to the video showing the patient on day 2 after surgery:
https://youtu.be/nJ02V7bklsg

CLINICAL CASES
Case report 9. Fixation of pubic fractures in
patients with cystostomy
A 33-year-old male patient. He sustained a fall from the 3rd
floor.
Admission diagnosis: severe polytrauma (ISS 38): multiple rib
fractures, lung rupture, left-sided hemopneumothorax, soft
tissue emphysema, left intrapulmonary hematoma. Closed
fracture of the lateral end of the left clavicle. Closed fracture
of the left scapula. Rupture of the left hemidiaphragm,
spleen injury, intraperitoneal bladder rupture,
hemoperitoneum. Closed bilateral fracture of the pubic bone
and lateral part of sacrum AO/OTA 61B3.2b; 54C2.
Comminuted stable L4 spinal fracture without neurological
deficit. Open (GA I) displaced metaphyseal fracture of the left
forearm bones, abrasions, and contusion of soft tissues of
the body and limbs.
On admission, the patient underwent laparotomy during
which the spleen was removed, the bladder was sutured and
drained by cystostomy, supraacetabular PEF was applied, and
left pleural and peritoneal cavities were drained.
The distraction test showed a rotationally unstable pelvis
with abnormal mobility bilaterally and severe pain.

CLINICAL CASES
After stabilization of the patient on day 4 post-injury, closed
fixation in the S1 segment with a 6.5 mm cannulated screw
were performed. The estimated blood loss was minimal.
Duration of surgery 90 minutes.
The early postoperative course was uncomplicated and the
wounds healed by primary intention. The patient reported no
pelvic pain and was able to sit and ambulate with a walker.

CLINICAL CASES
patients with draining tubes inserted through the
anterior abdominal wall
A 31-year-old male patient. He sustained a fall from the 4th
floor.
Admission diagnosis: severe polytrauma (ISS 41): closed chest
injury. Right multiple rib fractures, lung injury, soft tissue
emphysema. Blunt abdominal trauma, retroperitoneal
hematoma. Closed displaced bilateral fracture of pubic and
iliac bones (floating pubic symphysis), bilateral fracture of
lateral parts of sacrum AO/OTA 61C3.3b (right and left
Nakatani II); 54C2 (bilateral Denis II). Closed intertrochanteric
fracture of the right femur. Open fracture of the mid-third
and distal metaphysis of the right humerus, type IIIC brachial
artery injury, type IIIA open fracture of the distal metaphysis
of the right humerus.

CLINICAL CASES
On admission, the abdominal cavity was laparoscopically examined, the right pleural and peritoneal cavities were drained,
supraacetabular PEF was applied and external fixation of upper and lower extremities was performed.
Posttraumatic pancreatitis with high-grade fever occurred on day 2 of admission. Intensive therapy included copious local
irrigation of the peritoneal cavity through double-lumen draining tubes.
External view of the patient after stabilization of pelvic fractures, upper
and lower extremity fractures using the Ex-Fix.

CLINICAL CASES
On day 14 after admission and stabilization of the patient,
fixation of both pubic bones was performed using Nikita's
Nail(Pu-Lock™) and minimally invasive bilateral sacroiliac
screw fixation with 6.5 mm cannulated screws. The
estimated blood loss was minimal. Duration of surgery 100
minutes.
Despite the presence of draining tubes in the anterior
abdominal wall and ongoing irrigation of the peritoneal
cavity to resolve inflammation, internal fixation of the
anterior arch was performed. Pelvic fixation allowed to
mobilize the patient on the next day after surgery to prevent
complications associated with recumbency.
The postoperative period was clear. Sutures were removed
on day 14. The patient was allowed to turn on the side and
stomach and sit immediately after surgery. The patient was
discharged from the hospital on day 69.

CLINICAL CASES
patients with colostomy
A 19-year old female patient. She sustained injuries in a road
traffic accident (a motorbike passenger). On the day of injury,
she was taken to another healthcare institution. She was
transferred to our hospital on day 9.
Admission diagnosis: severe polytrauma (ISS 41): contusion
of anterior abdominal wall, small bowel perforation,
extraperitoneal rupture of the bladder, multiple displaced
pelvic fractures, comminuted displaced fracture of the left
acetabulum, extensive abrasions and lacerations of the left
hip, extensive detachment of soft tissues in the lumbar
region.

CLINICAL CASES
Laparotomy with colostomy and bladder suturing were performed on the day of admission. The pelvis and left
acetabulum were stabilized with a Ex-Fix (pelvis-left hip), the floating fragment of the anterior arch was openly fixed
with a Schanz screw through the body of the left pubic bone using Ex-Fix. Soft tissue detachment in the lumbar
region was drained through a 6 cm incision using rubber sheets.
Appearance of the patient on admission. Ex-Fix pelvis-left hip,
colostomy with a stoma bag.
Necrosis of soft tissues in the sacral region, the dashed line
shows the borders of skin detachment (the Morel-Lavallee
injury).

CLINICAL CASES
CT showed vertically and rotationally unstable pelvic fracture AO/OTA 61B2.3b with comminuted impacted vertical
fracture of the lateral part of sacrum AO/OTA 54B3 (Denis II) with a ~2 cm displacement, vertical comminuted
bilateral fractures of pubic and iliac bones (Nakatani II) (floating pubic symphysis). Low transverse (infratectal)
fracture and left posterior acetabular wall fracture AO/OTA 62B1.1a. The incompetence of Schanz screws in the
right pelvis (loosening and inflammation around screws). Status post-laparotomy, small-bowel ostomy in the
anterior abdominal wall (a stoma bag is attached). Lacerations and extensive abrasions of the left hip (soft tissue
necrosis with marginal inflammation around Schanz screws, seropurulent discharge covered by necrotic material).
Extensive skin detachment in the lumbar region with draining tubes (Morel-Lavallee ~2% area), the wound with
serofibrinous discharge and odor. An ~0.5% area of necrosis and skin detachment in the sacrococcygeal region
connected with the cavity under detached skin in the lumbar region. No blood in the urine from the catheter.
Massive swelling of labia minora. Relative shortening of the left lower limb by 2 cm.
Chief complaint: severe pain in the lower back and left hip on movements. The patient could not sit or turn on the
side because of the PEF. All wound dressing changes were performed under IM sedation. The patient was subfebrile.

CLINICAL CASES
On day 10 after the injury, the PEF was removed, closed
fixation in the S1 segment with a 6.5 mm cannulated screw
were performed. The estimated blood loss was minimal.
Duration of surgery 120 minutes.
https://youtu.be/5oIFEY6a5tc

CLINICAL CASES
The patient was then rolled on the right side, necrotic soft tissues in the sacral area were dissected and debrided, the cavity
under detached skin in the lumbar region was copiously irrigated.

CLINICAL CASES
The early postoperative period was uncomplicated and the wounds healed. Pelvic pain significantly subsided and
the patient is able to sit. Walking with crutches with a full weight bearing of the right leg was allowed.
The patient can sit in the bed on day 5 and stand up using crutches on day 10 after surgery.

CLINICAL CASES
A link to the video of the patient
4 months after surgery:
https://youtu.be/BKrXo7nnmzo
Pelvic radiograph 4 months after surgery.

CLINICAL CASES
Functional outcome 4 months after surgery.

CLINICAL CASES
4 months after surgery

We have created a community of trauma surgeons from all over the world who are interested in
the theme of treatment of pelvic fractures.
A distinctive feature of our marketing strategy is that the brand name of the project isn’t an
abstract company, but the author of the methodology himself - Nikita Nikolaevich Zadneprovsky.
He is one of the best pelvic surgeon in Russia. After the development and application of this
technique in his practice, he gained popularity throughout the world.

instagram.com/pelvicfractures/
facebook.com/PelvicFractures/
facebook.com/groups/DOCTIVE

We had got positive feedback from such major specialist as Haim Shtarker (President of Israeli Orthopaedic
Association), Reiner Schnettler (Director of Clinic of casualty surgery, Prof., Giessen, Germany), Jassim M
Alfailakawi (the main pelvic surgeon of Kuwait), Michel Oransky (the Head of the Emergency Traumatology
Department at Aurelia Hospital and at the European Hospital in Rome, Italy), Mariangela Mata Espinoza (One of
the five teachers of AOTrauma Online Editorial Group in the world), Premjeet Singh Thind(Consultant
orthopedic surgeon at JJ trauma centre and Thind Hospital, India)

Interlocking intramedullary nailing for pubic rami fractures is an
advanced and revolutionary technology in pelvic surgery.

Thank You!
Yaroslav Beryozkin
CEO & Co-founder
Email: beryozkin@doctive.me
Web: http://doctive.me
https://www.facebook.com/YaroslavBeryozkin
April 2020

Pu-Lock - Nikita's Nail

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