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Sun Y, Chen J, Liu F, Chen Z, Li X, Lv F. Study of anatomical parameters and intraoperative fluoroscopic techniques for transiliac crest anterograde lag screws fixation of the posterior column of the acetabulum. J Orthop Surg Res 2023; 18:697. [PMID: 37723587 PMCID: PMC10506344 DOI: 10.1186/s13018-023-04208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Currently, there is a lack of research investigating the feasibility of employing anterograde lag screw fixation through the iliac crest for minimally invasive percutaneous treatment of the posterior acetabular column, which encompasses retrograde and anterograde screw fixation in posterior acetabular lag screw fixation. And consequently, the purpose of this study was to examine the anatomical parameters of anterograde lag screw fixation of the posterior column of the pelvis through the iliac crest as well as to investigate the intraoperative fluoroscopy technique, to furnish a scientific rationale supporting the practical utilization of this method within clinical settings. METHODS In this study, pelvic CT data of 60 healthy adults, including 30 males and 30 females, were accumulated. The mimics 21.0 software was developed to reconstruct the three-dimensional pelvis model, simulate the anterograde lag screw fixation of the posterior column of the acetabulum through use of the iliac crest, and precisely identify the insertion point: Utilizing the widest iliac tubercle as the starting point, the insertion point was moved toward the anterior superior iliac spine by 1.0 cm at a time until it reached 4.0 cm. With a total of five insertion points, all oriented toward the lesser sciatic notch, the initial diameter of the virtual screw measured 5.0 mm, and it was progressively enlarged by 1.0 mm increments until reaching a final diameter of 8.0 mm. Besides, the longest lengths of virtual screws with distinct diameters at divergent entry points were measured and compared. At the same time, the intraoperative fluoroscopy technique for optimal access was analyzed. RESULTS The cross-section from the iliac crest to the lesser sciatic notch was irregular, with multiple curved shapes. Furthermore, the diameter of the screw was determined by the anteroposterior radians and width of the iliac crest plate, while the screw length was determined by the curvature of the square body. On the condition that the screw diameter of the D channel (3.0 cm outward from the widest part of the iliac tubercle to the lesser sciatic notch) was 5 mm, 6 mm as well as 7 mm, the longest screw lengths were (145.6 ± 12.8) mm, (143.6 ± 14.4) mm and (139.9 ± 16.6) mm, correspondingly, indicating statistically substantial distinctions from other channels (P < 0.0001). Intraoperative fluoroscopy demonstrated that the C-arm machine was tilted (60.7 ± 2.9) ° to the iliac at the entrance position and perpendicular to the D-channel at the exit position. CONCLUSION It is possible to use the new channel to fix the posterior column of the acetabulum with an anterograde lag screw through the iliac crest. In specific, the channel is 3.0 cm outward from the widest part of the iliac tubercle to the lesser sciatic notch. Providing a wide channel, long screw insertion, and high safety, this technique offers a novel approach for minimally invasive treatment of posterior column fractures of the acetabulum.
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Affiliation(s)
- Yangyang Sun
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Jian Chen
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhixue Chen
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Xiaohui Li
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Fuxin Lv
- Department of Orthopaedic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China.
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Altinayak H, Karatekin YS, Tülüce I, Bitiş C. Evaluation of the effect of pelvis type in percutaneous acetabular column fixation: a computed tomography study. Acta Orthop Belg 2023; 89:333-339. [PMID: 37924551 DOI: 10.52628/89.2.9727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
This study aimed to evaluate the effect of pelvis type in percutaneous acetabular column fixation. What is the effect of pelvis type in percutaneous acetabular colon fixation? The available pelvic computed tomography (CT) scans which were obtained in the diagnostic imaging center with a 1 mm slice width were evaluated. The pelvic type was classified with the help of MPR (Multiplanar Reformat) and 3D (Three Dimensional) imaging modes. All evaluated bony pelvic structures were anatomically intact. 40 types of android, gynecoid, anthropoid, and platypelloid pelvis were determined. CT sections were created in MPR imaging mode. Anterior obturator oblique (AOO) and inlet images were created for anterior column evaluation, while iliac oblique (IO) and outlet images were created for posterior column evaluation. The possibility of obtaining a linear corridor for acetabular columns was investigated by measuring corridor width and lengthon images of pelvic CTs. A linear corridor could not be obtained between the pubic tubercle and the supraacetabular region of 12 (30%) CTs in the anterior column of gynecoid pelvis group. The diameter of the anterior column corridor was below 5.5 mm in 10 (25%) of Gynecoid pelvis group, 5 (12.5%) of Anthropoid pelvis group, and 10 of Platypelloid pelvis group, , and all those scans belonged to the female gender. There was a statistically significant difference between pelvis types in terms of anterior and posterior column diameters (p <0.001). While the android pelvis type had the highest diameter and corridor length in both anterior column and posterior column measurements, the gynecoid pelvic type had the lowest diameter and corridor length. In the evaluations made according to gender, both anterior and posterior column diameters were larger and longer in males than in females (p <0.001). Pelvis type is an important factor which can affect anterior and posterior column diameter and length of acetabulum. Pelvic typing before acetabular surgery can help the surgeon determining the most appropriate patient position, surgical approach, and implant selection. Level of Evidence: Level 2.
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Havermans RJM, Lansink KWW, Gosens T, de Jongh MAC. Comparing Patient-Reported Outcomes Measurement Information System Computer Adaptive Testing With Existing Measures After Operative Interventions for Extremity Fractures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023:S1098-3015(23)00063-3. [PMID: 36878312 DOI: 10.1016/j.jval.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Patient-Reported Outcomes Measurement Information System (PROMIS) enables the use of computer adaptive testing (CAT). The aim of this prospective cohort study was to compare the most commonly used disease-specific instruments with PROMIS CAT questionnaires in patients with trauma. METHODS All patients with trauma (ages 18-75) who underwent an operative intervention for an extremity fracture between June 1, 2018, and June 30, 2019, were included. The disease-specific instruments were the Quick Disabilities of the Arm, Shoulder, and Hand for upper extremity fractures and the Lower Extremity Functional Scale (LEFS) for lower extremity fractures. Pearson's correlation (r) between the disease-specific instruments and the PROMIS CAT questionnaires (PROMIS Physical Function, PROMIS Pain Interference, and PROMIS Ability to Participate in Social Roles and Activities) was calculated at week 2, week 6, month 3, and month 6. Construct validity and responsiveness were calculated. RESULTS A total of 151 patients with an upper extremity fracture and 109 patients with a lower extremity fracture were included. At month 3 and month 6, the correlation was strong between the LEFS and PROMIS Physical Function (r = 0.88 and r = 0.90, respectively), and at month 3, the correlation was strong between the LEFS and PROMIS Social Roles and Activities (r = 0.72). At week 6, month 3, and month 6, there was a strong correlation between the Quick Disabilities of the Arm, Shoulder, and Hand and PROMIS Physical Function (r = 0.74, r = 0.70, and r = 0.76, respectively). CONCLUSIONS The PROMIS CAT measures are acceptably related to existing non-CAT instruments and may be a useful tool during follow-up after operative interventions for extremity fractures.
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Affiliation(s)
- Roos J M Havermans
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands.
| | | | - Taco Gosens
- Department of Orthopedics, ETZ Hospital, Tilburg, The Netherlands
| | - Mariska A C de Jongh
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, The Netherlands
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Comparison of Percutaneous Screw Fixation to Open Reduction and Internal Fixation in Acetabular Fractures: A Matched Pair Study Regarding the Short-Term Rate of Conversion to Total Hip Arthroplasty and Functional Outcomes. J Clin Med 2023; 12:jcm12031163. [PMID: 36769810 PMCID: PMC9917484 DOI: 10.3390/jcm12031163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were matched with patients treated with ORIF based on sex, age, and fracture classification. Surgery-dependent and -independent factors of the in-hospital stay, the conversion rate to total hip arthroplasty (THA), and quality of life were assessed. The ORIF group had a higher preoperative fracture step (p = 0.04) and gull wing sign (p = 0.003) compared with the CRPIF group. Postoperatively, the gap and step size were not significantly different between the groups (p > 0.05). CRPIF required less time (p < 0.0001) and transfusions (p = 0.009) and showed fewer complications (p = 0.0287). Four patients were converted to THA (CRPIF, n = 1; ORIF, n = 3; p = 0.155) because of posttraumatic osteoarthritis. Functional outcomes and pain were similar in both groups (p > 0.05). The present study revealed less blood loss and a lesser extent of reduction in patients treated with CRPIF than in those treated with ORIF. The rates of conversion to THA and functional outcomes did not differ between CRPIF and ORIF. CRPIF appeared to be a valuable treatment option for selected patients.
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Cavalié G, Boudissa M, Kerschbaumer G, Seurat O, Ruatti S, Tonetti J. Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum. Orthop Traumatol Surg Res 2022; 108:103288. [PMID: 35470116 DOI: 10.1016/j.otsr.2022.103288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Antegrade posterior column screw fixation (APCS) provides stable fixation while reducing the complications related to dual acetabular approaches. The objective of this study was to present the radiological and clinical outcomes of fixation of the posterior column of the acetabulum through a single anterior approach. HYPOTHESIS APCS will produce better clinical and radiological outcomes relative to not placing any screws in the posterior column. PATIENTS AND METHODS This was a retrospective single-center study of 69 patients operated through a single anterior approach for a both-column fracture of the acetabulum between 2014 and 2018. Patients were divided into two groups (APCS+, n=24 and APCS-, n=45) depending on whether the posterior column was fixed with an antegrade lag screw or not. The radiological outcomes were defined by the quality of the reduction according to Matta. The clinical outcomes were evaluated using the Harris Hip score and Merle Postel D'Aubigné (MDP) score at the final assessment. A sequential hierarchical analysis was done with a Chi2 test for the radiological criterion and Student's t test for the clinical outcomes. RESULTS In the APCS+ group, the reduction was anatomical in 71% (17/24) of patients, imperfect in 12% (3/24) and poor in 17% (4/24). In the APCS- group, the reduction was anatomical in 33% (15/45) of patients, imperfect in 31% (14/45) and poor in 35% (16/45). This difference between groups was statistically significant (p=.012). The differences between groups in the Harris (p=.201) and MDP (p>.05) scores were not significant. Mean irradiation in the APCS+ group was significantly higher (114.8 cGy.cm-2) relative to the APCS- group (39.8 cGy.cm-2) (p<.001). None of the patients in the APCS+ group underwent a subsequent total hip arthroplasty, while 8 patients from the APCS- group did (p=.031). The differences in the postoperative complications were not statistically significant. DISCUSSION APCS yields satisfactory radiological and clinical outcomes without increasing the complication rate; this must be balanced out against the additional irradiation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guillaume Cavalié
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire d'Anatomie des Alpes Françaises (LADAF), Faculté de médecine, Domaine de la Merci, 38700 La Tronche, France.
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire TIMC-IMAG, CNRS UMR 5525, 38000 Grenoble, France
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Houwen T, de Munter L, Lansink KWW, de Jongh MAC. There are more things in physical function and pain: a systematic review on physical, mental and social health within the orthopedic fracture population using PROMIS. J Patient Rep Outcomes 2022; 6:34. [PMID: 35384568 PMCID: PMC8986932 DOI: 10.1186/s41687-022-00440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet, many articles studied heterogeneous groups with chronic orthopedic disorders in which fracture patients were included as well. At this moment, there is no systematic overview of the exact use of PROMIS measures in the orthopedic fracture population. Therefore this review aimed to provide an overview of the PROMIS health domains physical health, mental health and social health in patients suffering an orthopedic fracture.
Methods This systematic review was documented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched Embase, Medline, Web of Science Core Collection, and Cochrane Central Register of controlled Trials, CINAHL and Google Scholar in December 2020 using a combination of MeSH terms and specific index terms related to orthopedic fractures and PROMIS questionnaires. Inclusion criteria were available full text articles that were describing the use of any PROMIS questionnaires in both the adult and pediatric extremity fracture population. Results We included 51 relevant articles of which most were observational studies (n = 47, 92.2%). A single fracture population was included in 47 studies of which 9 involved ankle fractures (9/51; 17.6%), followed by humeral fractures (8/51; 15.7%), tibia fractures (6/51; 11.8%) and radial -or ulnar fractures (5/51; 9.8%). PROMIS Physical Function (n = 32, 32/51 = 62.7%) and PROMIS Pain Interference (n = 21, 21/51 = 41.2%) were most frequently used questionnaires. PROMIS measures concerning social (n = 5/51 = 9.8%) and mental health (10/51 = 19.6%) were much less often used as outcome measures in the fracture population. A gradually increasing use of PROMIS questionnaires in the orthopedic fracture population was seen since 2017. Conclusion Many different PROMIS measures on multiple domains are available and used in previous articles with orthopedic fracture patients. With physical function and pain interference as most popular PROMIS measures, it is important to emphasize that other health-domains such as mental and social health can also be essential to fracture patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00440-3.
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Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands. .,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Leonie de Munter
- Department of Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Koen W W Lansink
- Department of Surgery, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
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Effect of Percutaneous Posterior Pelvic Ring Reduction and Fixation on Patient-Reported Outcomes. J Orthop Trauma 2022; 36:S17-S22. [PMID: 35061646 DOI: 10.1097/bot.0000000000002321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to assess patient outcomes using Patient-Reported Outcomes Measurements Information System (PROMIS) scores after closed reduction and percutaneous fixation (CRPF) of the posterior pelvic ring and determine whether quality of reduction affects the outcomes. DESIGN This is a retrospective cohort study. SETTING The study involved a Level I trauma center. PATIENTS The study included 46 adult patients with operatively treated pelvic ring injuries (63% OTA/AO 61-B) who underwent CRPF between 2014 and 2018 at a single institution. INTERVENTION The intervention involved closed reduction and percutaneous posterior pelvic ring fixation. MAIN OUTCOME MEASUREMENTS The main outcome measurements were postoperative patient PROMIS scores, including physical function, pain interference, anxiety, and depression, and radiographic measurements of postoperative displacement and pelvic deformity. RESULTS After CRPF, PROMIS scores of physical function, pain interference, and anxiety were significantly improved at the time of final follow-up when compared with the first postoperative visit. The amount of malreduction or pelvic deformity did not significantly affect outcome scores; however, results were limited by small sample size. CONCLUSIONS CRPF of posterior pelvic ring injuries results in good functional and radiographic outcomes. Degree of malreduction may not affect outcomes as much as previously believed. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Levin S, Krumins R, Shaath MK, Avilucea FR. Clinical outcomes in prone positioning for percutaneous fixation of posterior column acetabular fractures. Eur J Trauma Emerg Surg 2021; 48:3721-3727. [PMID: 33740064 DOI: 10.1007/s00068-021-01636-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Percutaneous retrograde fixation of posterior column acetabular fractures is becoming a commonly practiced technique. Prone positioning provides reliably reproducible intraoperative fluoroscopic images necessary for precise preparation of the osseous fixation corridor necessary for accurate and safe implant placement. Additionally, the prone position facilitates an open posterior approach if an open reduction is necessary. The purpose of this study was to analyze the radiographic and clinical outcomes of retrograde posterior column fixation utilizing the prone position. METHODS From 2017 to 2020, 41 patients were included in the retrospective study. Clinical outcomes were collected for a minimum of 6 months. Implant placement was assessed on post-operative pelvic computed tomography (CT) scans and fracture union was assessed on routine follow-up radiographs. RESULTS All (100%) cases achieved union by 4 months, with an average time to union of 3.2 months. Every post-operative CT scan demonstrated screw placement contained throughout the posterior column with no intrusion into the hip joint or sciatic notch. Clinically, one patient reported pain with sitting. No patients required additional surgical intervention. CONCLUSION Prone positioning is a versatile and effective approach for retrograde percutaneous fixation of posterior column acetabular fractures. This study is the first to report clinical outcomes utilizing this technique and contributes to a growing body of the literature supporting the value and safety of percutaneous fixation of acetabular fractures appropriate for this fixation strategy.
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Affiliation(s)
- Samantha Levin
- Department of Orthopaedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA.
| | - Ryan Krumins
- Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA
| | - M Kareem Shaath
- Level One Orthopedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA
| | - Frank R Avilucea
- Level One Orthopedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA
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Technical Considerations and Fluoroscopy in Percutaneous Fixation of the Pelvis and Acetabulum. J Am Acad Orthop Surg 2019; 27:899-908. [PMID: 31192885 DOI: 10.5435/jaaos-d-18-00102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Surgical treatment of the pelvic ring and acetabulum continues to evolve. Improved imaging technology and means for closed reduction have meant that percutaneous techniques have gained popularity in the treatment of the pelvic ring and, more recently, in the acetabulum. Potential benefits include decreased soft-tissue dissection, blood loss, and surgical time. However, these are technically demanding procedures that require substantial expertise from both the surgeon and the radiographer. This article details the necessary fluoroscopic views and general methods used in percutaneous techniques around the pelvis and acetabulum. Despite most studies reporting good-to-excellent clinical and radiographic results, further work is needed to facilitate standardization and optimization of these outcomes.
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Franovic S, Gulledge CM, Kuhlmann NA, Williford TH, Chen C, Makhni EC. Establishing "Normal" Patient-Reported Outcomes Measurement Information System Physical Function and Pain Interference Scores: A True Reference Score According to Adults Free of Joint Pain and Disability. JB JS Open Access 2019; 4:e0019. [PMID: 32043056 PMCID: PMC6959908 DOI: 10.2106/jbjs.oa.19.00019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Numerous recent studies have demonstrated the validity and efficiency of the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) forms in patients undergoing orthopaedic surgical procedures. It is assumed that a score of 50 in each domain represents the health state of a “reference” population, but this threshold has not been definitively proven. In order to truly assess whether a given orthopaedic intervention is successful, the comparative scores of healthy individuals must be known for any given health domain measured. Therefore, the purpose of this study was to determine baseline scores for the PROMIS general physical function (PROMIS-PF), pain interference (PROMIS-PI), and upper-extremity physical function (PROMIS-UE) domains in physically healthy, asymptomatic adult individuals. We hypothesized that, in individuals <40 years old, the mean PROMIS-PF and PROMIS-UE scores would be >50 and PROMIS-PI scores would be <50. We further hypothesized that these scores would be impacted by participant age.
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Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Noah A Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Tyler H Williford
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Chaoyang Chen
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
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Abstract
OBJECTIVES To determine factors associated with nerve injury after acetabulum fracture and to evaluate recovery and outcomes. DESIGN Retrospective cohort study. SETTING Level 1 trauma center. PATIENTS AND PARTICIPANTS Nine hundred seventy-five skeletally mature patients with acetabulum fracture. INTERVENTION Operative and nonoperative management. MAIN OUTCOME MEASUREMENTS Nerve injuries, categorized as traumatic or iatrogenic, recovery (none, partial, or complete), and patient-reported functional outcomes with the Musculoskeletal Function Assessment (n = 353, 36.2%). RESULTS Thirty-two patients (3.3%) experienced nerve injury with 24 (78%) resulting from trauma and 23 with an associated posterior hip dislocation. Eight injuries (25%) were iatrogenic. Thirty-one (97%) occurred in patients with operative fractures (n = 738). The most common fracture pattern associated with nerve injury was transverse posterior wall (31% of injuries). Obesity was more common in patients with nerve injuries (59% vs. 30% in those without nerve injury (P = 0.001), but was not related to age or sex. Sixty-five percent of sciatic nerve injuries were to the common peroneal division only, while none were isolated to the tibial division. All iatrogenic injuries occurred after the ilioinguinal approach (P < 0.001). Overall, 50% experienced partial nerve recovery and 22% had complete recovery. However, 24% of patients with sciatic or common peroneal injuries had no recovery. Thirty-three percent of tobacco smokers experienced no recovery (vs. 26% of nonsmokers). Average Musculoskeletal Function Assessment scores for patients with nerve injuries was 32, similar to those without (33). CONCLUSIONS Posterior acetabulum fracture dislocations are associated with traumatic nerve injury, although 25% of nerve injuries were iatrogenic. Nerve injuries are more common in obese patients. More than one-quarter of patients had no recorded nerve recovery. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Early Experience and Results Using Patient-Reported Outcomes Measurement Information System Scores in Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2019; 34:2313-2318. [PMID: 31230957 DOI: 10.1016/j.arth.2019.05.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/08/2019] [Accepted: 05/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our study determined if preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores could predict achieving minimum clinically important differences (MCIDs) in postoperative PROMIS scores after primary total hip and knee arthroplasty. METHODS Ninety-three patients were administered the PROMIS Depression, Pain Interference, and Physical Function domains at their preoperative appointment and 6-week follow-up visit. MCIDs were drawn from existing literature for the PROMIS domains. RESULTS The MCID was achieved in 74% of patients for Pain Interference, 34% for Physical Function, and 24% for Depression. Our model could predict with 90% specificity which patients would meet MCID if their preop PROMIS Pain score was above 38, Physical Function score less than 19, or Depression score above 22. CONCLUSION Preoperative PROMIS Pain Interference, Physical Function, and Depression scores can predict achieving MCID in postoperative PROMIS scores.
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Abstract
Acetabular fractures are encountered by radiologists in a wide spectrum of practice settings. The radiologist's value in the acute and long-term management of acetabular fractures is augmented by familiarity with systematic computed tomography-based algorithms that streamline and simplify Judet-Letournel fracture typing, together with an appreciation of the role of imaging in initial triage, operative decision making, postoperative assessment, prognostication, and evaluation of complications. The steep increase in incidence of acetabular fractures in the elderly over the past several decades places special emphasis on familiarity with geriatric fracture patterns.
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Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Christina A LeBedis
- Department of Radiology, Boston University Medical Center, 715 Albany Street, Boston, MA 02118, USA
| | - Jason W Nascone
- Department of Orthopaedics, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA
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van der Meij E, Anema JR, Huirne JAF, Terwee CB. Using PROMIS for measuring recovery after abdominal surgery: a pilot study. BMC Health Serv Res 2018; 18:128. [PMID: 29458373 PMCID: PMC5819257 DOI: 10.1186/s12913-018-2929-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To assess the construct validity and responsiveness of the PROMIS Physical Function v1.2 short form 8b (PROMIS-PF), and the PROMIS Ability to Participate in Social Roles and Activities v2.0 short form 8a (PROMIS-APS) in postoperative recovery. METHODS An observational pilot study was conducted in which 30 patients participated, undergoing various forms of abdominal surgery. Patients completed the PROMIS-PF and PROMIS-APS, the Short Form 36 Health Survey (SF-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) at several time points before and after surgery. The construct validity and responsiveness of the two PROMIS short forms were evaluated by testing pre-defined hypotheses and were considered adequate when at least 75% of the data was consistent with the hypotheses. Construct validity was evaluated by calculating Spearman correlations and the responsiveness by calculating effect sizes. RESULTS 6/7 (85.7%) of the results were consistent with the hypotheses supporting the construct validity of the PROMIS-PF. For the PROMIS-APS this was the case in 7/15 (46.7%) of the results. For the PROMIS-PF, 6/7 (85.7%) of the results were consistent with the hypotheses, supporting responsiveness. Regarding the responsiveness of the PROMIS-APS, only 7 out of 13 (53.8%) of these results were consistent with the hypotheses. CONCLUSIONS This study supported the construct validity and the responsiveness of the PROMIS-PF v1.2 short form 8b for measuring recovery in abdominal surgery. Considering the major advantages of PROMIS, we recommend the use of the PROMIS-PF in abdominal surgery.
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Affiliation(s)
- Eva van der Meij
- Department of Obstetrics and Gynecology, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynecology, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Ahmed M, Abuodeh Y, Alhammoud A, Salameh M, Hasan K, Ahmed G. Epidemiology of acetabular fractures in Qatar. INTERNATIONAL ORTHOPAEDICS 2018; 42:2211-2217. [PMID: 29430606 DOI: 10.1007/s00264-018-3824-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to review the epidemiological aspects of acetabular fractures treated at Hamad Medical Corporation in Qatar. The study is the first orthopaedic trauma epidemiological study in Qatar and will provide a platform to advance high-level clinical research. METHODS We obtained data for 103 patients who presented to our level I trauma centre from 2008 to 2010 with a diagnosis of acetabular fracture. Age, sex, the cause of injury, fracture classification, mode of treatment, associated nerve injuries, and other complications were analyzed. RESULTS The incidence of acetabular fracture was 2/100,000/year. Males (93.2%) predominated. The mean age at injury time was 36 years, and the most common cause of injury was motor vehicle collisions (49.5%). Injuries were mostly primary acetabular fractures (73.6%) in comparison to (26.4%) for associated fractures. Posterior wall fractures were the most common pattern (25.2%). Associated posterior hip dislocation occurred in 21.3% of cases. Data revealed a lower incidence of post-traumatic sciatic nerve palsy (7%) that was present at the time of injury. There were no cases of reported mortality. CONCLUSION Acetabular fractures are uncommon injuries with motor vehicle collision being the most common cause of injury. Posterior wall fracture was the most frequent pattern, and most of the patients were males. The incidence of post-traumatic sciatic nerve palsy and the proportion of injured women were lower than those reported in literature. Well-trained surgeons and specialized centres for treating these injuries are recommended.
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Affiliation(s)
- Malik Ahmed
- Queen Medical Center, Nottingham University Hospital, Nottingham, UK
| | - Yousef Abuodeh
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - AbdulJabbar Alhammoud
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Motasem Salameh
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Khalid Hasan
- Jackson Health System, University of Miami, Gables, FL, USA
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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Abstract
Despite increased availability of modern imaging techniques, plain radiographs remain the initial step in the classification of acetabular fractures. The ability to interpret the injury configuration allows the surgeon to develop a thorough preoperative plan and to evaluate the quality of reduction and fixation intraoperatively. Proficiency in the mental conversion of a two-dimensional radiograph into a three-dimensional conceptual image is imperative. The widely used radiographic classification scheme developed by Judet and Letournel in the 1960s is both practical and simple. However, understanding the subtleties of the fracture pattern can be a challenge even for experienced surgeons. Current evaluation methods include CT and three-dimensional reconstructions in addition to plain radiographs. Our diagnostic algorithm uses three plain radiographs to classify the fracture into one of the 10 fracture patterns described by Judet and Letournel.
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Boudissa M, Francony F, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, Tonetti J. Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res 2017; 103:335-339. [PMID: 28235575 DOI: 10.1016/j.otsr.2017.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidemiological studies of acetabular fractures (AFs) are scarce and, to our knowledge, the most recent one from France, by Letournel and Judet, dates back to 1993. Studies have suggested a decrease in high-energy AFs contrasting with an increase in low-energy AFs due to the longer life expectancy. However, a French case-series study failed to confirm these data. We therefore conducted a 10-year retrospective study in a level-1 trauma centre to: (1) characterise the epidemiological profile of AF; (2) and to describe the treatment strategy. HYPOTHESIS The epidemiological profile of AF in France is consonant with data from European case-series studies. METHOD All patients managed for AF between 2005 and 2014 were included in this single-centre retrospective study. All patients were re-evaluated at our centre or another facility 6 months after the fracture. The epidemiological data were compared in the three treatment groups: non-operative, open reduction and internal fixation (ORIF), and total hip arthroplasty (THA). RESULTS Between 2005 and 2014, 414 patients were admitted for AF. Mean age was 49.4 years (range: 15-101 years). Treatment was non-operative in 231 (56%) older patients, most of whom had low-energy fractures involving the anterior wall. THA with or without acetabular reinforcement and screw-plate fixation was performed in 27 (7%) older patients, most of whom had posterior-wall fractures and experienced postoperative complications (26/27 patients, 96%). ORIF was used in 156 (38%) younger patients, most of whom had high-energy fractures of greater complexity. CONCLUSION Our results reflect the current indications in AF management. The epidemiological characteristics in our population are comparable to those reported in the few recent European epidemiological studies. To our knowledge, this is the largest French epidemiological study since the landmark work by Letournel and Judet. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France.
| | - F Francony
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - G Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Ruatti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - M Milaire
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Merloz
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
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Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study. J Am Coll Surg 2017; 224:245-254.e1. [DOI: 10.1016/j.jamcollsurg.2016.11.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 11/20/2022]
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Salama W, Mousa S, Khalefa A, Sleem A, Kenawey M, Ravera L, Masse A. Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures. INTERNATIONAL ORTHOPAEDICS 2016; 41:181-189. [DOI: 10.1007/s00264-016-3175-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022]
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