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Jia Z, Qin H, Lin J, Wang X, Bai R, Zou S, Huang W, Hu X. Minimally Invasive Treatment of Pelvic Fractures with Titanium Elastic Nailing: An Innovative Technology. Surg Innov 2024:15533506241249260. [PMID: 38654530 DOI: 10.1177/15533506241249260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Minimally invasive treatment has become the most popular and effective treatment for pelvic fractures. This study aimed to evaluate the safety and efficacy of a new technique, titanium elastic nailing (TEN), for the minimally invasive treatment of pelvic fractures. METHOD Twenty-four patients with pelvic fractures were referred to us between January 2020 to January 2022, including sixteen males and 8 females. Pelvic fractures were temporarily fixed by pelvic fixation belt accompanied by traction from the lower limb bone. Anterior pelvic ring injuries (superior ramus of pubis) and ilium fractures were treated with closed reduction and intramedullary fixation with minimally invasive TEN. Intraoperative C-arm, including pelvic anteroposterior, pelvic outlet, inlet and ilium oblique views, and O-arm fluoroscopy (intraoperative CT) were employed to assess fractures reduction and determine the location of the elastic titanium nail within the bone channel. RESULTS By adopting closed reduction and minimally invasive incision techniques, pelvic fractures could be safely fixed by placing an elastic titanium nail in the osseous medullary cavity channels of the pelvis. Postoperative investigation indicated that the wounds of all patients were healed in the first stage without any occurrence of complications, such as injuries to the nerves, blood vessels, and important tissue structures. Patients are essential quickly after the operation and could perform the functional exercise in the early stages of the recovery. CONCLUSION TEN can be used for minimally invasive treatment of pelvic fractures. This novel technique has no obvious complications and is worthwhile in clinical practice.
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Affiliation(s)
- Zhaofeng Jia
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Hanjun Qin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jiandong Lin
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xin Wang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Ruochen Bai
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Suying Zou
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Wenjun Huang
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xinjia Hu
- Department of Traumatic Orthopedics and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and Technology, Shenzhen, China
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El Naga AN, Working ZM, Hoogervorst P, Knox R, Marmor MT. Identification of subtle residual sacroiliac joint flexion and extension malreductions in AO/OTA 61-C1.2 (APC3) pelvic injuries after provisional anterior ring reduction. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03840-x. [PMID: 38376587 DOI: 10.1007/s00590-024-03840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Hemipelvis reduction in the setting of AO/OTA 61-C1.2 (APC3) pelvic injuries can be challenging. A common strategy is to provisionally reduce or fix the anterior ring prior to definitive fixation of the posterior ring. In this scenario, it is difficult to assess whether residual sacroiliac joint (SIJ) widening is due to hemipelvis flexion/extension or lateral displacement. This simulation sought to identify a radiographic marker for posterior ilium flexion or extension malreduction in the setting of a reduced anterior ring. METHODS Symphyseal and both anterior and posterior SIJ ligaments were cut in 8 cadaveric pelvis. The symphysis was reduced and wired. One centimeter of posterior flexion or extension at the SIJ was created to mimic the clinical scenario of hemipelvis flexion or extension malreduction, and a lateral compressive force was applied. SIJ widening and the direction of anterior or posterior ileal displacement relative to the contralateral joint were assessed via inlet views. SIJ widening and the direction of cranial or caudal ileal displacement were assessed using outlet views. Comparisons between flexion and extension models used Fisher's exact test. RESULTS On outlet views, all flexed hemipelvis demonstrated caudal ileal translation at the superior SIJ, in contrast to all extended hemipelvis demonstrated cranial translation (p < 0.0005); the scenarios were easily distinguishable. Conversely, inlet imaging was unable to identify the direction of malreduction. Flexion/extension scenarios resulted in similar amounts of SIJ widening. CONCLUSION Residual flexion and extension hemipelvis malreductions in APC3 injuries after provisional anterior fixation can be differentiated by the direction of ileal displacement at the superior SIJ on the outlet view.
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Affiliation(s)
- Ashraf N El Naga
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA
| | - Zachary M Working
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Paul Hoogervorst
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Riley Knox
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA
| | - Meir T Marmor
- San Francisco-Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 2540 23Rd Street, Bldg 7, 3Rd Floor, Rm 310, San Francisco, CA, 94110, USA.
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Saiz AM, O'Donnell E, Kellam P, Cleary C, Moore X, Schultz BJ, Mayer R, Amin A, Gary J, Warner SJ, Routt ML, Eastman JG. Bladder Repair With Irrigation and Debridement and Open Reduction Internal Fixation of the Anterior Pelvic Ring Is Safe and Decreases Risk of Infection in Pelvic Ring Injuries With Extraperitoneal Bladder Ruptures. J Orthop Trauma 2024; 38:72-77. [PMID: 37941118 DOI: 10.1097/bot.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To determine the incidence of infection in nonoperative versus operative management of extraperitoneal bladder ruptures in patients with pelvic ring injuries. METHODS DESIGN A retrospective cohort study of 2 prospectively collected trauma registries. SETTING Two Level 1 trauma centers. PATIENT SELECTION CRITERIA Patients with operative pelvic ring injuries, 68 (6%) had extraperitoneal bladder ruptures. OUTCOME MEASURES AND COMPARISONS The primary outcome was the incidence and associated risk factors of deep pelvic infection requiring return to OR for surgical debridement. Secondary outcomes included quality of reduction, other complications, and radiographic union. Comparisons were made based on the status of any associated bladder injury. RESULTS Of 1127 patients with operative pelvic ring injuries, 68 patients had extraperitoneal bladder ruptures, 55 had bladder repair and 13 did not. Of those 13 without repair, none had ORIF of the anterior pelvic ring. Patients without bladder repair had an increased odds of infection 17-fold compared to patients who did have a repair performed (OR 16.9, 95% CI 1.75 - 164, P = 0.01). Other associated factors for deep pelvic infection included use of suprapubic catheter ( p < 0.02) and a closed reduction of the anterior ring ( p < 0.01). Patients undergoing anterior ring ORIF and bladder repair had improved reductions and no increased infection risk. CONCLUSIONS Operative repair of extraperitoneal bladder ruptures decreases risk of infection in patients with pelvic ring injuries. Additionally, ORIF of the anterior pelvic ring does not increase the risk of infection and results in better reductions compared to closed reduction. Treatment algorithms for these combined injuries should consider recommending early bladder repair and anterior pelvic ORIF. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Augustine M Saiz
- University of Texas Health Science Center at Houston, Houston, TX
- University of California, Davis, Sacramento, CA; and
| | | | - Patrick Kellam
- University of Texas Health Science Center at Houston, Houston, TX
| | - Courtney Cleary
- University of Texas Health Science Center at Houston, Houston, TX
| | - Ximia Moore
- University of Texas Health Science Center at Houston, Houston, TX
| | - Blake J Schultz
- University of Texas Health Science Center at Houston, Houston, TX
| | - Ryan Mayer
- University of Texas Health Science Center at Houston, Houston, TX
| | - Adeet Amin
- University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua Gary
- Keck School of Medicine of USC, Los Angeles, CA
| | - Stephen J Warner
- University of Texas Health Science Center at Houston, Houston, TX
| | - Milton L Routt
- University of Texas Health Science Center at Houston, Houston, TX
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Davidson A, Giannoudis VP, Kotsarinis G, Santolini E, Tingerides C, Koneru A, Kanakaris NK, Giannoudis PV. Unstable pelvic fractures in women: implications on obstetric outcome. INTERNATIONAL ORTHOPAEDICS 2024; 48:235-241. [PMID: 37710070 PMCID: PMC10766730 DOI: 10.1007/s00264-023-05979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Obstetric outcomes in women following pelvic injuries requiring surgical fixation is not thoroughly known. We aimed to evaluate if radiographic measurements (RMs) can be used to provide information on delivery methods outcome after these injuries, and to evaluate if metal work removal is required prior to delivery. METHOD A retrospective study in a level 1 trauma centre of female patients with pelvic fractures treated operatively, aged 16-45 at the time of injury. Participants completed a questionnaire regarding their obstetric history. RM evaluating pelvic symmetry, displacement, and pelvimetry were conducted on postoperative radiographs and CT scans. Patients who gave birth after the injury were divided to two groups according to the delivery method: vaginal delivery (VD) and caesarean section (CS). These two groups RM were compared. RESULTS Forty-four patients were included, comparison of the RM of patients who delivered by CS (9) and patients who had only VD (11) showed no significant difference between the groups. Two patients underwent a trial of VD who subsequently underwent urgent CS due to prolonged labour, their RM were below the average and their pelvimetry measurements were above the cut-off for CS recommendation. Eleven patients had uncomplicated VD, all had retained sacroiliac screws at the time of delivery and one patient had an anterior pubic plate. CONCLUSION Postoperative RM did not show an effect on delivery method of women after pelvic fracture fixation. A relatively high number of patients who underwent normal vaginal delivery had retained sacroiliac screws. These findings can form the foundation for larger cohort studies.
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Affiliation(s)
- Amit Davidson
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK.
| | - Vasileios P Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Georgios Kotsarinis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Emmanuele Santolini
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Constantinos Tingerides
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anish Koneru
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
- NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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Charsley J, Jarman H. Assessment and management of pelvic fractures from high-energy trauma in adults. Emerg Nurse 2023; 31:20-25. [PMID: 36880213 DOI: 10.7748/en.2023.e2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 03/08/2023]
Abstract
Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department.
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Affiliation(s)
- Julia Charsley
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, England
| | - Heather Jarman
- midwifery and allied health professions, Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, England
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Kwon H, Jang JH, Moon NH, Rhee SJ, Ryu DY, Ahn TY. Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study. J Orthop Sci 2023:S0949-2658(23)00279-8. [PMID: 37867061 DOI: 10.1016/j.jos.2023.10.007] [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: 07/19/2023] [Revised: 09/04/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Intrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures. METHODS We retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated. RESULTS In total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23-85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns. CONCLUSIONS SGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.
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Affiliation(s)
- Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Trauma Center, Pusan National University Hospital, Busan, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Dong Yeon Ryu
- Department of Trauma and Surgical Critical Care, Trauma Center, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae Young Ahn
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Lu S, Yang Y, Li S, Zhang L, Shi B, Zhang D, Li B, Hu Y. Preoperative Virtual Reduction Planning Algorithm of Fractured Pelvis Based on Adaptive Templates. IEEE Trans Biomed Eng 2023; 70:2943-2954. [PMID: 37126611 DOI: 10.1109/tbme.2023.3272007] [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: 05/03/2023]
Abstract
OBJECTIVE The minimally invasive treatment of pelvic fractures is one of the most challenging trauma orthopedics surgeries, where preoperative planning is crucial for the performance and outcome of the surgery. However, planning the ideal position of fragments currently relies heavily on the experience of the surgeon. METHODS A pelvic fracture virtual reduction algorithm for target position is provided based on statistical shape models (SSM). First, according to sexual dimorphism, pelvic SSM based on point cloud curvature down-sampling are constructed as adaptive templates. Then, an optimization algorithm is designed to iteratively adjust the target pose of the fragments and the adaptive matching of the templates. Finally, the feasibility of the method is verified by simulating fractures and clinical data. RESULTS The pelvis has complex shape characteristics, which can be analyzed by SSM to clearly understand the pattern of change. Experiments showed that the SSM-based pelvic fracture reduction method had translation and rotation errors of 2.20±1.09 mm and 3.16±1.26° in simulated cases, and 2.78±0.95 mm and 3.10±0.53° in clinical cases, which has higher accuracy than methods based on mean shape models, and wider applicability than methods based on pelvic symmetry. CONCLUSION The pelvic digital model created by SSM has good generalization properties, and the SSM-based virtual reduction algorithm can effectively reconstruct the target position of the fractured pelvis in preoperative planning. SIGNIFICANCE The proposed reduction method has the characteristics of high precision and wide application range, which provides a powerful tool for the surgeon's virtual preoperative planning.
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Morello V, Zingg M, Andereggen E, Ansorge A, Valisena S, Gamulin A. High-energy blunt pelvic ring injury incidence and polytrauma caseload in a single level I trauma center during COVID-19 related pseudo-lockdown measures: a retrospective cohort study based on a prospective registry. Eur J Med Res 2023; 28:325. [PMID: 37684644 PMCID: PMC10486067 DOI: 10.1186/s40001-023-01313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Pelvic ring injuries are potentially lethal lesions associated with polytrauma patients and need an efficient trauma team for their management. The purpose of this study was to evaluate the incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients in a single level I trauma center during the 2020 pseudo-lockdown period related to the Coronavirus pandemic, and to compare it with corresponding periods in 2014-2019 in order to better understand the need of organized and dedicated personnel and infrastructures. METHODS This retrospective cohort study was based on data prospectively recorded into the institutional Severely Injured Patients' Registry. Data were obtained for each year period (January 1st to December 31st) and corresponding pseudo-lockdown period (March 16th to June 19th). High-energy blunt pelvic ring injuries inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) pelvic ring injury presence. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; (3) penetrating, blast, burn and electrical injuries, drownings; (4) patients living outside the defined institution's catchment area; and (5) any document attesting the patient's will to not participate in any study. Polytrauma patients inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) Injury Severity Score ≥ 16. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; and (3) any document attesting the patient's will to not participate in any study. Categorical variables were reported using proportions and continuous variables using medians and interquartile ranges. Because data were exhaustive for the authors' level I trauma center, no inferential statistics were computed. RESULTS The incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients remained within range of previous years despite pseudo-lockdown measures. CONCLUSIONS These observations bring better knowledge about pseudo-lockdown's impact on trauma and may help for future health strategy planning by pointing out the importance of maintaining the activity of level I trauma centers in terms of personnel and infrastructures.
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Affiliation(s)
- Vanessa Morello
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Elisabeth Andereggen
- Division of Emergency Medicine, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Alexandre Ansorge
- Division of Emergency Medicine, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Silvia Valisena
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland.
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Dai J, He J, Ying Y, Huang D, Feng L. Clinical and epidemiological characteristics of 369 patients with pelvic fractures in Eastern Zhejiang Province of China: a retrospective study. BMC Musculoskelet Disord 2023; 24:495. [PMID: 37328894 DOI: 10.1186/s12891-023-06632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Data on the epidemiological characteristics and prognostic factors of patients with pelvic fractures are lacking, particularly in China. This study aimed to summarise the clinical and epidemiological characteristics of patients with pelvic fractures in eastern Zhejiang Province, China, and to identify risk factors for poor prognosis. METHODS The clinical data of 369 patients with pelvic fractures admitted to the Ningbo No. 6 Hospital between September 2020 and September 2021 were retrospectively analysed. Data on the demographic characteristics; fracture classification; injury time, cause, and site; treatment plan; and prognosis were collected using the Picture Archiving and Communication System and the Hospital Information System. Differences in constituent proportions were analysed using the chi-square test. Logistic regression analysis was used to identify factors affecting patient prognosis. Statistical significance was set at p ≤ 0.05. RESULTS Among the 369 patients, there were 206 men and 163 women, at a ratio of 1.26:1, and the average age was 53.64 ± 0.78 years. More than 50% of patients were aged 41-65 years. The average length of hospital stay was 18.88 ± 1.78 days. The three most common causes of pelvic fractures were traffic accidents (51.2%), falls from height (31.44%), and flat-ground falls (14.09%). There were significant differences in the distribution of the three causes of injury depending on age (p < 0.001), sex (p < 0.001), and occupation (p < 0.0001). Most patients were manual workers (48.8%). Furthermore, most patients (n = 262, 71.0%) underwent surgical treatment for pelvic fractures. Postoperative complications occurred in 26 patients (7.05%), and infection was the main complication (73.08%). Age (p = 0.013), occupation (p = 0.034), cause of injury (p = 0.022), treatment options (p = 0.001), and complications (p < 0.0001) were independent factors affecting the prognosis of patients with pelvic fractures. One death (0.027%) occurred, which was due to severe blood loss. CONCLUSIONS Age, occupation, cause of injury, treatment options and complications were factors affecting patient prognosis. In addition, changes in blood flow and prevention of infection warrant attention.
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Affiliation(s)
- Jiao Dai
- Department of Traumatic Orthopedics, Ningbo No. 6 Hospital, Ningbo, China
| | - Junhong He
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Ying Ying
- Department of Nursing, Ningbo No. 6 Hospital, Ningbo, China
| | - Dichao Huang
- Department of Traumatic Orthopedics, Ningbo No. 6 Hospital, Ningbo, China
| | - Leling Feng
- Department of Nursing, Ningbo No. 6 Hospital, Ningbo, China.
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Ansorge A, de Foy M, Gayet-Ageron A, Andereggen E, Gamulin A. Epidemiology of high-energy blunt pelvic ring injuries: A three-year retrospective case series in a level-I trauma center. Orthop Traumatol Surg Res 2023; 109:103446. [PMID: 36270442 DOI: 10.1016/j.otsr.2022.103446] [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: 07/08/2021] [Revised: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND High-energy pelvic ring injuries (PRI) represent a heavy burden for institutions treating severely injured patients. Epidemiological data knowledge may help to provide them appropriate management. Only two epidemiologic studies about high-energy PRI were published during last decade. This study aimed to determine the gender-specific and global incidences of high-energy blunt AO/OTA type B or C PRI and their frequency among high-energy blunt trauma. It further reports the spectrum of these injuries and compares their characteristics and outcomes to high-energy blunt trauma without type B or C PRI. HYPOTHESIS Type B or C PRI incidence isn't gender specific and approximates 5/100,000/year. PATIENTS AND METHODS A prospective database of a level-I trauma center serving approximately 500,000 inhabitants was retrospectively queried for all high-energy trauma patients injured between 01.01.2014 and 12.31.2016. Inclusion criteria were: alive emergency department delivery; entire acute treatment at the authors' institution; age >16. Exclusion criteria were: penetrating, blast, burn and electrical injuries; drownings; low-energy trauma; patients living outside the institution's catchment area. Three authors performed PRI classifications. Clinical data were extracted from the database. RESULTS We analyzed 434 patients. High-energy blunt type B or C PRI incidence was 3.8/100,000/year without gender disparity (p=0.6697). High-energy blunt trauma incidence was lower in women than in men (20.5 vs. 51.6/100,000/year, p<0.001). Type B or C PRI frequency during high-energy blunt trauma was higher in women than in men (17.6% vs. 7.9%, p=0.003). Type B or C PRI patients were more severely injured and needed more treatment resources than other high-energy blunt trauma patients but didn't present higher complication or death rates. DISCUSSION The incidence of high-energy blunt type B or C PRI was comparable to previously published data. Women were less likely to sustain a high-energy blunt trauma, but when they sustained one, they were more likely to have a type B or C PRI. Despite higher injury severity score and resource requirements, complication and death rates weren't different between type B or C PRI patients and other high-energy blunt trauma patients. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Alexandre Ansorge
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000 Lucerne, Switzerland.
| | - Michaël de Foy
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Center, Faculty of Medicine, University of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Elisabeth Andereggen
- Division of Emergency Medicine, Department of Acute Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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Rungsinaporn V, Akkarawanit P, Kongmalai P. Benefits of early application of pelvic circumferential compression device to reduce bleeding in pelvic fractures. BMC Musculoskelet Disord 2022; 23:203. [PMID: 35241032 PMCID: PMC8892740 DOI: 10.1186/s12891-022-05166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background To study of efficacy of early pelvic circumferential compression device using in patients with suspected pelvic trauma, compared with conventional stepwise approach. Methods Traumatic injury and at least one of the following criteria are required for inclusion: loss of consciousness or a Glasgow coma score (GCS) of less than 13; systolic blood pressure less than 90 mmHg; falling from more than 6 m; injury to several important organs; and a positive pelvic compression test. Patients who satisfied the inclusion criteria for the experimental group were given an early application of a commercial pelvic sling beginning in July 2019. The control group consisted of cases who got the device after clinical or radiological confirmation of a pelvic fracture in the previous year. Gender, age, mechanism of injury, GCS, hospital stay, amount of packed red blood cell transfusion, hematocrit in emergency room, and hematocrit 24 h after application of pelvic binder were all assessed and compared. Results The study had a total of 30 participants, with 15 in each group. The number of packed red blood cell transfusions in the early pelvic binder group (0.80 ± 1.42) is considerably lower than in the control group (2.4 ± 2.32) (P = 0.008), although the hematocrit change is not statistically different between the groups (2.1 VS 0.7) (P = 0.191). The time it took to install a pelvic binder was considerably shorter in the early pelvic binder group (16.40 ± 5.45) than in the control group (40.40 ± 13.64) (P = 0.001). There were no problems associated to soft tissue and skin necrosis in either group of patients. Conclusions The use of the PCCD for 24 h prior to clinical and radiographic confirmation has significantly reduced the rate of packed red blood cell transfusion in any pelvic fracture patient without device-related complications. Trial registration The study was entered into the Thai Clinical Trials Registry (TCTR20210809007).
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Affiliation(s)
- Visit Rungsinaporn
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, 62 Moo 7, Rangsit-Nakhon Nayok Road, Ongkharak, Nakhon Nayok, 26120, Thailand
| | - Pawin Akkarawanit
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, 62 Moo 7, Rangsit-Nakhon Nayok Road, Ongkharak, Nakhon Nayok, 26120, Thailand
| | - Pinkawas Kongmalai
- Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, 62 Moo 7, Rangsit-Nakhon Nayok Road, Ongkharak, Nakhon Nayok, 26120, Thailand.
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12
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Zhang S, Mo H, Liu Y, Zhu G, Yu B. Failure of internal fixation of the anterior ring for unstable pelvic fractures, the experience of a single institute. J Orthop Surg Res 2021; 16:577. [PMID: 34587970 PMCID: PMC8482592 DOI: 10.1186/s13018-021-02735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials From January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The exclusion criteria included: (1) pathological fracture, or combined with pelvic bone tumor or severe osteoporosis; (2) femoral fracture and thoracolumbar fracture; (3) open pelvic fracture; (4) Morel-Lavallée injury; (5) complicated acetabular fracture. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system. Results According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5 to 28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate. Five patients undergoing revision surgery were followed up for 6–36 months with an average of 18 months. According to Majeed’s score at the last follow-up in the 5 patients undergoing revision surgery, there were 2 cases of excellent, 2 cases of good, 1 case of fair. The excellent and good rate reached 80%. Conclusion The treatment of complicated unstable pelvic fractures requires performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.
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Affiliation(s)
- Sheng Zhang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China. .,Department of Orthopedics, People's Hospital of Hua Zhou, Huazhou, Guangdong Province, China.
| | - Huagui Mo
- Department of Orthopedics, Jiangmen Central Hospital, Jiangmen, Guangdong Province, China
| | - Yucheng Liu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China
| | - Guohua Zhu
- Department of Orthopedics, People's Hospital of Hua Zhou, Huazhou, Guangdong Province, China
| | - Bin Yu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, China
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13
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Wu S, Chen J, Yang Y, Chen W, Luo R, Fang Y. Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases. J Orthop Surg Res 2021; 16:350. [PMID: 34059111 PMCID: PMC8165806 DOI: 10.1186/s13018-021-02387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
Background This study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures. Methods Intraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification. Results Twenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up. Conclusion INFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures. Trial registration ChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.
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Affiliation(s)
- Shuang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jialei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yun Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rong Luo
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, No.37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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Cheon SJ, Ahn TY, Jung SJ, Jang JH, Kim JH, Jeon CH. Does transarterial pelvic embolization have a negative effect on perioperative outcomes in pelvic ring injury and acetabular fracture? Asian J Surg 2021; 45:239-245. [PMID: 34078580 DOI: 10.1016/j.asjsur.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether TAE negatively impacted perioperative outcomes in patients who underwent open surgery for pelvic trauma. METHODS We retrospectively reviewed the medical records and radiographs of patients who had open surgery for an acute pelvic trauma between February 2014 and May 2017. The patients were classified into two groups: those who underwent TAE and those who did not. We evaluated preoperative demographics and perioperative outcomes between the two groups. Injury type-specific comparisons were also performed. RESULTS A total of 136 patients (50 TAE and 86 non-TAE) were included in this study. There were significant differences in preoperative demographics including the type of injury, injury severity score, revised trauma score, surgical approach, initial blood pressure, and the amount of transfusion within 24 h between the two groups. However, no differences in perioperative outcomes were identified except for the amount of total transfusion. There were significant differences between the two groups in the injury type-specific comparisons, specifically in the amount of transfusion within 24 h in patients with pelvic ring injury and in the injury severity score in patients with acetabular fracture. However, there was no difference in perioperative outcomes between the groups for either injury type. CONCLUSION In the present study, we were unable to identify negative effects of TAE on perioperative outcomes. Therefore, when considering open surgery subsequent to TAE, there is no evidence of increased risk for negative perioperative outcomes, especially with respect to bone healing and deep infection.
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Affiliation(s)
- Sang Jin Cheon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Tae Young Ahn
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Seok Jin Jung
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Republic of Korea
| | - Jae Hoon Jang
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Trauma Center, Pusan National University Hospital, Republic of Korea.
| | - Jae Hun Kim
- Department of Trauma Surgery, Trauma Center, Pusan National University Hospital, Republic of Korea
| | - Chang Ho Jeon
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Repubilic of Korea
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Chen YC, Chuang CH, Hsieh MH, Yeh HW, Yang SF, Lin CW, Yeh YT, Huang JY, Liao PL, Chan CH, Yeh CB. Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094868. [PMID: 34063602 PMCID: PMC8124968 DOI: 10.3390/ijerph18094868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Patients with pelvic fractures could encounter various complications during or after treatments. This cohort study investigated the risk of mortality and readmissions in patients with pelvic fractures, with or without urinary tract infections (UTIs), within 30 days following the pelvic fractures. This retrospective cohort study examined claim records from the Longitudinal Health Insurance Database 2000 (LHID2000). We selected patients hospitalized with pelvic fractures between 1997 and 2013 for study. Patients who had index data before 2000 or after 2010 (n = 963), who died before the index date (n = 64), who were aged <18 years (n = 94), or who had a pelvic injury (n = 31) were excluded. In total, the study cohort comprised 1623 adult patients; 115 had UTIs, and 1508 patients without UTIs were used as a comparison cohort. Multivariate analysis with a multiple Cox regression model and Kaplan-Meier survival analysis were performed to analyze the data. Our results showed that the 1-year mortality rate (adjusted hazard ratio [HR]: 2.32; 95% CI: 1.25-4.29) and readmission rate (adjusted HR: 1.72; 95% CI: 1.26-3.34) of the UTI group were significantly higher than those of the non-UTI group. Moreover, the Kaplan-Meier curve for the 1-year follow-up indicated that the UTI group had a higher cumulative risk of both mortality and hospital readmission compared with the non-UTI group. In conclusion, among patients with pelvic fracture, patients with UTI were associated with increased risks of mortality and readmission. Physicians must pay more attention to such patients to prevent UTIs among patients with pelvic fractures during hospitalization and conduct a follow-up after discharge within at least 1 year.
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Affiliation(s)
- Ying-Cheng Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Cheng-Hsun Chuang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ming-Hong Hsieh
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung 402, Taiwan;
| | - Ying-Tung Yeh
- Graduate School of Dentistry, School of Dentistry, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Chi-Ho Chan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-C.C.); (C.-H.C.); (S.-F.Y.); (J.-Y.H.)
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
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Assouline J, Tselikas L, Roux C, Yevich S, Delpla A, Najafi A, Al Ahmar M, Bijot JC, de Baère T, Deschamps F. Prophylactic Percutaneous Consolidation of Large Osteolytic Tumors of the Pelvic Ring Using Fixation by Internal Cemented Screws. Radiol Imaging Cancer 2021; 3:e200137. [PMID: 33988476 DOI: 10.1148/rycan.2021200137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the efficacy, durability, and safety of percutaneous fixation by internal cemented screw (FICS) for prophylactic consolidation of impending pathologic fractures of the pelvic ring. Materials and Methods In this single-institute retrospective study, patients with large, minimally symptomatic to asymptomatic osteolytic tumors of the pelvic ring that were treated with percutaneous cone-beam CT-guided FICS procedures were included (January 2014 to May 2019). Follow-up cross-section imaging and clinical reports were reviewed for procedural complications and assessment of the long-term consolidation efficacy on the basis of the development of pathologic fracture or need for additional surgical intervention. All continuous variables were expressed as a mean with standard deviation, and dichotomous variables were expressed as frequencies and percentages. Results Fifty consecutive patients (mean age, 60 years ± 12; 27 men) underwent prophylactic FICS for consolidation of 54 osteolytic tumors (mean size, 51 mm ± 21.5; range, 30-114 mm). Local tumor destruction was performed in association with FICS in 38 patients (76%) using percutaneous thermal and/or radiation therapy. Follow-up exceeded a year in 35 patients (70%), with mean follow-up of 22 months ± 18 (range, 1-67 months). Long-term consolidation efficacy was 98% (49 of 50), with the development of a pathologic fracture in only one patient 20 months after FICS. Procedural complications were limited to two patients with self-resolving hematoma, one patient with inflammatory sciatic pain, and one patient with focal pain at the ischial tuberosity. Conclusion Percutaneous FICS provides a safe and durable minimally invasive treatment for the prevention of pathologic fractures of the pelvic ring. Keywords: Interventional-MSK, Percutaneous, Skeletal-Axial, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Jessica Assouline
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Charles Roux
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Alexandre Delpla
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Arash Najafi
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Marc Al Ahmar
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Jean-Charles Bijot
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baère
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frédéric Deschamps
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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Kuner V, van Veelen N, Studer S, Van de Wall B, Fornaro J, Stickel M, Knobe M, Babst R, Beeres FJ, Link BC. Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures-Are Guidelines Followed in Daily Practice? J Clin Med 2021; 10:1297. [PMID: 33801087 PMCID: PMC8003916 DOI: 10.3390/jcm10061297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 01/02/2023] Open
Abstract
Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.
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Affiliation(s)
- Valerie Kuner
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
| | - Nicole van Veelen
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
| | - Stephanie Studer
- Medical Faculty, University of Zurich, 8091 Zurich, Switzerland;
| | - Bryan Van de Wall
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
| | - Jürgen Fornaro
- Department of Radiology, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland;
| | - Michael Stickel
- Department of Emergency Care, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland;
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
| | - Reto Babst
- Department of Health Science and Medicine, University of Lucerne, 6002 Luzern, Switzerland;
| | - Frank J.P. Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland; (N.v.V.); (B.V.d.W.); (M.K.); (F.J.P.B.); (B.-C.L.)
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18
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Zhou K, Tao X, Pan F, Luo C, Yang H. A novel Patient-Specific Three-Dimensional Printing Template Based on External Fixation for Pelvic Screw Insertion. J INVEST SURG 2020; 35:459-466. [PMID: 33377805 DOI: 10.1080/08941939.2020.1863528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the clinical effect of novel patient-specific 3D printing templates based on external fixation for pelvic screw insertion compared with the fluoro-navigation technique. MATERIALS AND METHODS We retrospectively studied 18 pelvic fracture patients from July 2017 to July 2018. For analysis, patients were divided into two groups: the template group (15 screws in 8 patients) and the fluoro-navigation group (22 screws in 10 patients). The screw insertion time, radiation exposure time, and accuracy of the screw insertion as evaluated by postoperative CT scans were analyzed. RESULTS In the template group, the average screw insertion time (11.5 ± 2.3 min/screw) was significantly 50.6% less than that in the fluoro-navigation group (23.3 ± 3.1 min/screw; P < 0.05). The average time of X-ray exposure in the template group (11.5 ± 3.9 s/screw) was also significantly 39.8% less than in the fluoro-navigation group (19.1 ± 2.5 s/screw; P < 0.05). In the template group, the mean deviation distance and angle between the actual and planned screw position was 2.6 ± 0.2 mm and 2 ± 0.3°. CONCLUSIONS The patient-specific template based on external fixation can guide the insertion of the pelvic screw accurately and safely while significantly reducing operation and radiation exposure time.
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Affiliation(s)
- Kaihua Zhou
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow, China.,Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Fudan University, Shanghai, China
| | - Xingguang Tao
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Fudan University, Shanghai, China
| | - Fugen Pan
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Fudan University, Shanghai, China
| | - Congfeng Luo
- Department of Orthopedics, Shanghai Sixth People's Hospital Shanghai Jiao Tong University, Shanghai, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow, China
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19
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Ead MS, Palizi M, Jaremko JL, Westover L, Duke KK. Development and application of the average pelvic shape in virtual pelvic fracture reconstruction. Int J Med Robot 2020; 17:e2199. [PMID: 33200858 DOI: 10.1002/rcs.2199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND With unilateral pelvic fractures, the contralateral hemipelvis can be used as a template in virtual reconstruction; however, this cannot be applied for bilateral fractures. Therefore, statistical shape modelling was used to build average pelvic shapes that can serve as templates when reconstructing bilaterally fractured pelvises. METHODS Four average shape models were created for male and female, left and right hemipelves from 20 male and 20 female subjects. They were used as templates to reconstruct eight unilaterally fractured pelvises. RESULTS The average root-mean-square of deviations between the reconstructed and intact hemipelves was 1.46 ± 0.32 mm, which is less than the 2 mm threshold for causing hip joint complications. CONCLUSION This indicates that the reconstructions are reliable and the average shape models can be used to reconstruct bilaterally fractured pelvises. The proposed technique can potentially provide quick and accurate treatment plans for pelvic fracture patients, which is necessary for recovery.
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Affiliation(s)
- Maha S Ead
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Mehrdad Palizi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Kajsa K Duke
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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20
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Watkins RJ, Hsu JM. The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures. Front Surg 2020; 7:58. [PMID: 32984402 PMCID: PMC7493634 DOI: 10.3389/fsurg.2020.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.
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Affiliation(s)
| | - Jeremy M Hsu
- Trauma Service, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
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21
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Rogich JJ, Kim RY, Chang S, Kaneshige J, Dao L. Pelvic Ring Fracture During a Professional Surfing Event at the Banzai Pipeline. Wilderness Environ Med 2020; 31:91-96. [PMID: 31955986 DOI: 10.1016/j.wem.2019.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
We present a case of a 32-y-old male professional surfer who sustained an isolated pelvic ring fracture after wiping out on a large wave and striking the ocean floor during a world championship tour surfing competition in Hawaii. The surfer was rescued by the water patrol lifeguards, evaluated by onsite medical staff, and stabilized for transfer and subsequent surgical management. As surfing and surfing competitions become increasingly popular, medical staff and event organizers must be aware of the possibility for severe, life-threatening injuries during surfing events. Although infrequent, staff must be prepared to manage these injuries, including immediate resuscitation, stabilization, analgesia, and transfer to definitive care. We hope this case encourages not only surf event organizers and medical staff, but also staff of all professional and recreational water sports, to increase their preparedness to stabilize and treat both life-threatening and minor injuries. Expeditious and appropriate treatment of an injured athlete has the potential to decrease morbidity and mortality while maximizing the athletes' functional outcome after injury.
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Affiliation(s)
| | - Reeo Yeop Kim
- The Queen's Medical Center, Department of Emergency Medicine, 301 Punchbowl St., Honolulu, HI, 96813
| | - Spencer Chang
- Hawaii Pacific Health, Department of Orthopedics, 55 Merchant St., Honolulu, HI, 96813
| | - Jason Kaneshige
- Hawaii Pacific Health, Department of Orthopedics, 55 Merchant St., Honolulu, HI, 96813
| | - Leland Dao
- Kaena Kai Clinic, 66-150 Kamehameha Hwy, Haleiwa, HI, 96712
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22
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Artoni C, Pogliacomi F, Guardoli L, Lasagni F, Leigheb M, Fontanesi F, Calderazzi F, Pompili M, Vaienti E, Ceccarelli F. Pelvic ring fractures: what about timing? ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:76-81. [PMID: 31821288 PMCID: PMC7233695 DOI: 10.23750/abm.v90i12-s.8949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries. Optimal timing for synthesis is not yet clear. The aim of this study was to define if surgical timing influenced clinic and radiographic outcomes following open reduction and internal fixation for Tile B and C fractures. MATERIALS AND METHODS 38 patients were included. Patients underwent a clinical examination with the Majeed Score, Iowa Pelvic Score and Orlando Pelvic Score. The radiographic assessment was performed according to Matta Pelvic Score. A statistical analysis of the data compared patients who were operated within 3 weeks (group 1) and those operated later (group 2). RESULTS Both clinical and radiological outcomes were influenced by timing of surgery. CONCLUSION Pelvic ring fractures interest many polytrauma patients and, therefore, their surgical orthopedic approach is frequently delayed as consequence of the severity of the associated clinical conditions. An early surgery of pelvic rong fractures allows a better quality of reduction and osteosynthesis.
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Affiliation(s)
- Carlotta Artoni
- Orthopaedics and Traumatology Clinic. Department of Medicine and Surgery. University of Parma. Italy. Via Gramsci 14, 43126 Parma (Italy).
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23
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Evolution of high-energy pelvic trauma in southern Finland: a 12-year experience from a tertiary trauma centre. Eur J Trauma Emerg Surg 2019; 47:541-546. [PMID: 31538218 PMCID: PMC8016785 DOI: 10.1007/s00068-019-01210-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022]
Abstract
Purpose We compared incidence, demographics, and injury mechanisms in severely injured patients with and without a pelvic ring fracture treated at a tertiary trauma centre. We also analyzed the changes in injury mechanisms that lead to high-energy pelvic trauma. Methods Data on severely injured adult patients (New Injury Severity Score [NISS] ≥16) from Helsinki Trauma Registry over the years 2006–2017 were reviewed. Patients with a pelvic ring fracture (PRF) and those without (N-PRF) were analyzed. Further subgrouping regarding time of the accident (2006–2009, 2010–2013, 2014–2017) was made. A comparison between groups was performed according to age, age > 60, gender, American Society of Anesthesiologists classification, injury scoring and mechanism, and 30-day in-hospital mortality. Results We included 545 PRF and 1048 N-PRF patients. Pelvic ring fracture patients were more likely to be female (39% vs 22%, p < 0.001), to be more severely injured (NISS 35.2 vs 30.4, p < 0.001), injured due to a high fall (41% vs 25%, p < 0.001), to have self-inflicted injuries (23% vs 8%, p < 0.001), and to have higher 30-day in-hospital mortality (13% vs 9%, p = 0.005). During the study period, we noted increasing mean age and proportion of patients aged > 60, improvement in outcome (shown by decreasing 30-day in-hospital mortality rate) in both groups, and a decrease in motor vehicle accidents (MVAs) leading to pelvic trauma (30–16%). Conclusions High-energy pelvic trauma can no longer be characterized as traffic accident injuries among young men. MVAs leading to pelvic trauma are decreasing and the most common injury mechanism is high fall. The patients are older and often female. Every fourth high-energy pelvic trauma was due to attempted suicide.
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24
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Fotouhi J, Unberath M, Song T, Hajek J, Lee SC, Bier B, Maier A, Osgood G, Armand M, Navab N. Co-localized augmented human and X-ray observers in collaborative surgical ecosystem. Int J Comput Assist Radiol Surg 2019; 14:1553-1563. [PMID: 31350704 DOI: 10.1007/s11548-019-02035-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Image-guided percutaneous interventions are safer alternatives to conventional orthopedic and trauma surgeries. To advance surgical tools in complex bony structures during these procedures with confidence, a large number of images is acquired. While image-guidance is the de facto standard to guarantee acceptable outcome, when these images are presented on monitors far from the surgical site the information content cannot be associated easily with the 3D patient anatomy. METHODS In this article, we propose a collaborative augmented reality (AR) surgical ecosystem to jointly co-localize the C-arm X-ray and surgeon viewer. The technical contributions of this work include (1) joint calibration of a visual tracker on a C-arm scanner and its X-ray source via a hand-eye calibration strategy, and (2) inside-out co-localization of human and X-ray observers in shared tracking and augmentation environments using vision-based simultaneous localization and mapping. RESULTS We present a thorough evaluation of the hand-eye calibration procedure. Results suggest convergence when using 50 pose pairs or more. The mean translation and rotation errors at convergence are 5.7 mm and [Formula: see text], respectively. Further, user-in-the-loop studies were conducted to estimate the end-to-end target augmentation error. The mean distance between landmarks in real and virtual environment was 10.8 mm. CONCLUSIONS The proposed AR solution provides a shared augmented experience between the human and X-ray viewer. The collaborative surgical AR system has the potential to simplify hand-eye coordination for surgeons or intuitively inform C-arm technologists for prospective X-ray view-point planning.
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Affiliation(s)
- Javad Fotouhi
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA. .,Department of Computer Science, Johns Hopkins University, Baltimore, USA.
| | - Mathias Unberath
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, USA
| | - Tianyu Song
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA
| | - Jonas Hajek
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA.,Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sing Chun Lee
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, USA
| | - Bastian Bier
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA.,Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Greg Osgood
- Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Mehran Armand
- Applied Physics Laboratory, Johns Hopkins University, Baltimore, USA.,Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Nassir Navab
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, USA.,Department of Computer Science, Johns Hopkins University, Baltimore, USA.,Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
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25
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Wu T, Su K, Zhang YZ, Yang ZY, Li HJ, Han YT. Biomechanical comparison of three kinds of fixation in fracture-dislocation of the sacroiliac joint. Technol Health Care 2019; 27:89-99. [PMID: 30507595 DOI: 10.3233/thc-181274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although there are several different kinds of fixation techniques for the sacroiliac fracture-dislocation, the treatment remains a challenge for orthopedic surgeons. OBJECTIVE The purpose of this study was to compare the stability of sacroiliac fracture-dislocation fixed with two iliosacral (IS) screws, tension band plate (TBP), and minimally invasive adjustable plate (MIAP). METHODS Five human cadavers (L4-pelvic-femora) were used to compare biomechanical stability. The pubic symphysis separation and left sacroiliac dislocation were created. The symphysis pubis was stabilized with a five-hole plate. The sacroiliac joint dislocation fracture was fixed with three kinds of internal fixation in a randomized design. The specimens were fastened in a biomechanical machine with a cycle vertical load. Displacements of the whole specimen and shifts in the fracture gap were recorded. RESULTS Under different vertical loads, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were similar to those in fractures fixed with two IS screws. However, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were significantly smaller than those fixed with TBP. CONCLUSIONS The stability of the sacroiliac joint dislocation fixed with MIAP was similar to that of dislocation fixed with two IS screws, and MIAP performed better than the TBP under vertical load.
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26
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Roux C, Tselikas L, Yevich S, Sandes Solha R, Hakime A, Teriitehau C, Gravel G, de Baere T, Deschamps F. Fluoroscopy and Cone-Beam CT-guided Fixation by Internal Cemented Screw for Pathologic Pelvic Fractures. Radiology 2018; 290:418-425. [PMID: 30422090 DOI: 10.1148/radiol.2018181105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the safety and efficacy of palliative treatment of patients with pathologic pelvic by using fluoroscopy and cone-beam CT needle guidance software to perform percutaneous fixation by internal cemented screw (FICS). Materials and Methods This single-center study involved retrospective analysis of 100 consecutive patients with cancer with pathologic pelvic fractures managed with percutaneous FICS. Image guidance was performed with fluoroscopy and cone-beam CT needle guidance software. Pain palliative outcomes and opioid use after FICS were compared by means of paired-sample t test. Results A total of 107 percutaneous FICS procedures were performed from 2010 to 2017 to palliate 141 pathologic fractures in 100 patients (mean age, 65.0 years ± 17.6 [standard deviation; female age, 66.3 years ± 18.0; mean, 63.7 years ± 17.2]). Of 107 procedures, 104 (97.2%) were technically successful, with mean postprocedure hospitalization of 2 days ± 3. Complications occurred in 14 patients: focal pain at procedure site for longer than 48 hours (n = 5), hematoma (n = 3), progressive fracture despite fixation (n = 2), infection (n = 1), tumor track seeding (n = 1), and screw displacement (n = 2). In the 88 patients who completed early follow-up, mean numeric rating scale pain score was significantly improved at 6 weeks from 6.1 ± 2.5 to 2.1 ± 3.0 (P < .001). Opioid use was reduced at 6 weeks (preprocedure vs postprocedure, 91.3 g ± 121 vs 64.6 g ± 124, respectively; P = .04). Conclusion Fluoroscopy and cone-beam CT-guided percutaneous fixation of pathologic pelvis fractures by internal cemented screw is a safe and effective approach that can reduce pain and opioid use. © RSNA, 2018.
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Affiliation(s)
- Charles Roux
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Raphael Sandes Solha
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Antoine Hakime
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Christophe Teriitehau
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Guillaume Gravel
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baere
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frederic Deschamps
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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27
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Deschamps F, Yevich S, Gravel G, Roux C, Hakime A, de Baère T, Tselikas L. Percutaneous Fixation by Internal Cemented Screw for the Treatment of Unstable Osseous Disease in Cancer Patients. Semin Intervent Radiol 2018; 35:238-247. [PMID: 30402006 DOI: 10.1055/s-0038-1673359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Interventional radiology expertise in image guidance has expanded the treatment options for cancer patients with unstable osseous disease. Percutaneous fixation by internal cemented screw (FICS) describes the technique by which the interventional radiologist stabilizes a fracture or impending fracture with the percutaneous placement of a cannulated screw that is locked in position by polymethyl methacrylate cement. The durable metallic screws provide added resistance to torque and tension stresses that complement the axial compression resistance of cement. Compared with cementoplasty alone, the procedure has been advanced as a more durable and precise technique for stabilization of osseous disease for certain disease presentations in cancer patients. The application of advanced image guidance techniques improves upon existing percutaneous surgical techniques to facilitate approaches that would otherwise prove quite challenging, particularly with stabilization of the pelvic flat bones. This article examines the applications of percutaneous FICS procedures for the treatment of unstable osseous disease in cancer patients. Indications, techniques, and follow-up care are reviewed. Case examples in which FICS can be performed in unstable pathology are detailed.
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Affiliation(s)
- Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guillaume Gravel
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Antoine Hakime
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
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28
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Abstract
PURPOSE OF REVIEW Complex traumatic pelvic ring disruptions are associated with a high mortality rate due to associated retroperitoneal hemorrhage, traumatic-hemorrhagic shock, and postinjury coagulopathy. The present review provides an update on current management strategies to improve survival rates form hemodynamically unstable pelvic ring injuries. RECENT FINDINGS Recently published international consensus guidelines have attempted to standardize the classification of hemodynamically unstable pelvic ring injuries and provided classification-based management algorithms for acute resuscitation and pelvic ring stabilization. SUMMARY Acute management strategies for pelvic ring disruptions with associated hemorrhagic shock include resuscitative endovascular balloon occlusion of the aorta for patients 'in extremis' in conjunction with point-of-care guided resuscitation for postinjury coagulopathy. Recent data indicate that a protocol of early pelvic external fixation in conjunction with direct preperitoneal pelvic packing and subsequent angioembolization in patients with ongoing hemorrhage results in significantly improved survival from retroperitoneal exsanguinating hemorrhage in at-risk patients with historic mortality rates as high as 50-60%.
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29
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Miller R. A Multidisciplinary Approach to Treating Traumatic Pelvic Fractures: 1.1 www.aornjournal.org/content/cme. AORN J 2018; 108:13-22. [PMID: 29953606 DOI: 10.1002/aorn.12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic fractures are traumatic injuries that can be caused by motor vehicle accidents, motorcycle accidents, motor vehicle-related pedestrian injuries, or falls from a significant height. These injuries can be life threatening because of the high vascularity of the pelvis and the difficulty in being able to see bleeding occurring in this area. Traditional approaches to treat pelvic fractures have been pelvic binding, external fixation, and open preperitoneal packing; however, the use of angiography and embolization enables faster pinpointing of the location of the bleeding. Increased use of hybrid ORs for treating traumatic pelvic fractures combines the superior imaging of interventional radiology with an OR that can quickly provide open interventions without needing to move a patient from an interventional radiology suite to another OR. This improvement in technology has combined the resources and knowledge of more diverse disciplines to provide a more centralized approach to improving patient outcomes.
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30
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Tempelaere C, Vincent C, Court C. Percutaneous posterior fixation for unstable pelvic ring fractures. Orthop Traumatol Surg Res 2017; 103:1169-1171. [PMID: 28964921 DOI: 10.1016/j.otsr.2017.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/11/2017] [Accepted: 07/25/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Several posterior fixation techniques for unstable pelvic ring fractures have been described. Here, we present a minimally invasive, percutaneous technique to fix the two posterior iliac crests using spinal instrumentation. Between September 2008 and March 2012, 11 patients with a mean age of 36.4 years were operated because of a vertically unstable Tile C pelvic ring fracture. Posterior fixation was performed using two polyaxial screws in each iliac crest with two subfascial connector rods. At the final follow-up, all patients were evaluated clinically and radiologically. The mean surgery time was 45 minutes; there were no intraoperative complications. At a mean follow-up of four years, the functional Majeed score was excellent in eight patients and good in three patients. The radiological results were excellent in eight patients and good in three patients. Percutaneous posterior fixation of vertically unstable pelvic fractures leads to good functional and radiological outcomes. TYPE OF STUDY Technical note, retrospective. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Tempelaere
- Centre hospitalier de Bicêtre, groupe des hôpitaux Paris-Sud, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France.
| | - C Vincent
- Centre hospitalier de Bicêtre, groupe des hôpitaux Paris-Sud, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France; Clinique des lilas, 49, avenue du Maréchal-Juin, 93260 Les-Lilas, France
| | - C Court
- Centre hospitalier de Bicêtre, groupe des hôpitaux Paris-Sud, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France
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Stevenson AJ, Swartman B, Bucknill AT. [Percutaneous internal fixation of pelvic fractures. German version]. Unfallchirurg 2017; 119:825-34. [PMID: 27659308 DOI: 10.1007/s00113-016-0242-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported. OBJECTIVES The purpose of this article is to outline the imaging, indication, planning, equipment, surgical technique and complications of these methods. METHODS A review of the literature is provided and the techniques for anterior and posterior pelvic stabilization are discussed. RESULTS High-quality preoperative CT scans are essential in planning for this technique. The anterior internal fixator ("InFix") is an effective method for stabilizing the anterior ring and should be usually used in conjunction with posterior fixation. Good technique avoids neurovascular injury, which can be a devastating complication. The retrograde anterior column screw (RACS) is a technique that can be used in most patients, although in smaller patients smaller screw diameters may be needed. The entry point for the screw is more lateral in women than men. Iliosacral screws (ISS) are an effective method of posterior stabilization and can be placed using 2D or 3D fluoroscopy, computer navigation or CT navigation. CONCLUSION Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.
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Affiliation(s)
- A J Stevenson
- Pelvic Reconstruction and Trauma Fellow, Royal Melbourne Hospital, Victoria, Australia
| | - B Swartman
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - A T Bucknill
- Pelvic Reconstruction and Trauma Fellow, Royal Melbourne Hospital, Victoria, Australia. .,Head of Orthopaedic Surgery, The University of Melbourne, Royal Melbourne Hospital, 3050, Victoria, Australia.
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Pelvic ring injuries: Surgical management and long-term outcomes. J Clin Orthop Trauma 2016; 7:1-6. [PMID: 26908968 PMCID: PMC4735567 DOI: 10.1016/j.jcot.2015.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/14/2015] [Indexed: 11/21/2022] Open
Abstract
Pelvic ring injuries present a therapeutic challenge to the orthopedic surgeon. Management is based on the patient's physiological status, fracture classification, and associated injuries. Surgical stabilization is indicated in unstable injury patterns and those that fail nonsurgical management. The optimal timing for definitive fixation is not clearly defined, but early stabilization is recommended. Surgical techniques include external fixation, open reduction and internal fixation, and minimally invasive percutaneous osteosynthesis. Special considerations are required for concomitant acetabular fractures, sacral fractures, and those occurring in skeletally immature patients. Long-term outcomes are limited by lack of pelvis-specific outcome measures and burden of associated injuries.
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Zhou KH, Luo CF, Chen N, Hu CF, Pan FG. Minimally invasive surgery under fluoro-navigation for anterior pelvic ring fractures. Indian J Orthop 2016; 50:250-5. [PMID: 27293284 PMCID: PMC4885292 DOI: 10.4103/0019-5413.181791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of pelvic fractures in trauma patients is reported to be 3-8.2%, with roughly half of these fractures being caused by high energy injuries with a potential for catastrophic hemorrhage and death. Indications for internal fixation of anterior pelvic ring are controversial. Because of fears of disturbing the pelvic hematoma and causing additional hemorrhage, open reduction and internal fixation of pelvic ring disruption is routinely delayed. In contrast to conventional surgery, percutaneous screw fixation is gaining popularity in the treatment of pelvic and acetabular fractures mainly because of minimal soft tissue damage, less operative blood loss, early surgical intervention and comfortable mobilization of the patient. Fluoro-navigation is a new surgical technique in orthopedic trauma surgery. This study is to investigate clinical results of fluoro-navigation surgery in anterior pelvic ring fractures. MATERIALS AND METHODS From January 2006 to October 2011, 23 patients with anterior pelvic ring fractures were treated with percutaneous cannulated screw under fluoro-navigation. There were 14 men and 9 women, with a mean age of 40.1 years (range 25-55). According to the AO and Orthopedic Trauma Association classification, there were seven A 2.1, two A 2.2, one A 2.3, six B 1.2, one B 2.1: 1, one B 2.2, one C 1.2, two C 1.3 and two C 2.3 types of fractures. Amongst these patients, 13 had posterior pelvic ring injuries, 8 had other injuries including urethral, lumbar vertebrae fractures and femoral fractures. All patients were operated when their general condition stabilized after emergency management. The mean time from injury to percutaneous screw fixation of the anterior pelvic ring fracture was 12 days (3-15 days). All the anterior ring fractures were fixed with cannulated screws by two senior surgeons. They were familiar with the navigation system and had gained much experience in the computer-assisted percutaneous placement of screws. RESULTS A total of 32 screws were inserted, including 19 in the pubic ramis and 13 in the anterior acetabular columns. The average surgical time was 23.3 min/screw. The average time of X-ray exposure was 19.1 ± 2.5 s/screw. The virtual images of fluoro-navigation were compared with real-time X-rays during and after the surgery. Compared to the final position of the screw, the average deviated distance was 3.11 mm and the average trajectory difference was 2.81°. Blood loss during the operation was minimal (22.3 ml/screw). One screw (3.1%) deviated out of the fracture site during the operation. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of the percutaneous screw fixation. All fractures united at the last followup. CONCLUSIONS Fluoro-navigation technique could become a safe, accurate, and fairly quick method for the treatment of anterior pelvic ring fractures. Standardization of the operative procedure and training are mandatory for the success of this procedure.
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Affiliation(s)
- Kai-Hua Zhou
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Cong-Feng Luo
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China,Address for correspondence: Prof. Cong-Feng Luo, Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200233, China. E-mail:
| | - Nong Chen
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Cheng-Fang Hu
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
| | - Fu-Gen Pan
- Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
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Halawi MJ. Pelvic ring injuries: Emergency assessment and management. J Clin Orthop Trauma 2015; 6:252-8. [PMID: 26566339 PMCID: PMC4600881 DOI: 10.1016/j.jcot.2015.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/14/2015] [Indexed: 01/26/2023] Open
Abstract
Pelvic ring injuries are associated with significant morbidity and mortality. Understanding the anatomy of the pelvic ring is essential for accurate diagnosis and treatment. A systematic approach taking into account the mechanism of injury, physical examination, and radiographic assessment is important to quickly identify unstable pelvic disruptions and associated injuries. Because the pelvis is a ring structure, isolated pubic rami fractures on plain radiographs are unusual and should warrant careful evaluation for posterior pelvic disruption with computed tomography. Hemorrhagic shock can occur in about 10% of pelvic ring injuries. Immediate recognition and treatment of this life-threatening condition is critical in emergency management. In addition to fluid resuscitation and blood transfusion, circumferential wrapping, angiographic embolization, laparotomy with pelvic packing, and external fixation can be important life-saving adjuncts in the setting of hemodynamic instability.
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Liu Z, Wang K, Zhang K, Zhou J, Zhang Y. Minimally invasive surgery (MIS) of anterior ring fracture combined with pubic symphysis separation. Med Sci Monit 2014; 20:1913-7. [PMID: 25308286 PMCID: PMC4207289 DOI: 10.12659/msm.892358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to evaluate the reliability of open reduction and minimally invasive plate osteosynthesis (MIPO) for anterior ring fracture combined with pubic symphysis separation and to explore the operative techniques and therapeutic efficacy. Material/Methods We used minimally invasive plate osteosynthesis (MIPO) to treat anterior ring fracture combined with pubic symphysis separation. Results During postoperative follow-up, all patients recovered well, with no fat liquefaction, infection, femoral nerve or iliac blood vessels injury, deep vein thrombosis, heterotopic ossification, or any and other complications. Conclusions The MIS or MIPPO for anterior ring fracture combined with pubic symphysis separation has the advantages of short operation time and less blood loss. This clinical operation is safe and feasible, with therapeutic efficacy.
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Affiliation(s)
- Zhendong Liu
- Department of Orthopaedics and Traumatology, Third Xiangya hospital of Central South University, Changsha, China (mainland)
| | - Kuixiang Wang
- Department of Orthopaedics and Traumatology, Third Xiangya hospital of Central South University, Changsha, China (mainland)
| | - Kexiang Zhang
- Department of Orthopaedics and Traumatology, Third Xiangya hospital of Central South University, Changsha, China (mainland)
| | - Jiahui Zhou
- Department of Orthopaedics and Traumatology, Third Xiangya hospital of Central South University, Changsha, China (mainland)
| | - Yuanjun Zhang
- Department of Orthopaedics and Traumatology, Third Xiangya hospital of Central South University, Changsha, China (mainland)
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