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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; 31:373-380. [PMID: 38654530 DOI: 10.1177/15533506241249260] [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] [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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Du S, Li X, Wei C, Ma Y, Liu J, Wu Y. Comparison of the operation safety and biomechanical stability of sacral alar-iliac vs. sacroiliac screws in the fixation of sacroiliac joint in simulated models of low bone density. Injury 2024; 55:111191. [PMID: 37972487 DOI: 10.1016/j.injury.2023.111191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sacral alar-iliac screws (SAISs) have been used for sacroiliac joint and are superiority to traditional sacroiliac screws (SISs) in patients with low bone density. The aim of this study was to investigate the operation safety and biomechanical stability of the SIS, transsacral-transiliac screw (TSTIS), S1AIS and S2AIS in the treatment of sacroiliac joint in simulated models of low bone density. METHODS CT data from 80 normal pelvic structures were employed to measure the anatomical parameters, including the safety zones of the S1AIS and S2AIS at the insertion point and the trajectory lengths of the SIS, TSTIS, S1AIS and S2AIS. Sixteen synthetic pelvises with simulated osteoporotic bone structure were used to simulate type C Tile lesions and divided into 4 groups with an anterior plate and posterior fixation using one of the following: 1) one SIS on each side, 2) one TSTIS fixing both sides, 3) one S1AIS on each side, or 4) one S2AIS on each side. The stiffness and maximum load of the specimens were analyzed using a biomechanical machine under vertical loading. RESULTS The safety zone of S1AIS was larger than that of S2AIS (p < 0.05). The TSTIS had the largest trajectory length, followed by the S1AIS and S2AIS, and the SIS had the smallest trajectory length (p < 0.05). However, the lengths of the TSTIS (26.1 ± 1.7 mm) and SIS (27.8 ± 1.8 mm) trajectories on the short side (the iliac side) were smaller than those of S1AIS (40.4 ± 3.8 mm) and S2AIS (39.1 ± 3.8 mm), thus indicating significant differences (p < 0.05). The stiffness and maximum load of S1AIS and S2AIS were similar and the greatest, followed by TSTIS and SIS (p < 0.05). CONCLUSION The stability of S1AIS and S2AIS is similar, both stronger than that of SIS and TSTIS, which have shorter lengths of the screw trajectories on the ilium side. However, the safety zone of S2AIS at the insertion point is smaller than that of S1AIS. Therefore, considering both safety and stability, S1AIS is the preferred choice for fixation of sacroiliac joint dislocation in simulated models of low bone density.
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Affiliation(s)
- Shihao Du
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Xin Li
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Changbao Wei
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Yunhong Ma
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China.
| | - Jun Liu
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Yongwe Wu
- Department of Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
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Hamilton WG, Sershon RA, Gupta A, Goldstein L, Kabiri M, Holy CE, Diaz R. Readmission rate and healthcare utilization outcomes of computer-assisted fluoroscopy-based hip navigation versus manual total hip arthroplasty. Expert Rev Med Devices 2023; 20:779-789. [PMID: 37466357 DOI: 10.1080/17434440.2023.2238609] [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] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The study evaluates the technology of fluoroscopy-based hip navigation that has shown to improve implant positioning in total hip arthroplasty (THA). METHODS Premier Healthcare data for patients undergoing manual THA or fluoroscopy-based hip navigation THA between 1 January 2016-30 September 2021, were analyzed 90- and 365-day post-THA. The primary outcome was inpatient readmission. Secondary outcomes were operating room (OR) time, length of stay, discharge status, and hospital costs. Baseline covariate differences were balanced using fine stratification and analyzed using generalized linear models. RESULTS Among 4,080 fluoroscopy-based hip navigation THA and 429,533 manual THA balanced patients, hip-related readmission rates were statistically significantly lower for the fluoroscopy-based hip navigation THA cohort vs. manual THA for both 90-day (odd ratio [95% CI]: 0.69 [0.52 to 0.91] and 365-day (0.63 [0.49 to 0.81] follow-up. OR time was higher with fluoroscopy-based hip navigation THA vs. manual THA (134.65 vs. 132.04 minutes); however, fluoroscopy-based hip navigation THA patients were more likely to be discharged to home (93.73% vs. 90.11%) vs. manual THA. Hospital costs were not different between cohorts at 90- and 365-day post-operative. CONCLUSIONS Fluoroscopy-based hip navigation THA resulted in fewer readmissions, greater discharge to home, and similar hospital costs compared to manual THA.
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Affiliation(s)
| | | | - Anshu Gupta
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Laura Goldstein
- DePuy Synthes Digital, Robotics & Emerging Channels, Raynham, MA, USA
| | - Mina Kabiri
- DePuy Synthes Digital, Robotics & Emerging Channels, Raynham, MA, USA
| | - Chantal E Holy
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Rodrigo Diaz
- DePuy Synthes, Medical Affairs, Palm Beach Gardens, FL, USA
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Liuzza F, Smakaj A, Rovere G, De Mauro D, Rollo G, Erasmo R, Fidanza A, Gruobor P, Meccariello L. Outcomes at 2 years follow-up of sacral fractures associated with unstable vertical pelvic ring injuries in obese patients: a multicentric retrospective study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023153. [PMID: 37326262 PMCID: PMC10308469 DOI: 10.23750/abm.v94i3.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur in patients involved in high-energy trauma. When operative treatment is required, high surgical experience on the field is mandatory, especially in a sub-polpulation of obese patients which have increased risk of complications. The aim of this multicentric retroscpective study was to describe and analyze clinical and radiological outcomes of sacral vertical fractures in obese patients with a minimum of 2 years follow-up. Methods: A total of 121 pelvic fractures admitted to Emergency Departments of three II level trauma centres from April 2015 to April 2021 were retrospectively reviewed. Demographics, injury mechanism, surgical data and complications were collected. The quality of life and the pelvic function were respectively measured by SF-12 questionnaires, Denis Work Scale and Majeed Score. The inter-rater agreement between the clinical scores and the Denis Work Scale was assessed. Results: A total of 19 patients were included in the study. The average follow up was 41.16 months. The average BMI was 38.63 and the mean abdominal circumference was 128.10 cm. The average Majeed and SF-12 scores were respectively 66.47 and 74.32. Five patients were able to return to their previous employment. The post traumatic life's quality and related dysfunctions are influenced by the high BMI. Conclusions: Faster recovery and early weight-bearing should be persued in order to minimize complications, expecially in obese patients. In these sample of patients, "triangular osteosynthesis" was the best treatment choice for sacral vertical fractures.
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Brahme IS, Hu CH, Cole PA. Infection from an Iliosacral Screw 16 Years Postoperatively in Demolition Derby Umpire Crushed Between 2 Cars: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00021. [PMID: 36719947 DOI: 10.2106/jbjs.cc.22.00606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/20/2022] [Indexed: 02/01/2023]
Abstract
CASE A 47-year-old man crushed between 2 cars during a demolition derby, a nonracing North American motorsport, underwent open reduction and internal fixation, iliosacral screw fixation, arterial embolization, and multiple urologic procedures after massive pelvic ring injury, remarkably recovering nearly full function. Sixteen years after injury, he developed an abscess emanating from an iliosacral screw requiring irrigation, debridement, and hardware removal. CONCLUSION Deep surgical infections from iliosacral screws may present late, even more than 15 years after the original surgery. Obesity, preoperative embolization, diabetes, and urethral injuries are relevant risk factors. Similar patients should have a low threshold for infection workup when presenting with symptoms, even years after surgery.
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Affiliation(s)
- Indraneel S Brahme
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Caroline H Hu
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.,HealthPartners Orthopaedics & Sports Medicine, Bloomington, Minnesota
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Timmer RA, Mostert CQB, Krijnen P, Meylaerts SAG, Schipper IB. The relation between surgical approaches for pelvic ring and acetabular fractures and postoperative complications: a systematic review. Eur J Trauma Emerg Surg 2022; 49:709-722. [PMID: 36434301 PMCID: PMC10175345 DOI: 10.1007/s00068-022-02118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
Material and Methods
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
Results
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher–Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4–8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
Conclusion
External fixation of pelvic fractures is associated with highest complications rates including SSI’s and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
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Amer MH, Elnahal WA, Khaled SA, Abdel-Kader KF, Cass MA, Gibbs J, Stott PM. Minimally invasive sacroiliac fusion, a case series, and a literature review. SICOT J 2022; 8:42. [PMID: 36282089 PMCID: PMC9595039 DOI: 10.1051/sicotj/2022042] [Citation(s) in RCA: 3] [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] [Received: 08/27/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Non-autoimmune sacroiliac joint pain contributes to nearly a quarter of low back pain patients. Non-surgical management fails to satisfy patients. A new minimally invasive technique for sacroiliac stabilization has been introduced, defying the traditional rules of fusion. The results outside explanatory trials and in day-to-day practice have not been reported. MATERIALS AND METHODS This case series includes 20 patients diagnosed with chronic sacroiliac pain resistant to conservative management for at least 6 months. The diagnosis was confirmed with a positive sacroiliac injection. Patients underwent stabilization using the iFuse® implant. Patients were followed up for a minimum of one year. The primary outcome was the functional outcomes, assessed using VAS, ODI, and SF36. Secondary procedure rates, complication rates, and radiological assessments of fusion were collected as secondary outcomes. RESULTS At one year, the mean VAS score improved from 81.25 ± 10.7 SD preoperatively to 52.5 ± 26.8, p-value 0.0013. The mean ODI improved from 54.8 ± 11.21 SD preoperatively to 41.315 ± 15.34, P value = 0.0079. The mean PCS and MCS of SF36 improved by 17 and 20 points, respectively. Only 55% of patients achieved the MCID for the VAS score. 35% of the cohort had secondary procedures. DISCUSSION Minimally invasive sacroiliac fusion resulted in an improvement in mean functional scores with a wide dispersion. Patients not achieving MCID are patients with either a malpositioned implant, an associated lumbar pathology, or an inaccurate diagnosis. Our results are underwhelming compared to similar work but are still better than conservative cohorts in comparative studies. CONCLUSION Minimally invasive sacroiliac fusion can be used successfully in select patients. Attention to diagnosis and surgical technique can improve the reproducibility of results.
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Affiliation(s)
- Mohammad H. Amer
- Department of Trauma and Orthopaedics, University Hospital of Sussex NHS Trust, Royal Sussex County Hospital Eastern Road Brighton BN2 5BE United Kingdom,Department of Trauma and Orthopaedics, Cairo University, Al Kasr Al Aini Hospital Old Cairo Cairo 4240310 Egypt,Corresponding author:
| | - Walid A. Elnahal
- Department of Trauma and Orthopaedics, Cairo University, Al Kasr Al Aini Hospital Old Cairo Cairo 4240310 Egypt
| | - Sherif A. Khaled
- Department of Trauma and Orthopaedics, Cairo University, Al Kasr Al Aini Hospital Old Cairo Cairo 4240310 Egypt
| | - Khaled F.M. Abdel-Kader
- Department of Trauma and Orthopaedics, Cairo University, Al Kasr Al Aini Hospital Old Cairo Cairo 4240310 Egypt,Orthopaedics Department, Armed Forces College of Medicine Cairo 4460015 Egypt
| | - Michael A. Cass
- Consultant Spinal Surgeon Spring Orthopaedic Group; Honorary Consultant Spinal Surgeon University Hospitals of Sussex NHS Trust, Montefiore Hospital Montefiore Road Hove BN3 1RD United Kingdom
| | - James Gibbs
- Department of Trauma and Orthopaedics, University Hospital of Sussex NHS Trust, Royal Sussex County Hospital Eastern Road Brighton BN2 5BE United Kingdom
| | - Philip M. Stott
- Department of Trauma and Orthopaedics, University Hospital of Sussex NHS Trust, Royal Sussex County Hospital Eastern Road Brighton BN2 5BE United Kingdom
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Völker A, Steinke H, Heyde CE. The Sacroiliac Joint as a Cause of Pain - Review of the Sacroiliac Joint Morphology and Models for Pain Genesis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:507-516. [PMID: 33940639 DOI: 10.1055/a-1398-6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In recent years, the sacroiliac joint has become increasingly important as a generator of low back pain with and without pseudo-radicular pain in the legs. Up to 27% of reported back pain is generated by disorders in the sacroiliac joint. METHOD This review is based on a selective literature search of the sacroiliac joint (SIJ) as a possible pain generator. It also considers the anatomical structures and innervation of the sacroiliac joint. RESULTS The SIJ is a complex joint in the region of the posterior pelvis and is formed by the sacrum and the ilium bones. The SIJ is very limited in movement in all three planes. Joint stability is ensured by the shape and especially by strong interosseous and extraosseous ligaments. Different anatomical variants of the sacroiliac joint, such as additional extra-articular secondary joints or ossification centres, can be regularly observed in CT scans. There is still controversy in the literature regarding innervation. However, there is agreement on dorsal innervation of the sacroiliac joint from lateral branches of the dorsal rami of the spinal nerves S I-S III with proportions of L III and L IV as well S IV. Nerve fibres and mechanoreceptors can also be detected in the surrounding ligaments. CONCLUSION A closer look at the anatomy and innervation of the SIJ shows that the SIJ is more than a simple joint. The complex interaction of the SIJ with its surrounding structures opens the possibility that pain arises from this area. The SIJ and its surrounding structures should be included in the diagnosis and treatment of back and leg pain. Published literature include a number of plausible models for the sacroiliac joint as pain generator. The knowledge of the special anatomy, the complex innervation as well as the special and sometimes very individual functionality of this joint, enhance our understanding of associated pathologies and complaints.
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Affiliation(s)
- Anna Völker
- Orthopaedic, Trauma Surgery and Plastic Surgery Clinic, Leipzig University Clinics, Germany
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Wan Y, Yu K, Xu Y, Ma Y, Zeng L, Zhang Z, Yin Z, Song Q, Chen K, Guo X. Both-Column Acetabular Fractures: Should Pelvic Ring Reduction or Acetabulum be Performed First? Orthop Surg 2022; 14:2897-2903. [PMID: 36148520 DOI: 10.1111/os.13493] [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: 06/08/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Both-column acetabular fracture is a type that accumulates both the pelvis and acetabulum with complex fracture line alignment and has variant fracture fragments. The selection of different reduction landmarks and sequences produces different qualities of reduction. This study aims to compare the operation-related items, quality of reduction, and hip functional outcome by using different reduction landmarks and sequences for management of both-column acetabular fractures (BCAF). METHODS A consecutive cohort of 42 patients from January 2013 to January 2019 with BCAF were treated operatively with different reduction landmarks and sequences: pelvic ring fractures reduction first (PRFRF group) and acetabular fractures reduction first (AFRF group). Preoperative computer visual surgical procedures were applied. There were 22 patients in PRFRF group and 20 patients in AFRF group. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by the Matta scoring system. The functional outcome was evaluated by the modified Merle d'Aubigné and Postel scoring system. The measurement data were analyzed using the t-test of independent samples and rank-sum test of ranked data. RESULTS The real reduction sequence in both groups was almost identical to the preoperative surgical procedures. The excellent/good quality of reduction in PRFRF group (21/22) was better than AFRF group (17/20). Operative time (152.3 ± 16.3 mins) and intra-operative blood loss (639.5 ± 109.9ml) were significantly reduced in PRFRF group (p < 0.05). The incidence of deep vein thrombosis in PRFRF group (2/22) was less than AFRF group (4/20), but without statistical signification. CONCLUSION Selection of an appropriate reduction landmark and sequence could result in better quality of reduction, operative time, and decreased blood loss during treatment of BCAF.
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Affiliation(s)
- Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Keda Yu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yi Xu
- Ningbo City First Hospital, Ningbo, China
| | - Yan Ma
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ziming Zhang
- The Third Clinical College of Hubei Medical College, Shiyan, China
| | | | | | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Kress H, Klein R, Pohlemann T, Wölfl CG. Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060809. [PMID: 35744073 PMCID: PMC9227275 DOI: 10.3390/medicina58060809] [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: 05/15/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3-7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0-60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved.
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Affiliation(s)
- Hannah Kress
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
| | - Roman Klein
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
| | - Tim Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Saarland University Medical Center, 66421 Homburg, Germany;
| | - Christoph Georg Wölfl
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhaus Klinikum Hetzelstift, 67434 Neustadt an der Weinstraße, Germany; (H.K.); (R.K.)
- Correspondence:
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Sivapathasuntharam D, Smith G, Master MA, Bates P. Fragility fractures of the pelvis in the older population. Age Ageing 2022; 51:6550829. [PMID: 35305085 DOI: 10.1093/ageing/afac063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/12/2022] Open
Abstract
Pelvic fractures are an increasingly common injury seen in the older population and represent a significant burden of morbidity and mortality in this age group, as well as a large financial burden on the health service. It is well established that early fixation of femoral neck and acetabular fractures improves outcomes and increases the chances of patients returning close to their premorbid functional baseline. However, fixation of fragility fractures of the pelvis is less well established in current practice. There has been recent development of novel stabilisation techniques for unstable pelvic fractures, designed to tackle the difficulties associated with fixation in poor bone quality, along with medical trials of parathyroid hormone analogue treatment. However, it is still current practice to manage nearly all fragility fractures of the pelvis conservatively. In this article, we consider whether the development of surgical stabilisation techniques for pelvic fragility fractures may have the potential to improve the well-described morbidity and mortality associated with them.
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Affiliation(s)
| | - Gillian Smith
- Trauma Service, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Peter Bates
- Department of Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Booth J, Perriman DM, Szczepanski J, Walton-Sonda D, Smith PN. What's old is best again Is anterior plating best for fixation of type-C pelvic fractures? A systematic review and meta-analysis. Injury 2022; 53:301-312. [PMID: 34625237 DOI: 10.1016/j.injury.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3. RESULTS Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%. CONCLUSIONS Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.
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Affiliation(s)
- Joshua Booth
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Diana M Perriman
- The Australian National University, Canberra, Australian Capital Territory, Australia; The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Jason Szczepanski
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Dianne Walton-Sonda
- The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia
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Hoffmann P, Balik M, Hoffmannova M, Spacek J, Vanasek J, Rezac A, Dvorak P. Long-term experience with percutaneous biopsies of pelvic lesions using CT guidance. Sci Prog 2021; 104:368504211058555. [PMID: 34918561 PMCID: PMC10450592 DOI: 10.1177/00368504211058555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the accuracy, efficiency, complication rate, technical features, and relations among followed parameters of CT-guided percutaneous biopsies of the pelvic lesions. 140 biopsies in 136 patients for tumors, sizes 17-160 mm in largest diameter, were carried out in patients with probable tumorous pelvic process within ten years period. The patients were women in 77 cases and men in 59 cases, aged 21 to 87 years. The lesions´ size varied from 17 mm to 160 mm in largest diameter. In 135 biopsies (96.4%) results were true positive or true negative; only 5 procedures (3.6%) were histologically false negative and had to be verified surgically. Metastatic affection was the most common diagnosis (26.4%). Lymphomas were diagnosed in 25%; serous adenocarcinoma of ovary or uterine tube was verified in 15.7% of cases. Totally 7 complications (5%) were confirmed, all were minor hemorrhages. A statistically significant relation between the complication rate and hypervascular character (p = 0.00004), and between needle gauge and histological accuracy (p = 0.00429) was revealed. Core needle biopsy using percutaneous approach and CT guidance had a high overall accuracy in determining the final histological diagnosis including subtyping. Concurrently, the complication incidence was low.
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Affiliation(s)
- Petr Hoffmann
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Michal Balik
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Martina Hoffmannova
- Faculty of Education, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Spacek
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Vanasek
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Adam Rezac
- Department of Gynecology and Obstetrics, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Dvorak
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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Müller F, Füchtmeier B. A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries. SICOT J 2021; 7:40. [PMID: 34309508 PMCID: PMC8312281 DOI: 10.1051/sicotj/2021037] [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: 03/14/2021] [Accepted: 07/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To summarize the literature on transiliac internal fixator (TIFI) indications and outcomes for treating posterior pelvic ring injuries. METHODS We searched databases for original publications in journals. Biomechanical and clinical studies using a TIFI for posterior pelvic ring injuries were considered for inclusion. The dates of publications that were included ranged from January 2000 until December 2020. RESULTS A total of 13 articles were reviewed, including eight clinical studies and five biomechanical tests. We found only case series and no multicenter or randomized study. The clinical studies contained data for a total of 186 cases, including indications, treatments, complications, and outcomes, with a minimum follow-up time of 12 months. All studies reported superior results according to operation time, blood loss, complication, dislocation, and union. One biomechanical test evaluated inferior results. CONCLUSIONS The TIFI is a user-friendly and safe device to treat posterior pelvic injuries. It can also be used for acute, high-impact injuries, and fragility fractures. Nevertheless, there is no evidence concerning which types of pelvic fractures are most beneficial. Therefore, further biomechanical and clinical studies are necessary to resolve this question.
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Affiliation(s)
- Franz Müller
- Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - Bernd Füchtmeier
- Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
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Peng C, Yuan B, Wang J, Liu H, Wang D. Treating sacroiliac joint dislocation through percutaneous sacroiliac screw fixation with the aid of 2 fluoroscopes: a novel technique. Quant Imaging Med Surg 2021; 11:2076-2084. [PMID: 33936988 DOI: 10.21037/qims-20-448] [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: 11/06/2022]
Abstract
Background Percutaneous sacroiliac screw fixation is the standard treatment for sacroiliac joint (SIJ) dislocation. In most hospitals, the procedure is guided by a C-arm X-ray fluoroscopy system, which must be repeatedly repositioned during surgery. In this study, we investigated the feasibility of using 2 fluoroscopes simultaneously. Methods A total of 28 consecutive patients with SIJ dislocation were included in this study. The patients were randomly allocated to groups and underwent percutaneous sacroiliac screw fixation using either 1 or 2 fluoroscopes. Total radiation exposure frequency, radiation dose, and operation time were recorded and compared. Dislocation reduction quality was assessed using the Tornetta and Matta standard, and the Majeed functional score was used to evaluate clinical, imaging, and social function following pelvic injury. Complications were also recorded. Results The results showed that the radiation exposure frequency was significantly less with 2 fluoroscopes than with a single fluoroscope (21.5±8.6 and 42.6±18.3 times, respectively; P<0.001). However, the radiation dose (156.3±67.2 mGy for 1 fluoroscope and 157.8±38.2 mGy for 2 fluoroscopes; P>0.05) between the 2 groups was not significantly different. The total operation time was also significantly shorter with 2 fluoroscopic devices than with a single device (35.8±12.9 and 65.5±19.7 minutes, respectively; P<0.001). The dislocation reduction quality and Majeed functional score (92.3% and 86.7% for 1 fluoroscope, 93.3% and 84.6% for 2 fluoroscopes, respectively; P>0.05) did not differ significantly between the 2 groups at the final follow-up. Complications, such as pain, superficial infection, restricted squatting, limp, and screw failure, were rarely recorded in either group. Conclusions The simultaneous application of 2 fluoroscopes is highly appropriate during percutaneous sacroiliac screw fixation to treat SIJ dislocation, and can significantly reduce radiation exposure frequency and operation time.
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Affiliation(s)
- Chuangang Peng
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Baoming Yuan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China.,Jilin Clinical Research Center for Orthopaedic Disease, Changchun, China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China.,Jilin Clinical Research Center for Orthopaedic Disease, Changchun, China
| | - Dongsheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Huang H, Zhang BF, Liu P, Deng HL, Wang PF, Wang H, Li BF, Cong YX, Zhuang Y. The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study. BMC Musculoskelet Disord 2021; 22:110. [PMID: 33494747 PMCID: PMC7836564 DOI: 10.1186/s12891-021-03993-4] [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: 09/20/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. METHODS Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients' baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. RESULTS In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). CONCLUSIONS The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hai Huang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Bin-Fei Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Ping Liu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Hong-Li Deng
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Peng-Fei Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Hu Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Bao-Feng Li
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China
| | - Yu-Xuan Cong
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China.
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Beilin District, No. 555 Youyi East Road, Shaanxi Province, 710054, Xi'an, Republic of China.
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Pace V, Gul A, Prakash V, Park C, Placella G, Raine G. Wound Infiltration with Levobupivacaine, Ketorolac, and Adrenaline for Postoperative Pain Control after Spinal Fusion Surgery. Asian Spine J 2020; 15:539-544. [PMID: 32872752 PMCID: PMC8377213 DOI: 10.31616/asj.2020.0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design This study enrolled patients in from a single center who underwent primary spinal fusion procedure and divided them into two groups (group-control study). Purpose Good local infiltration can reduce postoperative analgesic requirements and enable expedited discharge. Administration of a combination of levobupivacaine (200 mg/100 mL, 0.9% normal saline), ketorolac (30 mg), and adrenaline (0.5 mg) as a wound infiltrate is recommended at an optimum combination. Overview of Literature There is currently no consensus on the optimum intraoperative local infiltration of spinal surgery patients undergoing operative fusion. Methods Patients who were enrolled in two spinal centers (over 24 months) undergoing primary spinal fusion procedures were allocated into two groups, comparing the type of local infiltration used at the time of the procedure. Group 1 received the combination of levobupivacaine (200 mg), ketorolac (30 mg), and adrenaline (0.5 mg), while group 2 received other types of local anesthetics. Primary outcome measures include patient-controlled analgesia (PCA) use, morphine consumption, and length of hospital stay. Secondary outcome measure are as follows: days of physiotherapy, pain score, side effects, and complications. Results There are a total of 140 patients enrolled. Seventy-five patients enrolled were allocated to group 1, receiving the study combination, and 65 patients were assigned in group 2, receiving other local infiltrations. All primary outcome measures (consumption of morphine, use of PCA, and length of stay) were significantly higher in group 2 than the study combination (p<0.05). The secondary outcomes of pain scores and days of physiotherapy values were also significantly higher in group 2 (p<0.05). Patient satisfaction questionnaires gave significantly better results in group 1 (p<0.05). There were no significant statistical differences with regard to any postoperative complications between the two groups. Conclusions Our data suggest that the studied wound infiltration is a safe and feasible option that could provide good postoperative pain control without significant side effects. It also allowed to reduce dependence of opioids and PCA, earlier postoperative mobilization, lower pain scores postoperatively, and reduced hospital stay.
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Affiliation(s)
- Valerio Pace
- Department of Trauma and Orthopaedic Surgery, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Arif Gul
- Department of Trauma and Orthopaedics, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Varadarajan Prakash
- Department of Trauma and Orthopaedics, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Chang Park
- Department of Trauma and Orthopaedic Surgery, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Giacomo Placella
- Department of Trauma and Orthopaedics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Geoffrey Raine
- Department of Anaesthetics, The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Hartensuer R, Lodde MF, Keller J, Eveslage M, Stolberg-Stolberg J, Riesenbeck O, Raschke MJ. Safety, Effect and Feasibility of Percutaneous SI-Screw with and without Augmentation-A 15-Year Retrospective Analysis on over 640 Screws. J Clin Med 2020; 9:jcm9082660. [PMID: 32824548 PMCID: PMC7463525 DOI: 10.3390/jcm9082660] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Minimally invasive sacroiliac-screw (SI-screw) fixation of the pelvis is used in energy trauma (Arbeitsgemeinschaft für Osteosynthesefragen (AO) classified) and fragility fractures (Fragility Fracture of the Pelvis (FFP) classified). However, available clinical data are based on small case series and biomechanical data seem to be contradictory. METHODS The present single center retrospective cohort study investigated percutaneous SI-screw fixation and augmentation over 15 years. Groups were compared concerning the general epidemiological data, mobilization, complication rates, duration of stay, and safety of SI-screw insertion. Multivariable analyses were performed using logistic regression. RESULTS Between 2005 and March 2020, 448 patients with 642 inserted SI-screws were identified. Iatrogenic neurological impairment was documented in 2.47% and correlated with screw misplacement. There was an increased complication risk in patients with AO type C over patients with AO type B and in FFP II over FFP III/IV patients. Cement-augmented FFP patients showed a 25% reduced stay in hospital and a reduced complication risk. Cement-associated complications were seen in 22% without correlation to neurologic impairment. CONCLUSIONS The present study confirms the safety and usability of percutaneous SI-screw fixation, despite specific risks. Cement augmentation seems to reduce the complication risk in FFP patients and shorten hospital stay for some reasons, without increased specific complications or correlated neurological impairment.
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Affiliation(s)
- René Hartensuer
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
- Correspondence: ; Tel.: +49-251-83-59204
| | - Moritz F. Lodde
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Jonas Keller
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Münster, Germany;
| | - Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Oliver Riesenbeck
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Muenster, 48149 Münster, Germany; (M.F.L.); (J.K.); (J.S.-S.); (O.R.); (M.J.R.)
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Abstract
OBJECTIVES To evaluate the accuracy with which the Majeed Pelvic Score has been reported in the English literature. DATA SOURCES Databases used to search for literature were PubMed, Embase, and Ovid, restricted to English language from inception to October 2, 2018. STUDY SELECTION Search words used were: Majeed, pelvis, and outcome. DATA EXTRACTION Articles were assessed for descriptions of scoring and proper reporting of Majeed Pelvic Outcome Score. DATA SYNTHESIS Descriptive statistics were used to report the outcome of our findings. CONCLUSIONS Ninty-two English articles were identified. Twenty-four (26%) articles were identified as including methodology related to the use and scoring of the Majeed Pelvic score. The remaining 68 presented mean Majeed scores with no methodological information. None (0/92) discussed how the range of possible scores for the most severe function was applied. Six (7%) reported adjusted scores for patients not working. Three (3%) included a discussion of the scores as adjusted for patients working before injury compared with those not working. Ten (11%) addressed the categorization of scores by excellent to poor describing what raw scores defined those categories. We observed poor accuracy and notable inconsistency in the use and reporting of the Majeed Pelvic Outcome Score in the literature. These data demonstrate that interpretation and comparison of research reporting this score should be done cautiously. Future studies should include specific information as to how the Majeed instrument calculated to allow for verification of the presented scores and subsequent conclusions.
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Dekimpe C, Andreani O, De Dompsure RB, Lemmex DB, Layet V, Foti P, Amoretti N. CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome. Eur Radiol 2019; 30:961-970. [PMID: 31628504 DOI: 10.1007/s00330-019-06439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. MATERIALS AND METHODS Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. RESULTS Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. CONCLUSION This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. KEY POINTS • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.
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Affiliation(s)
- Chloé Dekimpe
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France.
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Groupe Arnaud Tzank, Saint Laurent du Var, France
| | - Regis Bernard De Dompsure
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Devin Byron Lemmex
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Vivien Layet
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Pauline Foti
- Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France
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Katayama Y, Kitamura T, Hirose T, Kiguchi T, Matsuyama T, Takahashi H, Kiyohara K, Sado J, Adachi S, Noda T, Izawa J, Nakagawa Y, Shimazu T. Pelvic angiography is effective for emergency pediatric patients with pelvic fractures: a propensity-score-matching study with a nationwide trauma registry in Japan. Eur J Trauma Emerg Surg 2019; 47:515-521. [PMID: 31119320 PMCID: PMC8016779 DOI: 10.1007/s00068-019-01154-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/15/2019] [Indexed: 12/22/2022]
Abstract
Purpose The aim of this study was to evaluate the association between the implementation of pelvic angiography (PA) and outcome in emergency pediatric patients with pelvic fracture. Methods We extracted data on pelvic fracture patients aged ≤ 19 years between 2004 and 2015 from a nationwide trauma registry in Japan. The main outcome was hospital mortality. We assessed the relationship between implementation of PA and hospital mortality using one-to-one propensity-score-matching analysis to reduce potential confounding effects in comparing the PA group with the non-PA group. Results In total, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the PA group and 1130 patients (83.6%) included in the non-PA group. For all patients, the proportion of hospital mortality was higher in the PA group than in the non-PA group [13.6% (30/221) vs 7.1% (80/1130), crude odds ratio (OR) 2.062 (95% confidence interval (CI), 1.318–3.224); p = 0.002]. In the propensity-score-matched patients, the proportion of hospital mortality was lower in the PA group than in the non-PA group [10.5% (22/200) vs 18.2% (38/200), p = 0.027]. This finding was confirmed in both the multivariable logistic regression model [adjusted OR 0.392 (95% CI, 0.171–0.896); p = 0.026] and the conditional logistic regression model [conditional OR 0.484 (95% CI, 0.261–0.896); p = 0.021]. Conclusion The implementation of PA was significantly associated with lower hospital mortality among emergency pediatric patients with pelvic fractures compared with the non-implementation of PA.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, 565-0871, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, 565-0871, Japan.,Emergency and Critical Care Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Japan
| | - Takeyuki Kiguchi
- Kyoto University Health Services, Yoshida-honmachi, Sakyo-ku, Kyoto, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Hiroko-ji noboru, Kawaramachi-dori, Kamigyo-ku, Kyoto, Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Medicine, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, 12 Sanban-cho, Chiyoda-ku, Tokyo, Japan
| | - Junya Sado
- Department of Health and Sport Sciences, Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Japan
| | - Shingo Adachi
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, 2-23 Rinku Orai-kita, Izumisano, Japan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-5-7 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Junichi Izawa
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, 565-0871, Japan
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