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Injury Oct 2014Following pelvic fracture in females of childbearing age, the question of whether or not natural pregnancy and childbirth can occur is often asked by both patients and... (Review)
Review
BACKGROUND
Following pelvic fracture in females of childbearing age, the question of whether or not natural pregnancy and childbirth can occur is often asked by both patients and clinicians. The following is a systematic review of the literature examining caesarean section rate in patients with prior pelvic fracture.
METHODS
An extensive search of the English-language literature was performed to include all articles describing pregnancy outcomes in women with prior pelvic fracture. The primary outcomes analyzed were vaginal delivery and caesarean section. Secondary outcomes investigated included the rate of new caesarean section, indications for caesarean section, and caesarean section rates with operative versus nonoperative treatment of the pelvic fracture.
RESULTS
Eight articles assessing 148 patients who underwent childbirth after pelvic fracture were eligible for inclusion. Among the 148 patients who underwent childbirth after pelvic fracture, 79 (53%) delivered vaginally and 69 (47%) underwent caesarean section. When patients who had already undergone a caesarean section prior to their pelvic fracture were excluded, 137 patients remained. Among these 137 patients, 79 (58%) delivered vaginally and 58 (42%) had caesarean section performed. Indications for caesarean section were sporadically listed but in some series did include patient or obstetrician preference as a result of prior pelvic fracture. Prior pelvic fixation had no demonstrable effect on pregnancy outcomes (p>0.05).
CONCLUSIONS
Patients with prior pelvic fracture undergo caesarean section at a rate greater than those without prior pelvic fracture. The cause for this is not entirely understood but seems to be related at least in part to patient and obstetrician bias rather than solely due to the pelvic fracture and cephalopelvic disproportion.
Topics: Adult; Cesarean Section; Delivery, Obstetric; Female; Fractures, Bone; Humans; Pelvic Bones; Pregnancy; Pregnancy Outcome; Risk Factors
PubMed: 24830904
DOI: 10.1016/j.injury.2014.03.018 -
Seminars in Musculoskeletal Radiology Jul 2017
Review
Topics: Diagnosis, Differential; Fractures, Bone; Humans; Pelvic Bones; Tomography, X-Ray Computed
PubMed: 28571086
DOI: 10.1055/s-0037-1602409 -
ANZ Journal of Surgery 2015Hemipelvectomy is a major operation with significant risks including infection, prosthesis failure and fracture. This systematic review was designed to review the... (Review)
Review
BACKGROUND
Hemipelvectomy is a major operation with significant risks including infection, prosthesis failure and fracture. This systematic review was designed to review the functional outcomes, oncologic outcomes and complications in patients who received internal hemipelvectomy and pelvic reconstruction for primary pelvic tumour.
METHODS
Searches on MEDLINE, the Cochrane Library, Embase and Google Scholar were performed to locate studies involving patients receiving internal hemipelvectomy and pelvic reconstruction using a prosthesis, implant or bone graft. All studies were either prospective or retrospective observational studies published in English.
RESULTS
This systematic review included 12 studies from 1990 to 2011 involving 217 patients from 5 to 77 years of age who had received follow-up for a period from 3 weeks to 15 years. Among the 12 studies, the mortality rate, disease-free rate and incidence of local recurrence were 10-69.2, 23.1-90.0 and 9.1-41.7%, respectively. The post-operative Musculoskeletal Tumor Society (MSTS) functional score ranged from 50 to 70 in the more recent studies. Compared with prostheses and other implants, patients who received allografts had the highest post-operative function, as shown by their MSTS scores, but also had a greater incidence of post-operative infection. On the other hand, the prosthesis group was associated with the highest percentage of fracture and dislocations, as well as other significant complications.
CONCLUSION
This comprehensive review provided informative details regarding the goals, outcomes and complications associated with this procedure and underscored the need for further investigation into the various surgical approaches currently available.
Topics: Bone Neoplasms; Bone Transplantation; Hemipelvectomy; Humans; Incidence; Neoplasm Recurrence, Local; Pelvic Bones; Postoperative Complications; Prostheses and Implants; Plastic Surgery Procedures; Recovery of Function
PubMed: 25387591
DOI: 10.1111/ans.12895 -
Acta Chirurgiae Orthopaedicae Et... 2024Pelvic reconstructions after massive bone resections are among the most challenging practices in orthopedic surgery. Whether the bone gap results after a trauma, a tumor...
PURPOSE OF THE STUDY
Pelvic reconstructions after massive bone resections are among the most challenging practices in orthopedic surgery. Whether the bone gap results after a trauma, a tumor resection, or it is due to a prosthetic revision, it is mandatory to reconstruct pelvic bone continuity and rebuild the functional thread that connects spine and hip joint. Several different approaches have been described in literature through the decades to achieve those goals.
MATERIAL AND METHODS
To this date, 3D-printed implants represent one of the most promising surgical technologies in orthopedic oncology and complex reconstructive surgery. We present our experience with 3D-printed custom-made pelvic prostheses to fulfi ll bone gaps resulting from massive bone loss due to tumor resections. We retrospectively evaluated 17 cases treated with pelvic bone reconstruction using 3D-printed prostheses. Cases were evaluated in terms of both oncological and functional outcomes.
RESULTS
At the last follow-up, local complications were found in 6 cases (36%): in 4 (23.5%) of them the cause was a local recurrence of the disease, whereas only 2 (12.5%) had non-oncologic issues. The mean MSTS score in our population increased from 8.2 before surgery to 22.3 at the latest clinical control after surgery.
DISCUSSION
3D-printing technology, used to produce cutting jigs and prosthetic implants, can lead to good clinical and functional outcomes. These encouraging results are comparable with the ones obtained with other more frequently used reconstructive approaches and support custom-made implants as a promising reconstructive approach.
CONCLUSIONS
Our data confi rm 3D-printing and custom-made implants as promising technologies that could shape the next future of orthopedic oncology and reconstructive surgery.
KEY WORDS
custom made prosthesis, pelvic reconstruction, orthopedic oncology, cutting jigs, 3D-printing.
Topics: Humans; Retrospective Studies; Printing, Three-Dimensional; Technology; Pelvic Bones; Arthrodesis; Neoplasms
PubMed: 38447560
DOI: 10.55095/achot2024/004 -
European Journal of Trauma and... Apr 2018
Topics: Bone Plates; Bone Screws; Clinical Decision-Making; Compressive Strength; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Instability; Pelvic Bones; Practice Guidelines as Topic
PubMed: 29532138
DOI: 10.1007/s00068-018-0940-9 -
Injury Sep 2015Pelvic fractures are usually the result of high-energy trauma. In addition to the underlying disruption of the pelvic ring extensive damage to the surrounding soft... (Review)
Review
Pelvic fractures are usually the result of high-energy trauma. In addition to the underlying disruption of the pelvic ring extensive damage to the surrounding soft tissue envelope might be present. Different fixation techniques have been developed including open plating, external fixation and transramus intraosseous screw fixation. Recently another method has been reported the so called pelvic Bridge or Infix technique. In this short review article the different techniques of pelvic fixation are described.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Minimally Invasive Surgical Procedures; Patient Satisfaction; Pelvic Bones; Treatment Outcome; Weight-Bearing
PubMed: 26458296
DOI: 10.1016/S0020-1383(15)30008-5 -
The Bone & Joint Journal Nov 2014Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of... (Review)
Review
Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of anterosuperior and posteroinferior pelvic column support for component fixation and stability. The Paprosky classification is most commonly used when determining the location and degree of acetabular bone loss. Augments serve the function of either providing primary construct stability or supplementary fixation. When a pelvic discontinuity is encountered we advocate the use of an acetabular distraction technique with a jumbo cup and modular porous metal acetabular augments for the treatment of severe acetabular bone loss and associated chronic pelvic discontinuity.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Bone Diseases, Metabolic; Hip Prosthesis; Humans; Pelvic Bones; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation
PubMed: 25381406
DOI: 10.1302/0301-620X.96B11.34455 -
Korean Journal of Radiology May 2023To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery...
OBJECTIVE
To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery for proximal femur fractures.
MATERIALS AND METHODS
We retrospectively identified consecutive patients aged ≥ 65 years who underwent pelvic bone CT and subsequent surgery for proximal femur fractures between July 2018 and September 2021. Eight CT metrics were calculated from the cross-sectional area and attenuation of the subcutaneous fat and muscle, including the thigh subcutaneous fat (TSF) index, TSF attenuation, thigh muscle (TM) index, TM attenuation, gluteus maximus (GM) index, GM attenuation, gluteus medius and minimus (Gmm) index, and Gmm attenuation. The patients were dichotomized using the median value of each metric. Multivariable Cox regression and logistic regression models were used to determine the association between CT metrics with overall survival (OS) and postsurgical intensive care unit (ICU) admission, respectively.
RESULTS
A total of 372 patients (median age, 80.5 years; interquartile range, 76.0-85.0 years; 285 females) were included. TSF attenuation above the median (adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.41-4.05), GM index below the median (adjusted HR, 2.63; 95% CI, 1.33-5.26), and Gmm index below the median (adjusted HR, 2.33; 95% CI, 1.12-4.55) were independently associated with shorter OS. TSF index (adjusted odds ratio [OR], 6.67; 95% CI, 3.13-14.29), GM index (adjusted OR, 3.45; 95% CI, 1.49-7.69), GM attenuation (adjusted OR, 2.33; 95% CI, 1.02-5.56), Gmm index (adjusted OR, 2.70; 95% CI, 1.22-5.88), and Gmm attenuation (adjusted OR, 2.22; 95% CI, 1.01-5.00) below the median were independently associated with ICU admission.
CONCLUSION
In older adult patients who underwent surgery for proximal femur fracture, low muscle indices of the GM and gluteus medius/minimus obtained from their cross-sectional areas on preoperative pelvic bone CT were significant prognostic markers for predicting high mortality and postsurgical ICU admission.
Topics: Female; Humans; Aged; Aged, 80 and over; Proximal Femoral Fractures; Retrospective Studies; Pelvic Bones; Body Composition; Tomography
PubMed: 37133212
DOI: 10.3348/kjr.2022.0835 -
Journal of Orthopaedic Trauma Feb 2022The purpose of this study was to assess patient outcomes using Patient-Reported Outcomes Measurements Information System (PROMIS) scores after closed reduction and...
OBJECTIVES
The purpose of this study was to assess patient outcomes using Patient-Reported Outcomes Measurements Information System (PROMIS) scores after closed reduction and percutaneous fixation (CRPF) of the posterior pelvic ring and determine whether quality of reduction affects the outcomes.
DESIGN
This is a retrospective cohort study.
SETTING
The study involved a Level I trauma center.
PATIENTS
The study included 46 adult patients with operatively treated pelvic ring injuries (63% OTA/AO 61-B) who underwent CRPF between 2014 and 2018 at a single institution.
INTERVENTION
The intervention involved closed reduction and percutaneous posterior pelvic ring fixation.
MAIN OUTCOME MEASUREMENTS
The main outcome measurements were postoperative patient PROMIS scores, including physical function, pain interference, anxiety, and depression, and radiographic measurements of postoperative displacement and pelvic deformity.
RESULTS
After CRPF, PROMIS scores of physical function, pain interference, and anxiety were significantly improved at the time of final follow-up when compared with the first postoperative visit. The amount of malreduction or pelvic deformity did not significantly affect outcome scores; however, results were limited by small sample size.
CONCLUSIONS
CRPF of posterior pelvic ring injuries results in good functional and radiographic outcomes. Degree of malreduction may not affect outcomes as much as previously believed.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adult; Fracture Fixation, Internal; Fractures, Bone; Humans; Patient Reported Outcome Measures; Pelvic Bones; Retrospective Studies; Treatment Outcome
PubMed: 35061646
DOI: 10.1097/BOT.0000000000002321 -
Colombia Medica (Cali, Colombia) Dec 2020Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of... (Review)
Review
Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.
Topics: Algorithms; Fractures, Bone; Hemodynamics; Humans; Pelvic Bones
PubMed: 33795905
DOI: 10.25100/cm.v51i4.4510