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Journal of Orthopaedic Surgery and... Jan 2021The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the... (Comparative Study)
Comparative Study
BACKGROUND
The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique.
METHODS
A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively.
RESULTS
From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%).
CONCLUSION
The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.
Topics: Adult; Bone Screws; Female; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Bone; Fractures, Ununited; Humans; Male; Middle Aged; Operative Time; Pelvic Bones; Quality of Health Care; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33509244
DOI: 10.1186/s13018-021-02239-2 -
Advances in Clinical and Experimental... Oct 2021Developmental dysplasia of the hip (DDH) is a common hip joint pathology seen in the pediatric orthopedist's practice. Pelvic osteotomies are the reliable surgical...
BACKGROUND
Developmental dysplasia of the hip (DDH) is a common hip joint pathology seen in the pediatric orthopedist's practice. Pelvic osteotomies are the reliable surgical option for DDH treatment in walking patients, and 3 osteotomies (Salter, Dega and Pemberton) are widely used in patients under 6 years of age. Plastic changes in hinge points occur during iliac fragment movement, after the performed osteotomy. The locations of these points are described in the literature, but some debate still exists about their true positions.
OBJECTIVES
To reveal hinge point locations during a simulation of pelvic osteotomies on biological models.
MATERIAL AND METHODS
Eighteen piglet pelvis complexes were obtained and separated according to their age. Pelvic osteotomies were simulated, and bone changes were assessed on computed tomography (CT) scans after the performed surgeries.
RESULTS
No bone changes were found after Salter osteotomy in younger piglets, while contralateral pubic bone metaphyseal fractures were found in older animals. After Pemberton osteotomy, greenstick fractures in iliac and pubic bones metaphyses in the triradiate cartilage area were revealed in younger and older piglets. After Dega osteotomy, a posterior medial cortical layer fracture of the uncut iliac bone in the greater sciatic notch was found in all piglets. In older piglets, an additional hinge point was detected in the ipsilateral pubic bone metaphysis.
CONCLUSION
It was found that the age of the piglets has an impact on hinge point number and location, and this may be explained by an age-related decrease in pelvic bone and cartilage plasticity. The results of this study may help surgeons to decrease the number of preventable complications during pelvic osteotomies.
Topics: Animals; Child; Hip Joint; Humans; Osteotomy; Pelvic Bones; Pelvis; Swine; Tomography, X-Ray Computed
PubMed: 34549556
DOI: 10.17219/acem/140548 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2020To summarize the related research results of minimally invasive treatment of anterior pelvic ring fracture, and to improve the understanding of minimally invasive... (Review)
Review
OBJECTIVE
To summarize the related research results of minimally invasive treatment of anterior pelvic ring fracture, and to improve the understanding of minimally invasive treatment of anterior pelvic ring fracture.
METHODS
The literature of minimally invasive treatment of anterior pelvic ring fracture at domestic and overseas in recent years was reviewed, and the reduction and fixation methods of minimally invasive treatment were summarized and analyzed.
RESULTS
The pelvic reduction frame may be an effective auxiliary method for minimally invasive reduction of pelvis. The fixation methods of anterior pelvic ring include percutaneous screw fixation, stent fixation, and percutaneous plate fixation.
CONCLUSION
One kind of fixation is not applicable to all types of anterior pelvic ring fracture, and the fixation method should be selected according to the type of fracture and the patient's condition to minimize the complications.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Minimally Invasive Surgical Procedures; Pelvic Bones
PubMed: 32291994
DOI: 10.7507/1002-1892.201907077 -
Journal of Perioperative Practice Sep 2021Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic...
Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient's journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.
Topics: Fractures, Bone; Humans; Pelvic Bones; Postoperative Complications; Retrospective Studies
PubMed: 32894996
DOI: 10.1177/1750458920947358 -
BMJ Case Reports Dec 2019Pelvic trauma is complex, most of current work centres around pelvic haemorrhage and fractures. It is important to remember that there is more anatomy in the pelvis than...
Pelvic trauma is complex, most of current work centres around pelvic haemorrhage and fractures. It is important to remember that there is more anatomy in the pelvis than bones and vessels. A 29-year-old male patient was admitted after an Road Traffic Collision (RTC) where his motorbike T-boned a car. He was noted to have a traumatic dislocation of his right testicle, which spontaneously reduced in the emergency department and he was admitted for scrotal exploration and observation. Due to difficulty in mobilising postoperatively, he underwent an MRI, which showed diastasis of his pubis symphysis as well as left-sided adductor tendon rupture, not evident on his initial CT scan, and underwent pelvic fixation. Why should an emergency physician be aware of this? This case emphasises the alternate differentials with pelvic trauma in a haemodynamically stable patient, and the requirement for continuous reassessment in patients failing to improve.
Topics: Accidents, Traffic; Adult; Diagnosis, Differential; Fractures, Bone; Humans; Male; Motorcycles; Pelvic Bones; Pelvis; Pubic Bone; Radiography; Tomography, X-Ray Computed
PubMed: 31806634
DOI: 10.1136/bcr-2019-232622 -
Journal of Orthopaedic Surgery (Hong... 2021Proper placement of infra-acetabular screws is technically demanding; there is a limited safe zone for screw fixation because of the complexity of the bone anatomy...
PURPOSE
Proper placement of infra-acetabular screws is technically demanding; there is a limited safe zone for screw fixation because of the complexity of the bone anatomy around the hip joint and the vulnerability of the major neurovascular bundles in the pelvic cavity. We aimed to present the obturator hook technique as a surgical technique for infra-acetabular screw placement in acetabular and pelvic fractures and report its radiological outcomes.
METHODS
Patients treated with infra-acetabular screw placement using the obturator hook technique between January 2015 and August 2020 were enrolled in this study. We collected data on demographics, surgical approach, reduction status, complications, and outcomes. The radiological outcomes of infra-acetabular screw placement based on computed tomography findings were evaluated as follows: success, articular penetration, or out of the bone.
RESULTS
Thirty-five patients underwent infra-acetabular screw placement (26 men, 9 women; mean age, 55 years; range, 27-90 years). One patient underwent bilateral infra-acetabular screw placement; therefore, 36 infra-acetabular screws were inserted in all patients. An ideal placement was achieved with 27 infra-acetabular screws (27/36, 75%). Seven infra-acetabular screws (7/36, 19%) showed articular penetration, and two infra-acetabular screws (2/36, 6%) were placed outside the bone. One patient with articular penetration and mechanical symptoms of the hip joint required screw replacement. No other complications, including obturator nerve and vascular injuries, were observed.
CONCLUSION
The obturator hook technique could be a favorable and individualized method for infra-acetabular screw placement in patients with acetabular and pelvic fractures.
LEVEL OF EVIDENCE
IV, retrospective descriptive study.
Topics: Acetabulum; Adult; Aged; Aged, 80 and over; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33641537
DOI: 10.1177/2309499021996838 -
BMC Musculoskeletal Disorders Jan 2018Positive association between body weight and bone mass is well established, and the concept of body mass index (BMI) is associated with higher areal bone mineral density...
BACKGROUND
Positive association between body weight and bone mass is well established, and the concept of body mass index (BMI) is associated with higher areal bone mineral density (aBMD) and reduced fracture risk. BMI, that comprises both fat mass (FM) and lean mass (LM) may contribute to peak bone mass achievement in different ways. This study explored the influence of body composition in terms of total body LM and FM on hip aBMD-values in adolescence.
METHODS
In 2010/2011, 93% of the region's first-year upper-secondary school students (15-17 years old) in Tromsø, Norway attended the Tromsø Study, Fit Futures. Areal BMD at femoral neck (aBMD) and total hip (aBMD) (g/cm), total body LM and FM (g) were measured by dual energy X-ray absorptiometry (DXA). Height and weight were measured, and BMI calculated. Lifestyle variables were collected by self-administered questionnaires and interviews, including questions on time spent on leisure time physical activity. Stratified analyses of covariance and regression models included 395 girls and 363 boys. Crude results were adjusted for age, height, sexual maturation, physical activity levels, vitamin D levels, calcium intake, alcohol consumption and smoking habits.
RESULTS
Unadjusted distribution indicated higher aBMD-levels at higher LM-levels in both genders (p < 0.001), but higher aBMD at higher FM-levels were found only in girls (p < 0.018). After multiple adjustments, aBMD-levels in girls were associated by 0.053 g/cm and 0.032 g/cm per standard deviation (SD) change in LM and FM (p < 0.001). Corresponding values in boys were 0.072 and 0.025 (p < 0.001). The high LM groups accounted for the highest aBMD-levels, while aBMD-levels at the LM/FM-combinations indicated different patterns in girls compared to boys. The adjusted odds ratio (95% CI) for low levels of aBMD was 6.6 (3.4,13.0) in boys, compared to 2.8 (1.6,4.9) in girls per SD lower LM.
CONCLUSIONS
LM and FM should be regarded as strong predictors for bone mass and hence bone strength in adolescents. A gender specific difference indicated that high lean mass is of crucial importance prominently in boys. In adolescents with low lean mass, especially in girls, high fat mass may partially ameliorate the effect of deficient lean mass levels.
Topics: Absorptiometry, Photon; Adipose Tissue; Adolescent; Body Mass Index; Body Weight; Bone Density; Cross-Sectional Studies; Exercise; Female; Forecasting; Humans; Life Style; Male; Norway; Pelvic Bones
PubMed: 29351755
DOI: 10.1186/s12891-018-1933-x -
Journal of Orthopaedic Surgery and... Jan 2023Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain...
BACKGROUND
Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD.
METHODS
Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications.
RESULTS
The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points.
CONCLUSION
The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.
Topics: Humans; Fracture Fixation, Internal; Fractures, Bone; Pelvic Bones; Pelvis; Physical Examination; Retrospective Studies
PubMed: 36658546
DOI: 10.1186/s13018-023-03523-z -
Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer.Japanese Journal of Radiology Jan 2021Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be...
PURPOSE
Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones.
MATERIALS AND METHODS
For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures.
RESULTS
Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P < 0.05-0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis.
CONCLUSION
Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.
Topics: Bone Density; Female; Fractures, Bone; Humans; Middle Aged; Pelvic Bones; Radiotherapy Dosage; Retrospective Studies; Risk Factors; Spinal Injuries; Spine; Tomography, X-Ray Computed; Uterine Cervical Neoplasms
PubMed: 32894410
DOI: 10.1007/s11604-020-01039-8 -
European Journal of Vascular and... 2022The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death.
OBJECTIVE
The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death.
METHODS
The study had a retrospective design, using data from a nationwide population based prospective registry of trauma patients in Japan. This propensity score matched study included all adult patients from the registry with pelvic fractures between January 2004 and December 2018. The primary outcome was hospital death. Secondary outcomes included 28 day survival and length of hospital stay (LOS) in days. Multivariable logistic regression analyses were performed to control confounding variables, including patient, clinical, and hospital related variables; concomitant trauma; severe trauma; and haemodynamic instability. A conditional logistic regression analysis was performed to assess the association between treatment of pelvic fracture with AE and hospital mortality rate.
RESULTS
Among 17 670 eligible patients with pelvic fractures, 2 379 (13.5%) underwent AE (AE group) and 1 512 (8.6%) died in the hospital. After one to one propensity matching with 2 138 patients from each group (AE and non-AE), the hospital mortality rate was significantly lower in the AE group than in the non-AE group (15.0% vs. 18.1%; p = .007). The AE group had significantly lower mortality (odds ratio; 95% confidence interval [CI] 0.60; 0.43 - 0.84; p = .003) and a significantly higher 28 day mean survival rate than the non-AE group (0.89; 95% CI 0.87 - 0.90 vs. 0.86; 0.85 - 0.88; p = .003), although there was no significant difference in the LOS (48 days vs. 46 days; p = .11).
CONCLUSION
This propensity score matched analysis showed an association between AE for pelvic fractures and lower hospital mortality rates. The findings in this large nationwide cohort study provide strong evidence for the benefit of embolisation for patients with pelvic fractures.
Topics: Adult; Humans; Cohort Studies; Retrospective Studies; Japan; Pelvic Bones; Fractures, Bone
PubMed: 36151007
DOI: 10.1016/j.ejvs.2022.05.048