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Pelvic ring fracture

Dewen Yan, Zhan Shi, Liping Wang, Xiumin Zhao
CASE: Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms...
October 16, 2018: European Journal of Contraception & Reproductive Health Care
Masaki Takao, Hidetoshi Hamada, Takashi Sakai, Nobuhiko Sugano
The purpose of this chapter is to review current evidence on indications, techniques, and outcomes of computer-navigated surgical treatment of pelvic ring injuries and acetabular fractures, particularly computer-navigated screw fixation.Iliosacral screw fixation of pelvic ring injury using navigation is attracting attention because the biomechanical stabilization of posterior pelvic ring disruption is of primary importance and is widely indicated because it does not require complete reduction of the fracture site...
2018: Advances in Experimental Medicine and Biology
T Pavelka, M Salášek
Anterior penetrating sacral injuries in children are extremely rare. These injuries are coupled with both a high energy mechanism (combat injury, motor vehicle accidents) and with foreign body impalement. The treatment is individual, laparotomy with penetrating wound exploration is indicated, osteosynthesis is performed in case of grossly displaced fractures, in an unstable injury to the posterior pelvic ring, and urgently in case of a neurological injury. The case report describes a 14-year-old girl with a left-sided anterior penetrating sacral injury at the level of S2/S3, who was injured during a bicycle accident (impalement on handlebars)...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
G H Sandmann, U Stöckle, T Freude, F M Stuby
PURPOSE OF THE STUDY Fragility fractures of the pelvic ring in the elderly population are a serious problem in orthopaedics. The treatment options range from conservative treatment to diverse operative options. We present a balloon guided new technique of implanting cement augmented screws aiming at improved implant anchorage and reduced cement leakage. MATERIAL AND METHODS We describe a new technique of balloon- guided cement augmented iliosacral screws. After the balloon has been insufflated and contrast medium has been instillated for leakage detection, iliosacral screws can safely be placed with a relevant cement depot...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Mika F Rollmann, Jörg H Holstein, Tim Pohlemann, Steven C Herath, Tina Histing, Benedikt J Braun, Hagen Schmal, Guy Putzeys, Ivan Marintschev, Emin Aghayev
PURPOSE: Secondary hip osteoarthritis after acetabular fractures requiring total arthroplasty (THA) poses a huge burden on the affected patients as well as health systems. The present study aimed to assess risk factors associated with THA after acetabular fractures based on the data from the German Pelvic Trauma Registry. METHODS: Retrospective analysis of 678 acetabular fracture cases without concomitant pelvic ring fracture treated and followed-up between January 2004 and May 2015 at six large trauma centres...
September 29, 2018: International Orthopaedics
J Šrám, S Taller, R Harcuba, M Křivohlávek, R Lukáš, V Džupa
PURPOSE OF THE STUDY The aim of this study is to evaluate the first experience gained with the new type of anatomical symphyseal plates intended to stabilise ruptured symphysis and closely located fractures. MATERIAL AND METHODS A retrospective evaluation was performed in 5 patients who had undergone surgery in the period from July 2015 to the end of 2016 using a new anatomical symphysial plate for pelvic ring injury. In four cases a stabilisation of symphyseolysis was carried out and in one case osteosynthesis of bilateral rami fracture near the symphysis was performed...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Josephine Berger-Groch, Darius M Thiesen, Dimitris Ntalos, Lars G Grossterlinden, Eric Hesse, Florian Fensky, Maximilian J Hartel
BACKGROUND: Gold standard to diagnose osteoporosis is standard dual-energy X-ray absorptiometry (DXA). CT is a standard diagnostic tool to detect injuries to the pelvic ring. The aim of the study was to collect information on bone density without DXA by determination of Hounsfield units (HU) in CT scans of patients with sacral fractures, to draw conclusions on the prevalence of osteoporosis in patients admitted to the investigating institution. HYPOTHESIS: Is the determination of HU in CT scans a useful method to gain more information about bone density in patients with sacral fractures? PATIENTS AND METHODS: We performed a retrospective analysis of all patients treated from 2004-2014 with sacral fractures confirmed with a CT scan...
September 19, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Peter A Cole, Daniel K Hesse, Anthony J Dugarte, Evgeny Dyskin
Introduction: An alternative method to external fixation for the treatment of unstable anterior pelvic ring injuries, termed the pelvic bridge technique, provides equivalent results with fewer complications and is performed using occipital cervical rods subcutaneously, with fixation into the iliac wings and parasymphyseal bone. Indications & Contraindications: <AbstractText Label="Step 1 Preoperative Planning" NlmCategory="UNASSIGNED">For preoperative planning, review the appropriate imaging, including radiographs and computed tomography (CT) scans, to mesh the findings on imaging to the clinical picture of the patient and ensure that the patient meets operative criteria and that none of the contraindications are present...
September 28, 2017: JBJS Essential Surgical Techniques
Francesco Liuzza, Noemi Silluzio, Michela Florio, Omar El Ezzo, Gianpiero Cazzato, Gianluca Ciolli, Carlo Perisano, Giulio Maccauro
PURPOSE: The sacrum is a mechanical nucleus working as the base for the spinal column, as well as the keystone of the pelvic ring. Thus, injuries of the sacrum can lead to biomechanical instability and nerve conduction abnormality. METHODS: The common classification is the Denis classification, but these fractures are often part of a lesion of the posterior pelvic ring and therefore the Tile classification is very useful. The goals of operative intervention are to reduce fracture fragments, protect neurological structures, and provide adequate stability for early mobilization...
September 17, 2018: International Orthopaedics
Chun-Chi Hung, Jia-Lin Wu, Yuan-Ta Li, Yung-Wen Cheng, Chia-Chun Wu, Hsain-Chung Shen, Tsu-Te Yeh
BACKGROUND: Pelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique...
September 17, 2018: Journal of Orthopaedic Surgery and Research
Julian Scherer, Simon Tiziani, Kai Sprengel, Hans-Christoph Pape, Georg Osterhoff
INTRODUCTION: Subcutaneous internal fixation (InFix) has become a valid alternative for anterior fixation of pelvic ring injuries. Complications associated with this technique are lateral femoral cutaneous nerve (LFCN) irritation and anterior thigh pain due to prominent implants. The aim of this study was to identify a configuration of the InFix that causes the least adverse side effects. METHODS: Nineteen patients (6 females, mean age 61 years) with 38 hemipelves were included...
September 8, 2018: International Orthopaedics
Bryant W Oliphant, Christopher J Tignanelli, Lena M Napolitano, James A Goulet, Mark R Hemmila
BACKGROUND: Pelvic ring fractures represent a complex injury that requires specific resources and clinical expertise for optimal trauma patient management. We examined the impact of treatment variability for this type of injury at Level 1 and 2 trauma centers on patient outcomes. METHODS: Trauma quality collaborative data (2011-2017) were analyzed. This includes data from 29 ACS-COT verified Level 1 and Level 2 trauma centers. Inclusion criteria were adult patients (≥ 16 years), ISS ≥ 5, blunt injury, and evidence of a partially stable or unstable pelvic ring fracture injury coding as classified using Abbreviated Injury Scale version 2005, with 2008 updates...
September 4, 2018: Journal of Trauma and Acute Care Surgery
James T Carson, Sabin G Shah, Gezzer Ortega, Sorawut Thamyongkit, Erik A Hasenboehler, Babar Shafiq
Background: There have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients. Methods: We retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16-85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010...
2018: Patient Safety in Surgery
Frank R Avilucea, Michael T Archdeacon, Cory A Collinge, Marcus Sciadini, H Claude Sagi, Hassan R Mir
BACKGROUND: Examination under anesthesia (EUA) has been used to identify pelvic instability. Surgeons may utilize percutaneous methods for posterior and anterior pelvic ring stabilization. We developed an intraoperative strategy whereby posterior fixation is performed, with reassessment using sequential EUA to determine the need for anterior fixation. Our aim in the current study was to evaluate whether this strategy reliably results in union with minimal displacement. METHODS: This was a multicenter retrospective study involving adult patients with closed lateral compression (LC) pelvic ring injuries treated during the period of 2013 to 2016...
September 5, 2018: Journal of Bone and Joint Surgery. American Volume
Christopher A Becker, Christian Kammerlander, Adrian Cavalcanti Kußmaul, Fabian Dotzauer, Matthias Woiczinski, Bianka Rubenbauer, Fabian Sommer, Christoph Linhart, Simon Weidert, Christian Zeckey, Axel Greiner
INTRODUCTION: Operative treatments of T-type acetabular fractures are challenging surgical procedures. Open reduction and internal fixation is the standard method for the operative management of these fractures, however this is associated with high blood loss, long hospital stay and longer rehabilitation. Anterior subcutaneous pelvic fixation (internal fixation=INFIX) and retrograde pubic screw fixation have shown promising results in minimally invasive treatment of pelvic ring fractures...
September 1, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Pierre-Louis Ricci, Stefan Maas, Jens Kelm, Torsten Gerich
BACKGROUND: The objective of the study is to investigate the load transmission within the pelvic ring under physiological loading during gait and to correlate these results with clinical findings. In a second approach, we analysed how load distribution is altered by fractures of the anterior pelvic ring. METHODS: Muscle forces and joint reaction forces are calculated by inverse dynamics and implemented in a finite element pelvis model including the joints. RESULTS: With the intact configuration and according to the moment of the gait, left and right superior and inferior rami show the highest stresses of the model, corresponding to the typical location of an anterior pelvic ring fracture...
September 3, 2018: Journal of Experimental Orthopaedics
M Winkelmann, M Lopez Izquierdo, J-D Clausen, E Liodakis, P Mommsen, R Blossey, C Krettek, C Zeckey
Aims: This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent. Patients and Methods: The study is a retrospective matched-pair analysis of patients with a pelvic fracture according to the modified Tile AO Müller and the Young and Burgess classification who presented to a level 1 trauma centre between January 2005 and December 2014...
September 2018: Bone & Joint Journal
Kevin L Chow, Eduardo Smith-Singares, James Doherty
Introduction: Pelvic fractures usually involve a high-energy traumatic mechanism and account for approximately 3% of all blunt traumatic skeletal injuries. Additional musculoskeletal injuries are found in over 80% of unstable pelvic fractures. Traumatic abdominal wall hernias (TAWHs) are a rare entity, and traumatic inguinal hernias (TIHs) associated with open-book pelvic fractures have not been described previously. Case Presentation: We present the case of a 45-year-old male motorcyclist involved in a collision resulting in a traumatic direct inguinal hernia due to abdominal wall disruption from an open-book pelvic fracture...
2018: Case Reports in Surgery
Marcel Wiley, Sheena Black, Case Martin, Jonathan Barnwell, Adam Starr, Ashoke Sathy
INTRODUCTION: Pelvic angiography with transcatheter arterial embolization (TAE) is an established intervention for management of pelvic arterial hemorrhage. This study analyzes complication rates after angiography among patients with pelvic trauma treated in the context of a multidisciplinary institutional pelvic fracture protocol. METHODS: Retrospective analysis of prospectively collected data was conducted. Demographics, fracture type, embolization (ie, unilateral versus bilateral and selective versus nonselective), and complications (ie, pseudoaneurysm, renal failure, soft-tissue necrosis/infection, and anaphylactic reactions) were noted...
August 13, 2018: Journal of the American Academy of Orthopaedic Surgeons
Michael T Archdeacon, Cory A Collinge, Adam P Schumaier, Georgina Glogovac
Pelvic fractures are common after high-energy trauma and are often associated with ligamentous injury. Treatment is guided by assessing stability of the pelvic ring, and unstable injuries frequently require surgery to achieve a desirable outcome. Assessment of pelvic ring stability is often possible with physical examination and standard imaging studies (plain radiographs and computed tomography); however, these "static" imaging modalities may not adequately identify dynamically unstable pelvic injuries that require surgery...
September 2018: Journal of Orthopaedic Trauma
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