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Pelvic ring fracture

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
Raymond D Wright
In acute trauma, pelvic ring instability can lead to hemorrhage and hemodynamic instability. Pelvic ring instability and displacement that is not stabilized may lead to chronic pain, sitting imbalance, and limb length inequality. Methods and timing of securing anterior pelvic ring injuries operatively is controversial and debatable. Many orthopaedic trauma surgeons would agree that acceptable methods to treat a disrupted anterior pelvic ring fracture include nonoperative care, external fixation, internal spanning fixators, intramedullary superior ramus screws, and open reduction internal fixation...
September 2018: Journal of Orthopaedic Trauma
Christopher Lee, Marcus Sciadini
The objective of this article was to highlight the indications and various methods of external fixation for management of the unstable anterior pelvic ring. Although most often used temporarily in the setting of significant hemorrhage from a pelvic ring fracture, external fixation remains an option for definitive stabilization of select pelvic ring injuries. Classically, the iliac crest frame has been used, although use of the supra-acetabular frame has gained favor due to its superior bone purchase and improved biomechanics...
September 2018: Journal of Orthopaedic Trauma
Jonathan G Eastman, Milton L Chip Routt
The superior ramus is an irregularly shaped, undulating, and curvilinear osseous structure that can provide an osseous conduit for intramedullary screws. A wide spectrum of variability between the curve and obliquity of the superior ramus osseous fixation pathway (OFP) exists in both the anteroposterior and the coronal planes. A detailed understanding of the osseous topography and how it correlates with fluoroscopic imaging is mandatory. Obtaining the correct intraoperative inlet and combined obturator oblique-outlet fluoroscopic views specific to each patient's anatomy is necessary for safe implant insertion...
September 2018: Journal of Orthopaedic Trauma
Geoffrey S Marecek, John A Scolaro
The evaluation and management of pelvic ring injuries continues to evolve. Historic treatment was primarily nonsurgical, which yielded to open surgical treatment as the benefits of restoring pelvic anatomy and stability became clear. The development of percutaneous techniques for pelvic ring fixation enabled surgeons to reduce and stabilize certain injuries without the need for large open surgical dissections. Although percutaneous iliosacral screw fixation of sacral fractures and sacroiliac disruptions is the standard for most posterior pelvic ring injuries, the evaluation and treatment of anterior pelvic ring disruptions remains a controversial topic among surgeons who treat these injuries...
September 2018: Journal of Orthopaedic Trauma
Laura W Lewallen, Amy L McIntosh, S Andrew Sems
The purpose of this study was to determine whether pelvic fracture pattern is associated with transfusion requirements or concomitant injuries in pediatric patients. This was a single-institution, retrospective review from 1970 to 2000. Pelvic ring injuries were classified using the Orthopaedic Trauma Association system. Injury Severity Scores were assigned. Ninety patients were included in this study. There were 27 A-type (30.0%), 51 B-type (56.7%), and 12 C-type (13.3%) injuries. Mean Injury Severity Scores were 8...
August 9, 2018: Orthopedics
Simone Ghisla, Francesca Napoli, Gyozo Lehoczky, Marco Delcogliano, Nermine Habib, Michele Arigoni, Giuseppe Filardo, Christian Candrian
INTRODUCTION: Posterior pelvic ring fractures frequently pose a problem of stability with an elevated risk of complications. The traditional method of percutaneous sacro-iliac (SI) stabilization with the use of fluoroscopic image amplifiers demands a high degree of experience and has an elevated risk of screws' malpositioning. HYPOTHESIS: Intraoperative 3D-CT scan coupled with a navigation system (O-Arm© ) can allow screw fixation accuracy while limiting the risk of complications for the treatment of posterior pelvic ring fractures...
August 3, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Josephine Berger-Groch, Marie Lueers, Johannes Maria Rueger, Wolfgang Lehmann, Darius Thiesen, Jan Philipp Kolb, Maximilian Johannes Hartel, Lars Gerhard Grossterlinden
INTRODUCTION: The objective of this study is to report the institutions experiences with standardized 2D computer-navigated percutaneous iliosacral screw placement (CNS), as well as the conventional fluoroscopically assisted screw placement method (CF) over a period of 10 years. PATIENTS AND METHODS: A total of 604 patients with sacral fractures (OTA B and C) were treated at the institution. Cases with both, a preoperative and postoperative CT scan were included for further analysis...
July 20, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Stephen M Mann, Daniel Banaszek, Katherine Lajkosz, Susan B Brogly, Shelby M Stanojev, Chris Evans, Davide D Bardana, Jeff Yach, Stephen Hall
INTRODUCTION: Although fractures of the pelvic ring account for only 2-3% of all fractures, they are present in approximately 7-20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period. METHODS: A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES)...
July 6, 2018: Injury
Florian Fensky, Wolfgang Lehmann, Andreas Ruecker, Johannes M Rueger
This video on the ilioinguinal approach presents its indications and techniques for the operative treatment of acetabular fractures. The principle of the ilioinguinal approach is to work through 3 different windows. The lateral window gives access to the pelvic bone from the sacroiliac joint to the lateral border of the iliopsoas muscle, the middle window accesses the medial border of the iliopsoas muscle to the femoral artery, and the medial window allows for control of the anterior pelvic ring medially from the femoral vein to the symphysis pubis...
August 2018: Journal of Orthopaedic Trauma
H Schmal, L Froberg, M S Larsen, N P Südkamp, T Pohlemann, E Aghayev, K Goodwin Burri
Aims: The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods: The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly...
July 2018: Bone & Joint Journal
Sverre Arvid Ingemar Loggers, Pieter Joosse, Kees Jan Ponsen
INTRODUCTION: Pubic rami fractures are common fractures in a growing osteoporotic geriatric population. Concomitant posterior ring fractures (cPRF) are often found when properly looked for. The pain and consequent immobilization leaves this vulnerable patient group at risk for complications. Conservative therapy is usually sufficient, but with cPRF's surgery can be indicated. Although previous studies have pointed out that mortality rates are high, longer term morbidity outcomes are lacking...
June 12, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Paul Schmitz, Stephan Lüdeck, Florian Baumann, Rainer Kretschmer, Michael Nerlich, Maximilian Kerschbaum
PURPOSE: Pelvic ring fractures, occurring in elderly patients are a challenging problem. Little known is about the patient-related outcome after these injuries. The primary objective of this study is to evaluate the quality of life after pelvic ring injuries in patients aged over 60 years. METHODS: Patients (≥ 60 years) with pelvic ring fractures treated in our trauma department between 2004 and 2014 were included. Next to patient data, injury-related details as well as treatment details were assessed...
June 26, 2018: International Orthopaedics
Kevin F Purcell, Patrick F Bergin, Clay A Spitler, Matthew L Graves, George V Russell
Acetabular and pelvic ring injuries in obese patients are difficult to treat. Obese patients require great attention to detail during the trauma evaluation to prevent medical and anesthetic complications in the perioperative period. Radiographic evaluation is often compromised by modalities available and loss of resolution with plain film imaging. Patient positioning must be meticulous to ensure stability on the bed while allowing access to the operative site, preventing pressure necrosis, and minimizing ventilation pressure...
July 2018: Orthopedic Clinics of North America
Hua-Shui Liu, Sheng-Jun Duan, Shi-Dong Liu, Feng-Shuang Jia, Li-Ming Zhu, Min-Cen Liu
PURPOSE: The purpose of this study was to investigate the safety and efficacy of the combination of robot-assisted percutaneous screw placement and pelvic internal fixator (INFIX) for minimally invasive treatment of unstable anterior and posterior pelvic ring injuries. METHODS: From September 2016 to June 2017, twenty-four patients with unstable anterior and posterior pelvic ring injuries were treated with TiRobot-assisted percutaneous sacroiliac cannulated screw fixation on the posterior pelvic ring combined with robot-assisted pedicle screw placement in the anterior inferior iliac spine along with INFIX on the anterior pelvic ring...
June 19, 2018: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Anthony Ding, Robert V OʼToole, Renan Castillo, Brad Reahl, Ryan Montalvo, Jason W Nascone, Marcus F Sciadini, Anthony R Carlini, Theodore T Manson
OBJECTIVES: To identify the risk factors for early reoperation after operative fixation of acetabular fractures. DESIGN: Retrospective evaluation. SETTING: Level I Trauma Center. PATIENTS: Seven hundred ninety-one patients with displaced acetabular fractures treated with open reduction and internal fixation (ORIF) from 2006 to 2015. Average follow-up was 52 weeks. MAIN OUTCOME MEASURES: Early reoperation after acetabular ORIF, defined as secondary procedure for infection or revision within 3 years of initial operation...
July 2018: Journal of Orthopaedic Trauma
J Hack, A Krüger, A Masaeli, R Aigner, S Ruchholtz, L Oberkircher
INTRODUCTION: Cement-augmentation is a well-established way to improve the stability of sacroiliac screw fixation in osteoporosis-associated fragility fractures of the posterior pelvic ring. However, to date little is known about the influence of different techniques of cement augmentation on construct stability. The aim of this study was to evaluate the primary stability of cement-augmented sacroiliac screw fixation with cannulated versus perforated screws under cyclic loading. MATERIALS AND METHODS: A total of eight fresh-frozen human cadaveric hemipelvis specimens with osteoporosis were used...
June 9, 2018: Injury
Yonggang Li, Xiguang Sang, Zhiyong Wang, Lin Cheng, Hao Liu, Tao Qin, Kai Di
BACKGROUND: It is often difficult to achieve stable fixation in Tile type C1 pelvic fractures and there is no standard fixation technique for these types of injuries. HYPOTHESIS: Iliac screw fixation can be used for treating Type C1 pelvic fractures. PATIENTS AND METHODS: A retrospective review was performed on 47 patients who underwent iliac screw fixation in posterior column of ilium (PCI) for Tile type C1 pelvic fractures from July 2007 to December 2014...
June 18, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Jacob D Gire, Sam Y Jiang, Michael J Gardner, Julius A Bishop
OBJECTIVE: To determine how the utilization of open versus percutaneous treatment of posterior pelvic ring injuries in early career orthopaedic surgeons has changed over time. METHODS: Case log data from surgeons testing in the trauma subspecialty for Part II of the ABOS examination from 2003 to 2015 were evaluated. CPT codes for percutaneous fixation (27216) and open fixation (27218) of the posterior pelvic ring were evaluated using a regression analysis. RESULTS: A total of 377 candidates performed 2,095 posterior ring stabilization procedures (1,626 percutaneous, 469 open)...
May 28, 2018: Journal of Orthopaedic Trauma
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