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Pelvic fractures

Jonathan D Stevenson, Minna K Laitinen, Michael C Parry, Vaiyapuri Sumathi, Robert J Grimer, Lee M Jeys
INTRODUCTION: Chondrosarcoma (CS) is the second most common primary bone sarcoma with no clear role for adjuvant therapy. The purpose of this study was to investigate (1) the relationship between surgical excision margins and local recurrence free survival (LRFS), and (2) the role of local recurrence (LR) in disease specific survival (DSS) in CS of the extremity and pelvis. MATERIAL AND METHODS: 341 pelvic and extremity CS diagnosed between 2003 and 2015 were studied retrospectively...
June 8, 2018: European Journal of Surgical Oncology
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
Michael Williamson, Felice Vanacore, Caroline Hing
Pubic symphysis diastasis injuries typically occur following a high velocity force such as road traffic accidents, horse riding, crush injuries and falls from a height. There are reports of a range of injuries caused by waterslides including spinal fractures, head injuries and vaginal injuries. Here we report the case of a 50-year-old female who suffered a pelvic diastasis injury during the use of a waterslide.
June 2018: Journal of Clinical Orthopaedics and Trauma
Fang-Chuan Kuo, Shin-Tsu Chang, Yin-Yin Liao, Cheng-Hung Lee
BACKGROUND AND PURPOSE: Patients with vertebral compression fracture (VCF) usually exhibit impaired postural control and consequently are at an increased risk of falling. This study aimed to assess the sensory and kinematic components of the limits of stability (LOS) test in patients with VCF. METHODS: This study enrolled 13 adults with (VCF), 13 older adults without spinal deformity (NE), and 13 young adults (NY). The Biodex balance system was employed to calculate the balance score and the LOS of participants...
June 19, 2018: Journal of Geriatric Physical Therapy
Christiane G Kruppa, Justin D Khoriaty, Debra L Sietsema, Marcel Dudda, Thomas A Schildhauer, Clifford B Jones
INTRODUCTION: Pediatric pelvic injuries are rare. Due to anatomic differences of the immature pelvis, different injury patterns may occur as compared to adults. The purpose was to analyze the effect of skeletal maturity on pediatric pelvic injury pattern, associated injuries, and treatment intervention. PATIENTS AND METHODS: Ninety children with a pelvic injury receiving treatment at a private orthopaedic practice in association with a Level One Teaching Trauma Center, between March 2002 and June 2011, were retrospectively analyzed...
June 16, 2018: Injury
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
Andrew B Ross, Brian Y Chan, Paul H Yi, Michael D Repplinger, David J Vanness, Kenneth S Lee
OBJECTIVE: To determine the diagnostic accuracy of an abbreviated, two-sequence MRI protocol using limited pulse sequences for the detection of radiographically occult hip and pelvis fractures in the elderly compared to the complete MRI examination. MATERIALS AND METHODS: One hundred and eleven consecutive emergency department patients age 65 or older who had undergone MRI to evaluate for clinically suspected hip fracture after negative radiographs were included in the study...
June 18, 2018: Skeletal Radiology
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 15, 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
Jonas Holtenius, Peyman Bakhshayesh, Anders Enocson
BACKGROUND: Presence of pelvic fractures in trauma patients has previously been related to high mortality. However, there are controversies on whether pelvic fractures are the underlying cause of death or if it is rather an indicator of injury severity. We aimed to assess whether the presence of pelvic fracture increased mortality among a cohort of trauma patients or if it was simply an indicator of severe injury. MATERIAL AND METHODS: Karolinska University Hospital is the largest trauma centre in Sweden...
June 12, 2018: Injury
Alex Quok An Teo, Jing Hui Yik, Sheldon Ng Jin Keat, Diarmuid Paul Murphy, Gavin Kane O'Neill
INTRODUCTION: Percutaneously-placed sacroiliac (SI) screws are currently the gold-standard fixation technique for fixation of the posterior pelvic ring. The relatively high prevalence of sacral dysmorphism in the general population introduces a high risk of cortical breach with resultant neurovascular damage. This study was performed to compare the accuracy of SI screw placement with and without the use of intraoperative navigation, as well as to externally validate the sacral dysmorphism score in a trauma patient cohort...
May 31, 2018: Injury
Candice Ostrowka, Stéphanie Bonhomme, Pomme Jouffroy, Guillaume Riouallon
INTRODUCTION: Fractures of the pelvis (acetabulum and pelvic ring) are complex in both radiological diagnosis and therapeutic management. They show high risk of thrombosis, with variable rates of venous thromboembolic complications in the literature, ranging from 10% to 50%, with 0.5-10% risk of fatal pulmonary embolism. The objective of the present study was to determine the rate of venous thromboembolic events in a consecutive cohort of pelvic fracture and to attempt to identify thromboembolic risk factors in this population...
June 12, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Sean Gipson, Mathew Weissenborn, Chip Bell, Chet Rees
Though hemorrhaging pelvic arteries can be treated with transcatheter arterial embolization, difficulty in selection of injured arteries can lead to increased morbidity and mortality due to embolization of untargeted vasculature and prolonged time to hemostasis, resulting in unnecessary ischemic injury and prolonged hemorrhage. This report describes a balloon occlusion technique utilized in the setting of an unselectable hemorrhaging obturator artery.
July 2018: Proceedings of the Baylor University Medical Center
Y Arlachov, R Ibrahem Adam
Acute hip pain is a common presenting complaint among patients attending Emergency Departments particularly following a traumatic event. A proximal femoral fracture is the main consideration, which requires urgent confirmation and treatment; however, there are a number of conditions, which could mimic neck of femur fracture and the causes may not be directly related to the hip, so systematic and careful observation of pelvic MRI could shed light on the true culprit of acute hip pain.
June 11, 2018: Clinical Radiology
Alexander Trulson, Markus Alexander Küper, Inga Maria Trulson, Christian Minarski, Leonard Grünwald, Bernhard Hirt, Ulrich Stöckle, Fabian Stuby
BACKGROUND: Dislocated pelvic fractures which require surgical repair are usually operated on via open surgery. Approach-related morbidity is reported with a frequency of up to 30%. The aim of this anatomical study was to prove the feasibility of endoscopic visualisation of the relevant anatomical structures in pelvic surgery and to perform completely endoscopic plate osteosynthesis of the acetabulum with available standard laparoscopic instruments. METHOD: In four human cadavers, we established an endoscopic preparation of the complete pelvic ring, from the symphysis to the iliosacral joint, including the quadrilateral plate and the sciatic nerve, and performed endoscopic plate osteosynthesis along the iliopectineal line...
June 14, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Séverin Ramin, Margaux Hermida, Ingrid Millet, Thibault Murez, Valérie Monnin, Mazen Hamoui, Xavier Capdevila, Jonathan Charbit
BACKROUND: The objective was to assess the predictive performance of different intravascular contrast extravasation (ICE) characteristics for need for pelvic transarterial embolization (TAE) to determine the risk factors of false-positives. METHODS: A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture were included. Pelvic ICE characteristics on computed tomography (CT) scan were studied: arterial (aSICE), portal surface (pSICE), and extension (exSICE) anatomic relationships...
June 12, 2018: Journal of Trauma and Acute Care Surgery
Alexander Arzeno, Tim Wang, James I Huddleston
Revision hip arthroplasty in the setting of periacetabular bone loss presents a significant challenge, as options for restoring bone loss are limited. Recombinant human bone morphogenetic protein-2 may offer a solution by promoting bone growth to restore bone stock before implant reimplantation. Here we present a case of a patient with a periprosthetic acetabulum fracture, resulting in pelvic discontinuity as the result of significant periacetabular bone loss. Using a staged approach, periacetabular bone stock was nearly entirely reconstituted using recombinant BMPs and allograft, which resulted in stable fixation, but with abundant heterotopic bone formation...
June 2018: Arthroplasty Today
Paul D Stein, Fadi Matta, Mary J Hughes
Background: Which patients with fractures, if any, have a lower mortality with prophylactic inferior vena cava filters has yet to be established. The purpose of this investigation is to determine if patients with low-risk fractures might benefit from a prophylactic inferior vena cava filter. Methods: Administrative data was analyzed from the National (Nationwide) Inpatient Sample using ICD-9-CM codes. Included patients were aged 18 years or older with a primary diagnosis of non-complex fracture of the pelvis, or fracture of the femuralone, or fracture of the tibia and/or fibula...
April 2018: Journal of Clinical Orthopaedics and Trauma
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