What are the risk factors for complications after combined injury of the pelvic ring and acetabulum?

Purpose

Combined acetabular and pelvic ring injuries represent a unique subset of pelvic trauma and little is known regarding their complications and outcomes. We sought to further evaluate these injury patterns and quantify their outcomes.

Methods

A retrospective review at a single level 1 trauma center was performed on all patients with operatively treated combined ring and acetabulum injuries during a seven-year period. Main outcome measurements include all-cause complication including residual neurologic deficit, deep infection, conversion to total hip arthroplasty, deep venous thrombosis and mortality.

Results

Seventy operatively treated combined ring and acetabulum patients with one-year follow-up were reviewed. The overall complication rate was 44%. Hip dislocation occurred in 40% of the cohort and was significantly associated with residual neurologic deficit and all-cause complication. Angiography with embolization was not associated with an increased rate of deep infection. Open acetabular approaches had a significantly higher complication rate compared to percutaneous procedures. Delay to definitive fixation greater than 36 h trended toward but did not reach association with all complications.

Conclusion

Combined injuries to the acetabulum and pelvic ring have high rates of complications. No individual fracture patterns were identified as risk factors, but hip dislocation was associated with an increased rate of complications. When possible, percutaneous reduction and fixation of acetabular fractures and early definitive fracture fixation lead to lower rates of complications. Use of angiography with embolization appears to be safe and does not increase the risk of infection or other complications.

     

Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study

BackgroundComplex anatomy of acetabular fracture is quite challenging for the orthopedic surgeons. Many Acetabular fracture fixation approaches have been used for a long time to treat different fracture patterns of acetabulum. Kocher-Langenbeck Approach (K-L approach) of acetabulum fracture is usually used by most of orthopedic surgeons. In this retrospective study, we evaluated the clinical and functional outcome of subtypes of acetabulum fractures treated with K-L approach. Assessment of Intra and postoperative complications of subtypes of acetabulum fractures was also done.MethodEighty patients (48 men and 32 women) were included in this retrospective study with a mean follow-up period of 2.6 years. Fractures were classified according to Letournal and Judet classification. K-L approach was performed in all these patients. Post operative reduction, Radiological outcome was quantified using Matta's criteria while the functional outcome was assessed according to Merle d’Aubigné and Postel scoring system. Postoperative complications were evaluated.ResultsThe mean age of a total of 80 cases was 43.64 ± 13.24 year. The type of fracture was found to be significantly associated with concentric/non-concentric reduction (p = 0.003) and with post op reduction (p = 0.005). The post operative reduction was found to be significantly associated with radiological (p < 0.001) and functional outcome (p < 0.001) at one year post op. The type of fracture was found to be significantly associated with radiological outcome (p < 0.001) while non-significantly found to be associated with functional outcome at 1 year (p = 0.050). The type of fracture was found to be significantly associated with post op complications (p = 0.003) and with arthritis (p = 0.001).ConclusionK-L approach is a multifaceted and convenient approach for treating acetabulum fractures. Type of fracture and post-operative reduction are key factors for a satisfactory outcome. Transverse with posterior wall fracture has the worst prognosis.     

Functional outcomes in pelvic fractures and the factors affecting them– A short term,prospective observational study at a tertiary care hospital

BackgroundPelvic fractures are markers of high energy trauma and are associated with significant morbidity and mortality. With evolution of modern diagnostic tools and intervention their management has come a long way.Research questionWhether or not modern healthcare could provide the victims of such high energy trauma with a good functional outcome and optimal quality of life, such that they are able to perform their activities of daily living independently?ObjectivesTo evaluate the functional outcomes in pelvic fractures and to find out factors that could indicate the prognosis.MethodologyOurs is a prospective observational study with 75 patients at a tertiary care hospital between September 2015 to December 2016. The minimum duration of follow up was six months. Patients' demographic profile, mode and pattern of injury, associated injuries, management and subsequent complications, if any were recorded prospectively. Functional outcomes were assessed using the Majeed score. All preoperative parameters were correlated statistically with the Majeed score to find out their association.ResultsMajeed scores were excellent in 27 patients, good in 29 patients, fair in 12 patients and poor in 7 patients. Overall functional outcome were good due to availability of sophisticated diagnostic tools, dedicated trauma management team and experienced pelvi-acetabular surgeon. Poorer outcomes were seen in male gender, associated urogenital injuries, associated acetabulum and sacrum fractures, associated nerve injuries and bedsore. No association were seen with age, fracture pattern, treatment modality and timing of surgery.ConclusionWith modern day diagnostic and therapeutic modalities the functional outcome a patient could achieve is promising. With associated risk factors guiding the outcome, the health care provider can individualise the management and decrease the overall morbidity and mortality of such high energy injuries.     

Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center

IntroductionTraumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management.Patients and methodsRetrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures.ResultsPatients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died.ConclusionsIn Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.     

Epidemiology and outcomes of tibial plateau fractures in adults aged 60 and over treated in the United Kingdom

BackgroundTibial plateau fractures are common in older adults, often resulting from low-energy falls. Although lower limb fragility fracture care has evolved, the management of tibial plateau fractures in older patients remains poorly researched. This study aimed to define the epidemiology, treatment and outcomes of tibial plateau fractures in patients aged over 60 years.MethodologyPatients aged 60 years or older with a tibial plateau fracture who presented to a single trauma center between January 2008 and December 2018 were identified. Incomplete records were excluded. Epidemiological data, fracture classification, injury management, radiological outcomes, complications, and mortality were assessed via retrospective case note and radiograph review. Local ethics approval was obtained.ResultsTwo-hundred and twenty patients with a mean age of 74 years (range 60–100) were included. 73% were female and 71% of injuries were sustained following low-energy falls. Median follow up was three months. 50% of fractures involved the lateral plateau. 60% of injuries were treated non-operatively. 76% of patients had their weight-bearing restricted for the first six weeks, with little difference between operatively and non-operatively managed patients. 8% of all patients required subsequent knee replacement. All-cause mortality at 30-days and one-year were 2% and 5% respectively.ConclusionThe majority of tibial plateau fractures in the over 60s are sustained from low-energy trauma. Management is relatively conservative when compared with younger cohorts. The data reported brings up questions of whether surgical treatment is beneficial to this patient group, or whether restricted weight bearing is either possible or beneficial. Prospective, multi-center comparative trials are needed to determine whether increased operative intervention or different rehabilitation strategies purveys any patient benefit.     

Fractures of the posterior wall of the acetabulum: Treatment using internal fixation of two parallel reconstruction plates

Objectives

Our aim was to evaluate the efficacy of the treatment method using internal fixation of parallel reconstruction plates for the posterior wall of the acetabulum fractures.

Design

Randomised, prospective.

Setting

Level I trauma centre. Patients/participants: 57 patients with posterior wall fractures of the acetabulum in our department from 2007 to 2010 were treated operatively using this technique. Intervention: internal fixation of two parallel reconstruction plates was used in this study. One of the plates was near the border of acetabulum. The other was parallel to the former one and was located to stress concentrated area. Main outcome measurements: The clinical outcome was evaluated using the clinical grading system and radiological outcome was evaluated according to the criteria described by Matta. In addition, complications were researched in this study.

Results

The percentages of the clinical excellent-to-good and fair-to-poor results were 93.0% and 7%, respectively. We found that clinical outcome had no correlation with age, operation time from injury to operation, nor had correlation with hip dislocation, comminuted fracture condition and marginal compression fracture. Anatomical reduction was significantly correlated with excellent-to-good clinical outcome. Necrosis of the femoral head and heterotopic ossification were prone to decline the outcome of acetabular fractures despite good fracture reduction.

Conclusions

the internal fixation of two parallel reconstruction plates facilitated rigid fixation and avoided fracture fragment injury, was an effective and reliable alternative method to treat fractures of the posterior wall of the acetabulum.     

Epidemiological assessment of acetabular fractures in a level one trauma centre: A 7-Year observational study

PurposeThe present study was conducted to evaluate the epidemiological characteristics of the Acetabular fractures treated in a level one trauma centre of India. This study is one of the largest to provide first-hand information regarding the demography, fracture patterns, other associated injuries, and the hospital stay of acetabular fractures in India.MethodPatients admitted with the diagnosis of acetabular fractures between January 2013 and November 2019 were retrospectively analyzed in terms of demographic data such as age and sex, mechanism of injury, other associated injuries, and the duration of hospital stay.ResultsA total of 305 patients with 313 fractures of the acetabulum were included in the study. Among the 305 patients, 268 (87.8%) were male and 37 (12.1%) were female, with a declining male to female ratio over the years. The mean age was 37.1 ± 13.2 years (range 14–84 years). During the seven years, the mean age of presentation progressively increased. Linear regression showed an increase from 33 to 40 years from 2013 to 2019 (R2 = 0.027). Road traffic injuries were the most common mechanism of injury, contributing to about 77.4% of all cases. Associated injuries were seen in 62% of total cases with multiple system involvement in 26.6% of patients. The most frequent pattern in this epidemiological study was an isolated posterior wall fracture (21.4%) while the isolated anterior wall was the least frequent (0.95%).ConclusionAcetabular fractures are increasing in numbers and with increasing knowledge so is their surgical management in our country. It shall be prudent to establish an integrated electronic national trauma registry to maintain complete documentation in all institutions dealing with trauma management to ascertain the changing trends of acetabular fracture patterns in the country over time.     

Epidemiological assessment of acetabular fractures in a level one trauma centre: A 7-Year observational study

PurposeThe present study was conducted to evaluate the epidemiological characteristics of the Acetabular fractures treated in a level one trauma centre of India. This study is one of the largest to provide first-hand information regarding the demography, fracture patterns, other associated injuries, and the hospital stay of acetabular fractures in India.MethodPatients admitted with the diagnosis of acetabular fractures between January 2013 and November 2019 were retrospectively analyzed in terms of demographic data such as age and sex, mechanism of injury, other associated injuries, and the duration of hospital stay.ResultsA total of 305 patients with 313 fractures of the acetabulum were included in the study. Among the 305 patients, 268 (87.8%) were male and 37 (12.1%) were female, with a declining male to female ratio over the years. The mean age was 37.1 ± 13.2 years (range 14–84 years). During the seven years, the mean age of presentation progressively increased. Linear regression showed an increase from 33 to 40 years from 2013 to 2019 (R2 = 0.027). Road traffic injuries were the most common mechanism of injury, contributing to about 77.4% of all cases. Associated injuries were seen in 62% of total cases with multiple system involvement in 26.6% of patients. The most frequent pattern in this epidemiological study was an isolated posterior wall fracture (21.4%) while the isolated anterior wall was the least frequent (0.95%).ConclusionAcetabular fractures are increasing in numbers and with increasing knowledge so is their surgical management in our country. It shall be prudent to establish an integrated electronic national trauma registry to maintain complete documentation in all institutions dealing with trauma management to ascertain the changing trends of acetabular fracture patterns in the country over time.     

传统正骨手法复位经皮弹性髓内钉固定治疗儿童肱骨近端骨折

目的 :探讨儿童肱骨近端骨折采用传统正骨手法复位经皮弹性髓内钉固定治疗的临床疗效和安全性。方法:回顾2012年10月至2016年5月,运用传统正骨手法复位弹性髓内钉经皮内固定治疗65例,其中男52例,女13例;年龄7~14岁,平均11.2岁;左侧23例,右侧42例;斜形骨折13例,横形骨折49例,粉碎性骨折3例。全部为闭合性明显移位性骨折,不合并血管、神经损伤。就诊时间为伤后20 min~5 d,平均3 d。术后随访观察骨折愈合及并发症的发生情况,并运用Neer肩关节功能评分法评价疗效。结果:手术时间30~40 min,平均35 min;术中出血5~10 ml,平均6.5 ml。65例均获随访,时间12~28个月,平均18个月,骨折全部愈合。按照Neer肩关节功能评分法评价疗效,优59例,良5例,可1例。4例针尾部皮肤少许分泌物,2例皮肤激惹现象,1例部分退针,均在取针后愈合。无断钉及退钉现象造成的骨不愈合现象发生,无血管、神经损伤病例发生。结论:手法复位经皮弹性髓内钉固定治疗儿童肱骨近端骨折的方法,具有创伤小、恢复快、并发症少、操作方法简单等优点。     

Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka,Bangladesh

PurposeIn Bangladesh the incidence of pelvic fracture is increasing day by day due to suboptimal roads and heavy traffic. However, there is no epidemiological study of these injuries in Bangladesh. Our aim was to study the epidemiology of patients admitted with pelvic fractures at two tertiary care hospital in Dhaka, Bangladesh.MethodsThis was a prospective study carried out on trauma patients with pelvic fracture at two level 1 trauma care center of two tertiary care hospital in Dhaka, Bangladesh. The study period was from July 2015 to June 2019 (48 months). Patient’s data including demography of patients, mechanism of injuries, fracture types, associated injuries, method of treatment, post-operative complications, length of hospital stay were recorded according to a unified protocol.ResultsThe study population was comprised of 696 patients, where 556 (79.88%) were male and 140 (20.12%) were female. Mean age was 37.75 years and road traffic accidents were the most common mode of injuries. Lateral compression fractures were the most common injuries and Urethral injuries were the most common associated injuries. Death was the outcome in 3.5% of the cases due to high energy trauma.ConclusionThis study revealed that pelvic fractures were significantly more frequent in men. Most frequent cause was road traffic accident. The majority of these cases did not required surgery. Mortality was associated with high velocity trauma with severe injuries.     

Percutaneous reduction and screw fixation of fracture neck talus

BackgroundFracture neck talus is a rare fracture represents about 1% of all fractures and usually due to high energy trauma. These fractures are usually associated with compromised soft tissues, concomitant skeletal fractures, or life threatening injuries. Talus has a tenuous blood supply which is affected by fracture displacement. Urgent fracture reduction ± fracture fixation is mandatory. The associated injuries may make the conventional open reduction and internal fixation is impossible to be done in urgent base as it may impacts the already tenuous blood supply of talus increasing the risk of AVN and non union. Percutaneous fracture reduction and fixation can overcome this problem, and decrease complications associated with conventional open reduction and internal fixation.Materials and methodsBetween 2006 and 2008, 16 patients with talar neck fractures were operated on by percutaneous reduction of fracture and percutaneous fixation with 3.5 mm cannulated screws. Injuries were classified according to modified Hawkins classification system. Patients were followed up over an average of 48 months.Results87.5% of the patients were satisfied and resumed their preoperative activities. The mean AOFAS Hind Foot Scale was 89.25 points (range: 74–100) and no poor outcomes.ConclusionAlthough the number of patients in this study is small, the results showed that, percutaneous reduction and fixation is a good treatment modality in treatment of fracture neck talus, especially in cases with increased risk of soft tissue complications and open reduction should be resort only when percutaneous reduction was failed.     

Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka,Bangladesh

PurposeIn Bangladesh the incidence of pelvic fracture is increasing day by day due to suboptimal roads and heavy traffic. However, there is no epidemiological study of these injuries in Bangladesh. Our aim was to study the epidemiology of patients admitted with pelvic fractures at two tertiary care hospital in Dhaka, Bangladesh.MethodsThis was a prospective study carried out on trauma patients with pelvic fracture at two level 1 trauma care center of two tertiary care hospital in Dhaka, Bangladesh. The study period was from July 2015 to June 2019 (48 months). Patient’s data including demography of patients, mechanism of injuries, fracture types, associated injuries, method of treatment, post-operative complications, length of hospital stay were recorded according to a unified protocol.ResultsThe study population was comprised of 696 patients, where 556 (79.88%) were male and 140 (20.12%) were female. Mean age was 37.75 years and road traffic accidents were the most common mode of injuries. Lateral compression fractures were the most common injuries and Urethral injuries were the most common associated injuries. Death was the outcome in 3.5% of the cases due to high energy trauma.ConclusionThis study revealed that pelvic fractures were significantly more frequent in men. Most frequent cause was road traffic accident. The majority of these cases did not required surgery. Mortality was associated with high velocity trauma with severe injuries.     

Determining indications and osteosynthesis techniques for the pelvic girdle]

1566 patients with fractures of the pelvis were treated at the Department of Traumatology of the Hannover Medical School between 1972 and 1990: 1350 patients had fractures of the pelvic ring, 216 isolated acetabulum fractures, 398 combinations of pelvic ring fractures and acetabular involvement; 718 of these patients were admitted with severe polytrauma. For 1254 patients a complete file was available for clinical and radiological evaluation of fracture distribution, classification (Tile and anatomical location) and concomitant injuries. During the observation period, significant increase in the severity of the trauma, the severity of the pelvic fractures and the rate of internal stabilization, especially of the posterior pelvic ring was observed. The overall mortality after pelvic fractures was 18.1%. This mortality depended significantly on the Hannover Polytrauma Score (PTS) and the associated pelvic and extrapelvic blunt trauma. Internal fixation of pelvic fractures was performed in 195 patients. This experience has now led to standardized procedures for the different fracture locations. With the task of minimizing soft tissue trauma and reducing the implant size, more differentiated treatment of sacral fractures is now applied. Adapted small fragment implants ("local osteosyntheses") can be applied, with an unilateral longitudinal dorsal incision providing an excellent overview over the fracture line. For internal fixation of sacral fractures, involvement (penetration by screws, transfixation) of the sacroiliac joint is avoided whenever possible. In our experience early open reduction and internal fixation of pelvic fractures facilitates the management of these severely injured patients.     

弹性髓内钉治疗儿童双侧股骨干骨折

目的:探讨弹性髓内钉闭合复位内固定治疗儿童双侧股骨干骨折的疗效及并发症。方法:自2005年2月至2008年3月采用弹性髓内钉闭合复位治疗儿童双侧股骨干骨折7例,男5例,女2例,年龄3～13岁,平均8.3岁。车祸伤6例,高处坠落伤1例。合并伤:肺挫伤2例,颅脑损伤3例,膀胱损伤1例,跟骨骨折1例,无神经血管损伤及骨筋膜室综合征,均为闭合性骨折。2例患者术后采用石膏辅助外固定。结果:7例患者均获得随访,时间21～37个月,平均30.3个月,无一例发生切口感染,无继发骨折移位及内固定物失效或断裂。7例患者14侧骨折全部愈合,骨愈合时间7～12周,平均8.7周。无延迟愈合,骨不连,旋转畸形,髋、膝关节的功能障碍。1例患者出现双下肢不等长(长度差5 mm)。根据Flynn提出的评分标准,结果均为优。结论:采用弹性髓内钉治疗儿童股骨干骨折符合生物学固定原则,创伤小,并发症少,是治疗儿童高能量损伤股骨骨折的较好选择。     

Noncontiguous and open fractures of the lower extremity: Epidemiology,complications, and unplanned procedures

IntroductionIsolated fractures of the lower extremity are relatively common injuries while multifocal injuries resulting from high-energy trauma are less frequently encountered. Our objectives are to characterise patients who sustained multiple noncontiguous fractures and open fractures of the lower extremity, report the incidence of major complications, and identify factors that may contribute to complications and unplanned re-operations.Patients and MethodsA retrospective review of patients was performed at a Level 1 trauma centre from 2000 to 2013. Patients who sustained two or more noncontiguous operative fractures in an ipsilateral lower extremity, with at least one open fracture were included. Noncontiguous was defined as fractures in the same lower limb that were not in continuity on preoperative radiographs or intra-operatively. Demographic, injury characteristics, and hospitalisation data were collected. Primary outcomes included non-union, deep infection, and the need for unplanned surgeries.Results257 patients sustained a total of 876 lower extremity fractures with an average of 1.7 open and 2.7 operative fractures in the qualifying limb. Ninety-nine patients (38.5%) sustained bilateral lower extremity injuries. Following their initial stay, 22.6% of patients had planned procedures (definitive fixation, skin, or planned bone grafting). Nearly half (45.9%) required one or more unplanned re-operation. Complications included deep infections (19.5%), non-unions (19.5%), and mal-unions (2.7%). 17.5% of the patients had at least one procedure for removal of painful implants. A deep infection was predictive of having a non-union (odds ratio, OR 7.5). The presence of a Gustilo-type IIIB/IIIC (OR 24.6/16.0) fracture was predictive of having a deep infection. After excluding painful implant removal, a type IIIB fracture was associated with an unplanned procedure (OR 13.8).ConclusionsPatients with multiple non-contiguous lower extremity injuries associated with open fractures can expect complications including non-unions, deep infections, and painful implants. Nearly half of the patients will need further operative treatment.     

Outcome of alternative approach to displaced acetabular fractures

IntroductionAnatomical reduction of displaced acetabular fracture is not without its’ limitations and complications. This study is conducted to assess clinical and radiological outcomes as well as complications of treating displaced acetabular fractures with emphasis on anatomical reduction in weight-bearing area, mainly the posterior column, and imperfect reduction of the anterior column is acceptable. However, stability of both columns is mandatory.MethodsIt was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36–68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12–38.7 months). Mean operation time was 160 min (range: 75–320 min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded.Result65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported.ConclusionsImperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities.     

Combined Anterior Pelvic (CAP) approach for fracture acetabulum fixation - Functional outcome evaluation and predictors of outcome

ObjectiveIlio-inguinal approach has been considered standard anterior approach for acetabulum fracture fixation. Different modifications of this approach have been described. This study analysed the patients treated using a Combined Anterior Pelvic (CAP) approach - minimal AIP (anterior intra-pelvic) with modified ilio-femoral along with ’anterior superior iliac spine’ osteotomy. This combined approach provides wide exposure of pelvis to direct visualise the entire anterior column from sacroiliac joint to pubic symphysis, medial side of quadrilateral plate and entire iliac wing with minimal retraction of soft tissues required.MethodsData of patients treated from July 2014 to June 2018 for acetabulum fracture using CAP approach was retrieved from hospital record system. Inclusion criteria were - acetabulum fractures treated surgically using CAP approach. Exclusion criteria were – age less than 18 years, associated pelvis ring injury and incomplete peri-operative radiological record (pre-operative/post-operative antero-posterior, 45° obturator and 45° iliac oblique radiographs and pre-operative computed tomographic (CT) scans. 62 patients who met inclusion exclusion criteria were called in out-patient-department for final functional evaluation using Matta modified Merle d’aubigne score.ResultsOut of 62 patients 47 patients who turned up for final functional evaluation were included in study. 19 patients had excellent, 15 had good, 2 had fair and 11 had poor results. Age less than 40 years, anterior column fracture pattern, Pre-operative fracture displacement >20 mm, fracture comminution and post-operative fracture reduction within 3 mm were the predictors of the functional outcome. When analysed using logistic regression model, post-operative fracture reduction was found to be the only significant predictor of functional outcome.ConclusionCAP approach is useful anterior approach to acetabulum. Fracture reduction is the independent predictor of functional outcome. Comparison of this approach with other anterior approaches to acetabulum can be area of further research.     

Combined Anterior Pelvic (CAP) approach for fracture acetabulum fixation - Functional outcome evaluation and predictors of outcome

ObjectiveIlio-inguinal approach has been considered standard anterior approach for acetabulum fracture fixation. Different modifications of this approach have been described. This study analysed the patients treated using a Combined Anterior Pelvic (CAP) approach - minimal AIP (anterior intra-pelvic) with modified ilio-femoral along with ’anterior superior iliac spine’ osteotomy. This combined approach provides wide exposure of pelvis to direct visualise the entire anterior column from sacroiliac joint to pubic symphysis, medial side of quadrilateral plate and entire iliac wing with minimal retraction of soft tissues required.MethodsData of patients treated from July 2014 to June 2018 for acetabulum fracture using CAP approach was retrieved from hospital record system. Inclusion criteria were - acetabulum fractures treated surgically using CAP approach. Exclusion criteria were – age less than 18 years, associated pelvis ring injury and incomplete peri-operative radiological record (pre-operative/post-operative antero-posterior, 45° obturator and 45° iliac oblique radiographs and pre-operative computed tomographic (CT) scans. 62 patients who met inclusion exclusion criteria were called in out-patient-department for final functional evaluation using Matta modified Merle d’aubigne score.ResultsOut of 62 patients 47 patients who turned up for final functional evaluation were included in study. 19 patients had excellent, 15 had good, 2 had fair and 11 had poor results. Age less than 40 years, anterior column fracture pattern, Pre-operative fracture displacement >20 mm, fracture comminution and post-operative fracture reduction within 3 mm were the predictors of the functional outcome. When analysed using logistic regression model, post-operative fracture reduction was found to be the only significant predictor of functional outcome.ConclusionCAP approach is useful anterior approach to acetabulum. Fracture reduction is the independent predictor of functional outcome. Comparison of this approach with other anterior approaches to acetabulum can be area of further research.     

Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures- A case series

IntroductionThe operative fixation of pelvic ring injuries and associated acetabulum fractures presents a challenging scenario to most of the orthopaedic trauma surgeons. Current development of anatomically contoured reconstruction (ACR) plates gained popularity in fixing complex pelvic ring fractures. This study was done to assess the functional and radiological outcomes using of lateral wall stainless steel (LWSS) calcaneal plates in posterior pelvic ring injuries and displaced iliac blade fractures.Materials and methodsRetrospectively selected eight cases of pelvic ring injuries planned for fixing posterior pelvic instability and iliac blade fractures using LWSS plates. Mean follow-up was 18 months (Range 12–26 months).ResultsAverage time for radiological bony union achieved in 18 weeks (Range 13–22). Seven patients returned to their normal work. Average Majeed score was 60 (Range 50–68). Mean duration of surgery was 160 min (Range 120–200).ConclusionThis technique can be routinely used as supplementary fixation for posterior pelvic ring instability and iliac blade fractures. LWSS calcaneal plates showed no screw breakage or implant failure. Further this technique was cost effective in developing countries with limited resources.     

Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

IntroductionIntramedullary nailing is an acceptable treatment option for femoral shaft fracture in young patients but not extensively studied in the elderly with osteoporotic fractures. Plate fixation for osteoporotic femoral shaft fractures have a high rate of complications and delayed healing time, and the most acceptable treatment is intramedullary nailing. This study evaluated the healing time and incidence of complications in osteoporotic femoral shaft fractures after intramedullary nailing.Patients &MethodsThis was a retrospective study that included 16 patients above 60 years old with osteoporotic femoral shaft fractures operated between January 2015 and December 2018. Patients with metastatic fractures or with atypical fractures were excluded. Thirteen patients had low-energy injuries such as a simple fall from standing height or lower and twisting injuries. The remaining 3 patients sustained high-energy-mechanism of injury. No patient received bisphosphonate except 2 patients received oral bisphosphonate for a period of 6 and 8 months, respectively.ResultsSixteen patients (12 females and 4 males) with mean age 69.5 ± 3.7 presented with femoral shaft fracture were operated with intramedullary nail, 10 patients were fixed with trochanteric entry nails with proximal neck screws, and 6 patients were fixed with piriformis entry nails. In 9 patients, closed reduction of fracture was achieved while 7 patients required open reduction, of which 5 fracture required cerclage wire addition. The mean bone healing time was 5.35±1.2 months. Intraoperative extension of femoral fractures during intramedullary nail insertion was observed in two cases that required open reduction and addition of cerclage wires around the fracture. The overall incidence of complications was 18.7%.ConclusionsIntramedullary nailing for osteoporotic femoral shaft fracture is a good acceptable option in elderly patients with reasonable healing time with no major complications.