Mortality,morbidity and functional outcome after open book and lateral compression lesions of the pelvic ring. A retrospective analysis of 100 type B pelvic ring lesions according to Tile's classification

A retrospective study was made of 100 Tile type B and 122 type C pelvic ring lesions. Type B1-open book lesions occurred in 52 patients while 48 had lateral compression lesions of type B2 or B3. Only 13.1% of the patients showed no associated lesions.The frequency of associated neurological lesions in the B1 group with 21% was higher than in the B2/B3 group with 12%. The frequency of urologic lesions in group B1 was 9.6% but in B2/B3 patients it was only 2.1%. A total of 66% of B-lesion patients were stabilized with an external fixator. The frequency of secondary operative procedures was 23% in B1-patients and 6.25% in the B2/B3 group. Overall mortality was 10.4%: 5% in the B-group and 14.8% in the C-group. Outcome for patients with B2/B3 lesions was, with 92% excellent and good end results,much better than in patients with B1 lesions (74%). The inverse was true for radiologic results: 93% of the B1- but only 75% of the B2/B3-patients had an anatomical reduction. Open book lesions, lateral compression lesions and combined vertical stable lesions should be differentiated. We suggest that lateral compression lesions be characterized as B1 and open book lesions as B2 type injuries in the classification system of AO.     

Prävention thromboembolischer Komplikationen in der Unfallchirurgie durch Dosisanpassung von niedermolekularem Heparin anhand TAT- und D-Dimer-Werten

Zusammenfassung Bei unfallchirurgischen Patienten tritt in bis zu 40% eine tiefe Beinvenenthrombose auf. Das individuelle Risiko kann kaum kalkuliert werden. 518 unfallchirurgische Patienten mit Prophylaxe durch eine tägliche Einzeldosis eines niedermolekularen Heparins (NMH) wurden präoperativ und bis zu 10 Tage postoperativ in einer prospektiven Untersuchung beobachtet. Sie wurden in 2 Gruppen unterteilt: Gruppe I mit Hüft- und Oberschenkeloperationen sowie Kniegelenkprothesen und Gruppe II mit Knie- und Unterschenkeloperationen. Bestimmt wurden Thrombin-Antithrombin-Komplex und D-Dimer. Eine 2. Dosis NMH wurde bei Überschreiten des D-Dimer-Cut-off-Wertes verabreicht. Bei sonographischem Verdacht auf eine tiefe Beinvenenthrombose (TVT) wurde diagnostisch immer eine Phlebographie angeschlossen. Es wurden 5 Thrombosen (Gruppe I: n=4, Gruppe II: n=1) ohne Embolien festgestellt. TAT und D-Dimer waren in Gruppe I signifikant höher als in Gruppe II (p<0,0005); 100 Patienten, davon 79 aus Gruppe I, wurden mit einer 2. Dosis NMH angepasst. Die höchste Sensitivität und Spezifität für einen täglichen Cut-off-Wert wurde für Tag 4 bestimmt. Nach individuellem Monitoring von Gerinnungsparametern zeigt sich das Thromboserisiko im Vergleich mit aktuellen Daten der Literatur niedrig.     

Nailing versus plating for comminuted fractures of the distal femur: a comparative biomechanical in vitro study of three implants

Purpose

The purpose of our study was to determine the biomechanical properties of three different implants utilized for internal fixation of a supracondylar femur fracture. The retrograde supracondylar nail (SCN), the less invasive stabilization system plate (LISS) and the distal femoral nail (DFN) were tested and their biomechanical properties compared.

Methods

Twenty pairs of fresh-frozen human femura were used. Each femur was osteotomised to simulate a comminuted supracondylar fracture (AO/OTA 33.A3) and then randomized to fracture fixation with either SCN (n=9) or LISS (n=9). Each contralateral femur was stabilized with DFN as a control (n=18). Two femur pairs were spent on pretesting. All femura were subjected to axial (10–500 N) and torsional (0.1–14 Nm) loading.

Results

Eighteen matched femur pairs were analyzed. The post-loading median residual values were 49.78, 41.25 and 33.51% of the axial stiffness of the intact femur and 59.04, 62.37 and 46.72% of the torsional stiffness of the intact femur in the SCN, LISS and DFN groups. There were no significant differences between the three implants concerning axial and torsional stiffness.

Conclusions

All implants had sufficient biomechanical stability under physiological torsional and axial loading. All three implants have different mechanisms for distal locking. The SCN nail with the four-screw distal interlocking had the best combined axial and torsional stiffness whereas the LISS plate had the highest torsional stiffness.     

A case of hypertrophic ischial tuberosity non-union treated by closed wedge osteotomy and plate and screws fixation

We report a case of a 21-year-old male with massive hypertrophic ischial tuberosity non-union. Among multiple other lesions, the patient suffered an open avulsion of the ischial tuberosity in a severe traffic accident in adolescence. A conservative treatment was decided for the avulsion. Because of sciatic pain and difficulties while sitting since the age of 19, X-rays were realised and showed a massive hypertrophic non-union of the ischial tuberosity. To preserve hamstring origin with bone attachment, the non-union was mobilised, reduced by osteotomy and fixed by plate and screws. At the follow up of one year, the patient sits without pain and can work without interruption. Avulsion of the ischial tuberosity is infrequent and the diagnosis is often missed (Gidwani et al., BMJ 329:99–100, 2004; Hamada, Clin Orthop 31:117–130, 1963). This lesion is more often seen in adolescence as the consequence of a sport injury (Gidwani et al., BMJ 329:99–100, 2004). Treatment is generally conservative and outcome good. Surgical therapy is only needed in cases with severe displacement. Long-term problems are seldom and surgical therapy to solve these problems is the exception.     

Versorgung von Fingerfrakturen mit der Minihakenplatte

Background

Fixation of the small bony fragments of the phalanges is often difficult. In this study a clinical and radiological evaluation was carried out after operative treatment using the mini-hook plate.

Patients and methods

Between 2003 and 2006 a total of 36 fractures were treated operatively using the mini-hook plate. Of the patients 24 had an basal avulsion fracture of the distal phalanx and 11 patients (12 fractures) had other bony avulsion fractures of the phalanges. The patients were evaluated clinically and radiologically as well as using the disabilities of the arm, shoulder and hand (DASH) questionnaire.

Results

A total of 29 patients with 30 fractures were examined. The mean follow-up was 13.6 months. The mean range of motion in the affected finger joint was 60.3?° and the mean DASH score was 2.8 points. Postoperatively five nail growth defects, one infection and one secondary dislocation of the implant were observed.

Conclusion

Using the mini-hook plate, preservation of the joint and stable internal fixation with no need for temporary arthrodesis is possible; however, prerequisites are experience and skill of the surgeon with a difficult surgical technique.     

Evidence for a Causal Relationship Between Early Exocrine Pancreatic Disease and Cystic Fibrosis–Related Diabetes: A Mendelian Randomization Study

Circulating immunoreactive trypsinogen (IRT), a biomarker of exocrine pancreatic disease in cystic fibrosis (CF), is elevated in most CF newborns. In those with severe CF transmembrane conductance regulator (CFTR) genotypes, IRT declines rapidly in the first years of life, reflecting progressive pancreatic damage. Consistent with this progression, a less elevated newborn IRT measure would reflect more severe pancreatic disease, including compromised islet compartments, and potentially increased risk of CF-related diabetes (CFRD). We show in two independent CF populations that a lower newborn IRT estimate is associated with higher CFRD risk among individuals with severe CFTR genotypes, and we provide evidence to support a causal relationship. Increased log_e(IRT) at birth was associated with decreased CFRD risk in Canadian and Colorado samples (hazard ratio 0.30 [95% CI 0.15–0.61] and 0.39 [0.18–0.81], respectively). Using Mendelian randomization with the SLC26A9 rs7512462 genotype as an instrumental variable since it is known to be associated with IRT birth levels in the CF population, we provide evidence to support a causal contribution of exocrine pancreatic status on CFRD risk. Our findings suggest CFRD risk could be predicted in early life and that maintained ductal fluid flow in the exocrine pancreas could delay the onset of CFRD.