Crescent fractures of the pelvis treated by open reduction and internal fixation: a critique of Day’s guidelines

Introduction

Day’s classification and treatment guidelines are considered the gold standard in crescent fractures of the pelvis. The objective of this study was to retrospectively evaluate 10 surgically treated crescent fractures of the pelvis in the context of Day’s recommendations.

Methods

This is a retrospective cohort study. Ten consecutive cases of crescent fractures that were treated surgically at a level 1 trauma center formed the cohort. Six were operated anteriorly, three posteriorly and one percutaneously. Classification and treatment strategy were compared to Day’s guidelines. The minimum follow-up was 13 months. Outcomes were assessed using the modified Majeed’s scoring system.

Results

Three out of 10 cases were difficult to classify by Day’s criteria. There were 4 type I, three type III and no type II cases. Our surgical strategy was independent of Day’s recommendations in this series and based on ease of access, ability to restore the sacroiliac joint anatomy and other associated injuries. All the patients were mobilized early and the fractures united without any major incident. The results of these cases were quite good with outcome scores over 67/96.

Conclusions

Assigning Day’s classification to a given case can be difficult in up to 33% patients with crescent fractures due to the obliquity of the iliac fracture line in axial sections. Sacroiliac articular alignment is the primary factor determining the surgical approach. Besides the fracture configuration, additional factors like delay in surgery, locking of the fracture fragments, comminution of the iliac or sacral fragment as well as access to the additional injuries contribute to the decision making.

     

Dosing strategies to optimize currently available anti-MRSA treatment options (Part 1: IV options)

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a predominant pathogen resulting in significant morbidity and mortality. Optimal dosing of anti-MRSA agents is needed to help prevent the development of antimicrobial resistance and to increase the likelihood of a favorable clinical outcome.

Areas covered: This review summarizes the available data for antimicrobials routinely used for MRSA infections that are not administered orally or topically. We make recommendations and highlight the current gaps in the literature. A PubMed (1966 – Present) search was performed to identify relevant literature for this review.

Expert commentary: Improvements in MIC determination and therapeutic drug monitoring are needed to fully implement individualized dosing that optimizes antimicrobial pharmacodynamics.Additional data will become available for these agents in regards to effectiveness for severe MRSA infections and pharmacokinetic data for special patient populations.     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.

     

Measuring disability in an urban slum community in India using the Washington Group questionnaire

Background

The UN recommends that the ‘Washington Group questionnaire (WGQ) on functioning’ is used for data collection on disability. There are few studies on the WGQ from India.

Combination therapy of oxidised regenerated cellulose/collagen/silver dressings with negative pressure wound therapy for coverage of exposed critical structures in complex lower‐extremity wounds

Complex wounds with exposed critical structures such as tendon and bone are a conundrum in wound management, especially in the setting where the patient is not a suitable candidate for flap surgery. While the individual use of negative pressure wound therapy (NPWT) and oxidised regenerated cellulose (ORC)/collagen/silver (PROMOGRAN PRISMA) dressing has been described in the literature, there are little data on the efficacy of their combined use. In this study, we describe a novel technique of combining the use of NPWT and ORC/collagen/silver dressings to manage complex wound beds as an alternative management option for patients not suitable for reconstructive flap surgery. This technique was performed in a series of 37 patients with complex lower‐extremity wounds that were not healing with conventional NPWT alone. All patients had open wounds with exposed critical structures that were difficult to manage, such as exposed tendon, bone, deep crevices, and joint. Successful coverage of exposed critical structures was achieved in 89% of patients, and coverage was achieved within 28 days of combination therapy in 82% of these patients, without any complications. The novel technique of combining ORC/collagen/silver dressing and NPWT provides a useful option in the armamentarium of a reconstructive surgeon dealing with difficult complex lower‐extremity wounds.     

Subcellular localization of hydrogen peroxide production in human polymorphonuclear leukocytes stimulated with lectins, phorbol myristate acetate, and digitonin: an electron microscopic study using CeCl3

The ultrastructural H2O2-producing site in human polymorphonuclear leukocytes (PMN) stimulated with soluble stimuli was studied using a CeCl3-technique. CeLlular aggregation and formation of small vacuoles were observed when PMN were stimulated with 100 microgram/ml concanavalin-A, 1 mg/ml phytohemagglutinin, or 100 microgram/ml wheat germ agglutinin for 10 min at 37 degrees C. Electron-dense deposits formed from the reaction of H2O2 and CeCl3 were observed on the contact surface of the plasma membrane of aggregated PMN stimulated with lectins. Treatment with 5 microgram/ml cytochalasin-B before lectin- stimulation induced an enhanced formation of vacuoles, degranuLation, rounding of the contour, cellular aggregation, and enhancement of the deposits. Phorbol myristate acetate (PMA; 100 ng/ml) induced strong leukocyte aggregation, the formation of multiple huge vacuoles, degranulation, and H2O2 production at almost all of the contact surface between adjoining PMN and between PMN and erythrocytes, mononuclear cells, or thrombocytes. In PMN stimulated with digitonin (B microgram/ml), vacuolar formation, degranulation, multiple projections on the surface, and H2O2 production on the whole surface membrane were demonstrated. It is shown that cellular aggregation and cell-to-cell contact have an important role in the induction of O2- production induced by lectins or PMA and that O2- production induced by the detergent is not dependent on leukocyte aggregation.     

The site of the breakpoint within the bcr is a prognostic factor in Philadelphia-positive CML patients [see comments]

The Philadelphia (Ph1) chromosome, characteristic of chronic myelogenous leukemia (CML), arises from a reciprocal translocation between chromosomes 9 and 22. The site of the breakpoint on chromosome 22 is within a small region called the breakpoint cluster region (bcr). We have mapped the breakpoint within the bcr in peripheral blood leukocyte DNA from 22 Ph1-positive CML patients. No correlation between the site of the breakpoint and the clinical phase of the disease was found. However, a striking correlation between the site of the breakpoint and the length of time between presentation and onset of acute phase was observed: on average, patients with a 5' break-point had a fourfold longer chronic phase (median, 203 weeks) than those with a 3' breakpoint (median, 52 weeks).