scholarly journals Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator

2021 ◽  
Author(s):  
Konrad Schuetze ◽  
Alexander Eickhoff ◽  
Christoph Dehner ◽  
Alexander Blidon ◽  
Florian Gebhard ◽  
...  
Keyword(s):  
Pain Relief ◽  
External Fixator ◽  
Surgical Complications ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Minimal Invasive ◽  
Screw Loosening ◽  
Early Mobilisation ◽  
Invasive Approach ◽  
Minimal Invasive Approach

Abstract Background The treatment of fragility fractures of the pelvis is rising challenge for orthopedic trauma surgeons. Operative treatment should allow immediate full weight bearing and early mobilisation but should also be as minimal invasive as possible. Sacroiliac (SI) or transsacral transiliac screws (TSTI) alone or depending on the fracture in combination with an external fixator meets both of these criteria. Material and methods The outcome of 121 operatively treated patients with fragility fractures of the pelvis were evaluated in this retrospective study. Depending on the type of fracture the patients were treated with navigated SI screw or TSTI screw alone or in combination with an external fixator. All patients were operated in supine position in a hybrid-OR, which consists of a fixed robotic 3D flatpanel detector (Artis zeego, Siemens Healthineers, Germany) and a navigation system (BrainLab Curve, BrainLab, Germany). Results 37 patients were treated with either one or two SI screws and 57 with one TSTI screw. An additional external fixator was combined with SI screws in 17 patients and with TSTI screws in 10 patients. The preoperative pain score was significantly higher compared to the postoperative score (5.1 ± 2.5 vs 2.2 ± 1.9, p < 0.05). Follow-up at 6 month was possible for 106 patients which showed screw loosening in 16.3% of the SI Screws (n = 49) compared to only 5.2% of TSTI screws (n = 57). No screw loosening was seen in the combination of TSTI-screw and external fixator (n = 10). There were two septic and three aseptic pin loosenings of the external fixator. Overall only one patient needed revision surgery due to screw loosening and local irritation. Overall 75.2% (n = 91) of the patients could be released in their home or in a rehabilitation unit and only 14% (n = 17) were released to a nursing home due to immobility despite the operation. Non-surgical complications rate was 21.5%. Conclusion SI or TSTI screws with possible combination with an external fixator show early pain relief and allows most of the patients to keep their former level of independence. With an also low surgical complication rate, it proved to be a safe and reliable treatment for fragility fractures of the pelvis. Due the effective pain relief and the minimal invasive approach, early mobilisation is possible and might prevent typical non-surgical complications which are very common during conservative treatment.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail

2018 ◽  
Vol 66 (07) ◽  
pp. 589-594 ◽  
Author(s):  
Celalettin Kocaturk ◽  
Hasan Akin ◽  
Sertan Erdogan ◽  
Salih Bilen ◽  
Kemal Karapinar ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Standard Treatment ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Treatment Method ◽  
Minimal Invasive ◽  
Invasive Approach ◽  
Pain Scores ◽  
Minimal Invasive Approach ◽  
Video Assisted Thoracoscopic Surgery

Objective Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for primary spontaneous pneumothorax. Concerns about lesser pain and better cosmesis led to the evolution of uniportal access. This study prospectively compared the results of the uniportal, two-port, and three-port thoracoscopic surgery. Material and Methods One hundred and thirty-five patients were randomized into three groups according to the port numbers. The groups were compared regarding the operation time, hospital stay, amount of drainage, area of pleurectomy, complications, recurrences, and pain scores. Results Except for the amount of drainage (p = 0.03), no factors were found to be statistically significant. The overall recurrence rate was 5%. Although the first and second week pain scores were not statistically significant, the single-incision group patients had significantly less pain at 4, 24, and 72 hours (p < 0.05). Conclusion The study indicated that uniportal VATS approach is less painful and has better cosmetic results, besides it is as efficient as two- or three-port VATS approach.

A New Minimal Approach in Cochlear Implant Surgery: The Colombian Experience

2005 ◽  
Vol 133 (1) ◽  
pp. 147-149 ◽  
Author(s):  
Jorge E. Almario ◽  
Jose G. Lora ◽  
Jose A. Prieto
Keyword(s):  
Cochlear Implant ◽  
Surgical Approach ◽  
Minimal Invasive ◽  
Surgical Trauma ◽  
Invasive Approach ◽  
Implant Surgery ◽  
Minimal Invasive Approach ◽  
Cochlear Implant Surgery ◽  
The Mean ◽  
Age Range

OBJECTIVES: To implement a minimal invasive approach in cochlear implant surgery for children and adults. In order to decrease surgical complications and morbidity with the surgery. SUBJECTS AND METHODS: During a 1-year period, 12 consecutive patients (5 female and 7 male; age range, 1.5 to 78 years; mean age, 14.5 years), who had cochlear implantation (1 Nucleus and 11 Clarion) through a new surgical approach, were prospectively evaluated. RESULTS: The surgical approach was accomplished in all the patients with no major complications. The mean surgical time was 3.2 hours and the mean time between surgery and process of programming was 2.7 weeks. CONCLUSION: The surgical trauma and postoperatory edema was decreased and allowed programming of the implant in a shorter period of time.

A successful outcome using a minimal invasive approach to manage a severe trauma to the primary maxillary incisor in a toddler

2010 ◽  
Vol 26 (3) ◽  
pp. 294-297 ◽  
Author(s):  
Senda Charone ◽  
Erika Calvano Kuchler ◽  
Marcelo De Castro Costa ◽  
Lucianne Cople Maia
Keyword(s):  
Severe Trauma ◽  
Minimal Invasive ◽  
Successful Outcome ◽  
Maxillary Incisor ◽  
Invasive Approach ◽  
Minimal Invasive Approach
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