Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation

Abstract The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

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Postoperative Outcomes for Plate-Screw Fixation in Adolescent Patients with Ankle Fracture

Journal of the American Podiatric Medical Association ◽

10.7547/19-080 ◽

2020 ◽

Vol 110 (6) ◽

Author(s):

Mehmet Ali Talmaç ◽

Mehmet Akif Görgel ◽

Yusuf Yahşi ◽

Muharrem Kanar ◽

Ali Seker ◽

...

Keyword(s):

Surgical Treatment ◽

Ankle Fracture ◽

Screw Fixation ◽

High Energy ◽

Low Energy ◽

Ankle Fractures ◽

Postoperative Outcomes ◽

Trauma Patients ◽

High Energy Trauma ◽

Adolescent Patients

Backround We compared postoperative outcomes in adolescent patients who did and did not undergo plate-screw fixation of at least one of the lateral, medial, or posterior malleoli in ankle fractures. It was hypothesized that using plate-screw fixation would not negatively affect postoperative outcomes. Methods All of the preoperative data and postoperative outcomes for 56 patients with ankle fractures aged 12 to 15 years who underwent surgical treatment between January 1, 2007, and December 31, 2017, were reviewed retrospectively. Patients were grouped into plate-screw fixation (n = 15) and non–plate-screw fixation (n = 41) groups and as high- and low-energy trauma patients. Results There were no significant differences in postoperative outcomes between the plate-screw fixation and non–plate-screw fixation groups. The mean American Orthopaedic Foot & Ankle Society score of high-energy trauma patients was significantly lower than that of low-energy trauma patients (P < .001), and the rate of degenerative change in high-energy trauma patients was significantly higher than that in low-energy trauma patients (P = .008). There were no significant differences between high- and low-energy trauma patients with respect to other postoperative outcomes. Conclusions If anatomical reduction is performed without damaging the growth plate, postoperative clinical outcomes may be near perfect regardless of screw-plate fixation use. Postoperative outcomes of adolescent ankle fracture after high-energy trauma, independent of Salter-Harris classification and surgical treatment methods, were negative.

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Functional Results of Open Reduction and Internal Fixation with Primary Arthrodesis for Injuries to the Tarsometatarsal Joint Complex

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000250 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Sean Lannon ◽

Michael Clare

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Functional Results ◽

High Energy ◽

Low Energy ◽

Lisfranc Joint ◽

Energy Group ◽

Energy Mechanism ◽

Viable Treatment

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy remains as to the optimal treatment of injuries to the tarsometatarsal (Lisfranc) joint complex. Recent studies have described open reduction internal fixation (ORIF) with primary arthrodesis as a viable treatment option but there is limited orthopaedic literature as to the functional results of primary arthrodesis for these injuries. The senior author began treating these injuries with primary arthrodesis in 2005. We present the functional results of a consecutive series of patients with injuries to the TMT joint complex treated by ORIF with primary arthrodesis. Methods: Sixty-eight consecutive patients underwent ORIF with primary arthrodesis from 2006 to 2015. Seventeen patients were unable to be evaluated or contacted and were therefore lost to follow up, leaving 51 patients available for follow-up evaluation. Clinical follow up and/or telephone interviews was conducted. AOFAS Midfoot scores and Foot and Ankle Ability Measure (FAAM) were collected as a measure of functional outcome at final follow up. Results: Sixty-seven of 68 patients (98.5%) went on to radiographic union following the index procedure. Among patients with a low energy mechanism (32 patients), AOFAS and FAAM were 88.7 and 94.0; among those with a high- energy mechanism (19 patients), AOFAS and FAAM were 86.9 and 89. Outcome scores were higher in the low energy group: AOFAS by 2.1(p=0.667); and FAAM by 5.0 (p=0.021). Injury to the lateral midfoot necessitating fixation was less likely in the low energy group compared to the high-energy group (7.5% versus 37.0%; p=0.0032). Eighteen of the 51 patients participated in professional, collegiate or recreational sports preoperatively. All 18 were able to return to their previous sport, with a mean FAAM sports sub scale score of 93. Conclusion: ORIF with primary arthrodesis remains a viable treatment for injuries to the tarsometatarsal (Lisfranc) joint complex, with functional results in the good to excellent range at midterm follow up. Patients with low energy mechanisms demonstrated higher functional scores compared to patients with high energy mechanisms, but outcomes remained good to excellent in both groups. Of those who participated in athletics prior to injury, all were able to return to their previous sport.

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Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

Emergency Medicine Journal ◽

10.1136/emermed-2014-204083 ◽

2014 ◽

Vol 32 (7) ◽

pp. 535-538 ◽

Cited By ~ 2

Author(s):

Shahram Paydar ◽

Armin Ahmadi ◽

Behnam Dalfardi ◽

Alireza Shakibafard ◽

Hamidreza Abbasi ◽

...

Keyword(s):

High Energy ◽

Trauma Centre ◽

Economic Effects ◽

Trauma Patients ◽

Radiological Evaluation ◽

High Energy Trauma ◽

Level 1

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Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.067 ◽

2013 ◽

Vol 57 (5) ◽

pp. 1196-1203 ◽

Cited By ~ 40

Author(s):

Andrew G. Georgiadis ◽

Farah H. Mohammad ◽

Kristin T. Mizerik ◽

Timothy J. Nypaver ◽

Alexander D. Shepard

Keyword(s):

Vascular Injury ◽

Knee Dislocation ◽

High Energy ◽

Low Energy ◽

Morbidly Obese ◽

High Energy Trauma

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Intra-articular Transcalcaneal Fracture-Dislocation Associated With Ipsilateral Transtalar Fracture: A Report of a Rare Combination

Foot & Ankle Specialist ◽

10.1177/1938640020913177 ◽

2020 ◽

Vol 13 (4) ◽

pp. 335-340

Author(s):

Danilo Ryuko Cândido Nishikawa ◽

Bruno Rodrigues de Miranda ◽

Fernando Aires Duarte ◽

Guilherme Honda Saito ◽

Rogério Carneiro Bitar ◽

...

Keyword(s):

Case Report ◽

High Energy ◽

Fracture Dislocation ◽

Calcaneal Fractures ◽

Short Term ◽

High Energy Trauma ◽

Rare Combination ◽

Severe Bone Loss ◽

Neck Fracture

The association of ipsilateral talar and calcaneal fractures is an uncommon combination and is typically the result of a high-energy trauma. It is often associated with comminution, marked fracture displacement, and soft-tissue compromise. Obtaining satisfactory clinical and radiographic results is very challenging. Residual deformities, multiple procedures, and limitations are usually the norm. Therefore, studies have suggested that primary arthrodesis may represent the best option of surgical treatment. In this study, we report a case of a 30-year-old male patient with a rare combination of a highly comminuted transcalcaneal fracture-dislocation associated with a talar neck fracture successfully treated with open reduction and internal fixation (ORIF) with an 18-month follow-up. This case demonstrates that even when there are associated fractures of the talus and calcaneus with severe bone loss, ORIF may provide satisfactory outcomes in the short-term postoperative period. Levels of Evidence: Level V: Case report

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Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01009-2 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Saleh Al-wageeh ◽

Faisal Ahmed ◽

Khalil Al-naggar ◽

Mohammad Reza Askarpour ◽

Ebrahim Al-shami

Keyword(s):

Case Report ◽

Cause Of Death ◽

Axial Skeleton ◽

High Energy ◽

Pelvic Trauma ◽

Anterolateral Thigh Flap ◽

Trauma Patients ◽

Anterolateral Thigh ◽

Life Threatening

Abstract Background Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.

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Traumatic infra-renal aortic dissection after a high-energy trauma: a case report of a primary missed diagnosis

Orthopedic Reviews ◽

10.4081/or.2014.5031 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Holger Godry ◽

Guido Rölleke ◽

Achim Mumme ◽

Thomas A. Schildhauer ◽

Martin Gothner

Keyword(s):

Aortic Dissection ◽

Ct Scan ◽

High Energy ◽

The Body ◽

Trauma Patients ◽

Traumatic Injuries ◽

High Energy Trauma ◽

Missed Injuries ◽

Lumbar Vertebral Body ◽

Life Threatening

A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed injuries, but trauma computed tomography (CT) scans in injured patients are still not standard. We report on a 54-year old Caucasian female patient who was involved in a car accident. The fellow passenger of the car was seriously injured. The patient had been previously treated at two different hospitals, and a dislocated acetabular fracture had been diagnosed. Because of this injury, the patient was transferred to our institution, a level 1 trauma-center where, according to the nature of the accident as a high-energy trauma, a complete polytrauma management was performed at the time of admission. During the body check, a moderate tension of the lower parts of the abdomen was detected. During the CT scan, an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery was observed. The patient required an operation on the day of admission. After 19 days post-trauma care the patient was able to leave our hospital in good general condition. Therefore, missed injuries in multiple injury patients could be fatal, and it is essential that the orthopedic surgeon leaves room for suspicion of injuries based on the nature of the trauma. Traumatic injuries of the abdominal aorta are rare. According to the ATLS® trauma schedule, all of the patients who have experienced high-energy trauma and associated fractures should undergo routine screening using a trauma CT scan with contrast agents to detect potential life-threatening injuries. In case of abdominal trauma, an aortic dissection, which can easily be overlooked, has to be considered.

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Routine whole body CT of high energy trauma patients leads to excessive radiation exposure

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-016-0199-2 ◽

2016 ◽

Vol 24 (1) ◽

Cited By ~ 27

Author(s):

Fredrik Linder ◽

Kevin Mani ◽

Claes Juhlin ◽

Hampus Eklöf

Keyword(s):

Radiation Exposure ◽

High Energy ◽

Whole Body ◽

Trauma Patients ◽

High Energy Trauma ◽

Whole Body Ct ◽

Body Ct

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Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163548 ◽

2016 ◽

Vol 2 (4) ◽

pp. 256

Author(s):

B. L. S. Kumar Babu ◽

Biju Ravindran

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

High Energy ◽

Walking Distance ◽

Early Weight Bearing ◽

Dual Plating ◽

Pubic Diastasis ◽

One Year

Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.

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Functional outcome of displaced mid shaft clavicular fractures treated by plate fixation: a prospective observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213381 ◽

2021 ◽

Vol 7 (5) ◽

pp. 996

Author(s):

Junaid Ebrahim ◽

Abdul Asraf Variyathodi ◽

Mohamed Shakeeb Kannan Thody Uppil Thody ◽

Nithin Chandrasekharan

Keyword(s):

Observational Study ◽

Functional Outcome ◽

Prospective Observational Study ◽

Plate Fixation ◽

Shoulder Girdle ◽

High Energy ◽

Young Males ◽

Clavicle Fractures ◽

Radiological Union

Background: Clavicle fractures are one of the commonest injuries to the shoulder girdle. Traditionally these fractures are treated conservatively. This study was to assess the functional outcome of displaced mid shaft clavicular fractures treated with plate fixation.Methods: This was a single center prospective observational study conducted at department of orthopaedics M.E.S medical college Perinthalmanna between the period January 2018 to December 2018 in patients with displaced mid shaft clavicle fractures treated by plate fixation. Out of 51 patients 35 patients were males and 16 were females with mean age of 37.7 years (range 19-59). All patients included in this study were included under Allman group 1. All Patients were treated with plate fixation. Post op follow done at 1 1/2 ,3 and 6 months. During follow up clinical and radiological union were checked. Final functional outcome was assessed at 6 months follow up by Constant-Murley Score.Results: Out of 51 patients with displaced mid shaft clavicle fractures treated with plate fixation 43 patients (84.3%) showed excellent functional outcome 8 patients (15.7%) showed good functional outcome. None of the patients showed moderate or poor outcome. The radiological union was attained at 9.35 weeks. No complications in 83.4% of patients.Conclusions: Mid shaft clavicle fractures are more common in young males sustaining high energy trauma, and those fractures treated with plate fixation has a better functional outcome in terms of pain relief, activities of daily living and range of motion.

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