Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures

2019 ◽  
Author(s):  
Markus Alexander Küper ◽  
Alexander Trulson ◽  
Christian Minarski ◽  
Fabian Stuby ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Impact Energy ◽  
Geriatric Patients ◽  
Pelvic Ring ◽  
Young Patients ◽  
High Energy ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Anatomical Structures ◽  
High Energy Trauma

AbstractInjuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.

scholarly journals Surgical treatment of displaced acetabular fractures

2011 ◽  
Vol 139 (7-8) ◽  
pp. 496-500 ◽  
Author(s):  
Sasa Milenkovic ◽  
Jordan Saveski ◽  
Mile Radenkovic ◽  
Goran Vidic ◽  
Neda Trajkovska
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Articular Surface ◽  
High Energy ◽  
Acetabular Fractures ◽  
Anatomical Reduction ◽  
Severe Injuries ◽  
Stable Internal Fixation

Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Nis from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d?Aubign? Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

scholarly journals Acute atraumatic bilateral acetabular insufficiency fractures

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901985857
Author(s):  
Daniel Benz ◽  
Patrick Lim ◽  
Zsolt J Balogh
Keyword(s):  
Case Report ◽  
Significant Risk ◽  
Early Mobilization ◽  
High Energy ◽  
Acetabular Fractures ◽  
Insufficiency Fractures ◽  
High Energy Trauma ◽  
Less Invasive

Bilateral acetabular fractures have been documented in the setting of high-energy trauma, but few reports regarding atraumatic bilateral acetabular fractures exist. The following is a case report of bilateral insufficiency acetabular fractures which occurred acutely in the absence of trauma in a 49-year-old female. The case highlights the importance of perioperative awareness of those patients at significant risk of insufficiency fractures and offers a relatively elegant, less invasive solution for early mobilization in the context of acetabula insufficiency fractures.

scholarly journals Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Kunal Mohan ◽  
Prasad Ellanti ◽  
Helen French ◽  
Niall Hogan ◽  
Tom McCarthy
Keyword(s):  
Systematic Review ◽  
Femoral Neck ◽  
Young Patients ◽  
Treatment Strategies ◽  
High Energy ◽  
Current Evidence ◽  
Implant Fixation ◽  
High Energy Trauma ◽  
Shaft Fractures ◽  
Significant Difference

Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable for inclusion, each comparing single device cephalomedullary nail fixation of both fractures with a combination of devices. All patients presented following high-energy trauma, at a median age of 32 years. While low complication rate and favorable outcomes were found across both groups, no significant difference could be inferred between either treatment strategy. This injury continues to occur in the traditionally described patient group, and results in acceptable postoperative outcomes. A paucity of randomized studies limits the ability to recommend a single or separate device treatment approach, and as such prospective, randomized trials with adequately powered sample sizes are required to definitively compare surgical management strategies in this rare but complex injury.

Determination of Indications to Surgical Treatment and Choice of Surgical Approaches in Complicated Complex Acetabular Fractures

2010 ◽  
Vol 17 (4) ◽  
pp. 30-37
Author(s):  
A V Beletskiy ◽  
A I Voronovich ◽  
Aleksandr Eduardovich Murzich ◽  
A V Beletskiy ◽  
A I Voronovich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Treatment Results ◽  
Complex Fractures ◽  
Comminuted Fractures ◽  
Simultaneous Use

Experience in surgical treatment of 65 patients with complex fractures of the acetabulum is presented. All patients underwent open reposition with internal fixation of fragments by reconstructive plates. Basic moments of the performance of portals to acetabulum, steps of reposition and fixation in multi-segment comminuted fractures are described. Algorithm for determination of indications to surgical treatment of complex acetabular fractures was determined. Clinical and roentgenologic results were studied at terms from 1 to 9 years. Excellent results were established in 39.5%, good and satisfactory in 34.9%, poor in 25.6% of patients. It was shown that in complex bi-columned fractures the technique of open osteosynthesis was the most effective when used within the first 3 weeks after injury. Simultaneous use of anterior and posterior accesses considerably facilitated the performance of reposition and stabilization of multi-segment comminuted fractures and enabled to achieve favorable treatment results.

Imaging of Pelvic and Femoral Fixation Hardware: Normal Findings and Hardware Failure

2019 ◽  
Vol 23 (02) ◽  
pp. e1-e19
Author(s):  
Hatice Sanal ◽  
Christina Boulton ◽  
Cagri Neyisci ◽  
Yusuf Erdem ◽  
Jason Lowe
Keyword(s):  
Pelvic Ring ◽  
Classification Systems ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Limb Alignment ◽  
Femoral Fixation ◽  
Hardware Failure ◽  
Femur Fractures ◽  
Articular Fractures ◽  
Fracture Classification Systems

AbstractGood outcomes following treatment of pelvic ring injuries, acetabular fractures, and femur fractures rely on restoration of native pelvic or limb alignment, anatomical reduction and rigid stability of articular fractures, and early postoperative mobilization. Multiple surgical approaches, reduction aids, and orthopaedic implants are available to stabilize these fractures. Despite best practices, complications including hardware failure, nonunions, malunions, and infections occur. This article discusses common fracture classification systems, implants, and imaging findings associated with unwanted complications in fractures of the pelvis, acetabulum, and femur.

scholarly journals Acetabular fractures in the elderly: modern challenges and the role of conservative management

2021 ◽  
Author(s):  
Kunal Mohan ◽  
James M. Broderick ◽  
Hasnain Raza ◽  
Brendan O’Daly ◽  
Michael Leonard
Keyword(s):  
Conservative Management ◽  
Young Patients ◽  
Treatment Strategies ◽  
The Elderly ◽  
High Energy ◽  
Acetabular Fractures ◽  
Individualized Approach ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

Abstract Introduction  The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. Aim  This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.  Conclusion Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

scholarly journals A STUDY ON SKELETALLY IMMATURE UNSTABLE PELVIC FRACTURES IN CHILDREN

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rakesh Kumar Gupta ◽  
Dr. Mohkam Singh
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Fractures In Children ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial traumas were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

scholarly journals RECTAL CULTURE SURVEILLANCE AND DEVELOPED SYSTEMIC INFECTIONS IN VANCOMYCIN-RESISTANT ENTEROCOCCI AND CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE CARRIERS

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Çiğdem Arabacı ◽  
Salih Emre
Keyword(s):  
Pelvic Ring ◽  
High Energy ◽  
Pelvic Fractures ◽  
Young Age ◽  
Economic Losses ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Age Group ◽  
High Energy Trauma ◽  
Unstable Fractures

Introduction: Globally, in the young age group of people mortality and morbidity is due to the high-energy trauma.  The losing of young age group of population will get impact in the social economic losses of family as well as the nation. Fractures are generally caused by high-energy trauma, high-impact accidents and are often associated with injuries to other organic lesions like abdominal viscera, genitourinary system, neurovascular, musculoskeletal structures and central nervous system. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. Aim: The main objective of this study is to study of Unstable Pelvic Fractures from children in tertiary care hospital Material and methods: In this study total 10 patients were included who had suffered unstable fractures of the pelvic ring with the age from  1 to 15 years old.. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. Result: In this study total 10 patients were included with unstable fractures of the pelvic ring evaluated where female were 6 and male were 4 with the ration 6: 4. The age ranges were 2 to 15 years with the mean age 7.5±4 years old. Symphysis disjunctions of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. The AO-OTA classification was used to evaluate the cases with the following distribution as 61 B1 (one case); 61 B2 (one case); 61 C3 (one cases), 61 C2 (one case) and 61 C1 (seven cases). Conclusion: Now  a day’s also many research which still have a controversy  for treatment,  which  has  been  recommended  for  treating  these  fractures  for  many  years. Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Keywords:  unstable pelvic facture, pelvic asymmetry, children

scholarly journals Antebrachial microvascular flap for reconstruction of the pelvic limb: case report

2019 ◽  
Vol 7 (5) ◽  
pp. 1952
Author(s):  
Rodrigo Banegas-Ruiz ◽  
Alan I. Valderrama-Treviño ◽  
J. A. Rivas-Montero ◽  
F. F. Gómez-Mendoza ◽  
E. García-Martínez ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissues ◽  
High Energy ◽  
Healing Time ◽  
Surgical Approaches ◽  
High Energy Trauma ◽  
Microvascular Flap ◽  
Pelvic Limb ◽  
The Right ◽  
Key Aspects

Complex defects in the soft tissues of the foot and ankle caused by high-energy trauma, infection, cancer or diabetes require rapid and effective treatment which decreases the risk of infection, bone healing time, hospital stay and number total of surgical approaches. Authors report a clinical case of a 23-year-old female patient who suffers high-energy trauma due to a motorcycle accident which causes exposure of the distal third of the tibia, loss of the tibial joint face, and loss of tissue throughout the region of the malleolus medial of the right pelvic extremity. Tissue transfer to the pelvic limb is performed using left contralateral radial antebrachial free flap as donor area. This case report aims to emphasize the key aspects of the high energy trauma approach by using microvascular flaps, as well as the satisfactory evolution of the patient that directly affects the prognosis for life and function.

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

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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