Injuries of the pelvis and hip in children

2011 ◽  
Author(s):  
Jon D. Hop ◽  
J.L. Marsh
Keyword(s):  
Avascular Necrosis ◽  
High Mortality ◽  
Major Trauma ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
The Body ◽  
Significant Problem ◽  
Intertrochanteric Fractures ◽  
Cervical Fractures ◽  
Single Breaks

♦ Displaced cervical fractures must be reduced and then fixed with lag screws♦ Avascular necrosis remains a significant problem♦ Intertrochanteric fractures may be treated closed with traction if an adequate reduction can be obtained and held♦ Dislocated hips should be reduced as soon as possible, open if necessary♦ Pelvic fractures are associated with a high mortality not so much from bleeding from pelvic veins as from accompanying major trauma to the rest of the body♦ The elasticity of children’s bones allows for single breaks in the pelvic ring.

scholarly journals Open pelvic fractures - results of an multi-institutional study

2021 ◽  
pp. 65-65
Author(s):  
Marko Mladenovic ◽  
Predrag Stoiljkovic ◽  
Ivica Lalic ◽  
Vladimir Harhaji ◽  
Andrija Krstic
Keyword(s):  
High Mortality ◽  
Pelvic Ring ◽  
Hypovolemic Shock ◽  
Colon Resection ◽  
Pelvic Fractures ◽  
Type I ◽  
Vertical Force ◽  
Abdominal Injuries ◽  
Mortality Factors ◽  
Pelvic Ring Fractures

Open pelvic fractures are devastating injuries, rare, and with high mortality. Leading causes of mortality are: haemorrhage, infection and associated injuries. The aim of this paper is to point out methods of treating these injuries and great number of prognostic mortality factors. Material - in period from January 2011 to December 2015, 221 patients with pelvis ringfracture were treated in three large clinical centers of Serbia, of which 13(5%) had an open fracture type. We have classified pelvic ring fractures according to the Young - Burgess classification. We have classified injuries according to Gustilo at I, II, and III degree, and the location of the wound according to Faringer classification was distributed in zone I, II and III. Urogenital and intra-abdominal injuries were monitored, and severity of injuries was determined according to Severity Score Injury (ISS) and Trauma Score (TS). Results - there were 6(46%) women and 7(54%) men at the average age of 41(13 - 76). Injuries from traffic trauma are dominant. The most common cause of pelvic ring fracture is an anterior posterior compression - 6(46%), lateral compression - 4(31%) and vertical force in 3 (23%) patients. Dominant injuries are type I and II according to Gustilo, and zone I according to Faringer classification. There were 6 (46%) patients with urogenital injuries, and the same number with intra-abdominal injuries, of which 3(23%) patients have been treated with colon resection and diversion. Due to abundant hemorrhage and hypovolemic shock 2 patients died, and another one died after three days due to sepsis and multisystem organ failure (MSOF). Conclusion - Open pelvic fractures have high mortality rate, due to: haemorrhage, infection, associated abdominal and genitourinary tract injuries, ISS> 25, TS <8 and age of patient >65 years.

Pelvic fractures: experience of pelvic ring fractures at a major trauma centre

2019 ◽  
Vol 74 (8) ◽  
pp. 649.e19-649.e26 ◽  
Author(s):  
S.E.T. Leach ◽  
V. Skiadas ◽  
C.E. Lord ◽  
N. Purohit
Keyword(s):  
Major Trauma ◽  
Pelvic Ring ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Pelvic Ring Fractures ◽  
Major Trauma Centre

Pelvic Impairments

2018 ◽  
Vol 23 (4) ◽  
pp. 9-10
Author(s):  
James Talmage ◽  
Jay Blaisdell
Keyword(s):  
Pelvic Ring ◽  
Reproductive Organs ◽  
High Impact ◽  
Pelvic Fractures ◽  
Motor Dysfunction ◽  
Impact Event ◽  
Concomitant Injuries ◽  
Rating Process ◽  
Pass Through ◽  
A Minor

Abstract Pelvic fractures are relatively uncommon, and in workers’ compensation most pelvic fractures are the result of an acute, high-impact event such as a fall from a roof or an automobile collision. A person with osteoporosis may sustain a pelvic fracture from a lower-impact injury such as a minor fall. Further, major parts of the bladder, bowel, reproductive organs, nerves, and blood vessels pass through the pelvic ring, and traumatic pelvic fractures that result from a high-impact event often coincide with damaged organs, significant bleeding, and sensory and motor dysfunction. Following are the steps in the rating process: 1) assign the diagnosis and impairment class for the pelvis; 2) assign the functional history, physical examination, and clinical studies grade modifiers; and 3) apply the net adjustment formula. Because pelvic fractures are so uncommon, raters may be less familiar with the rating process for these types of injuries. The diagnosis-based methodology for rating pelvic fractures is consistent with the process used to rate other musculoskeletal impairments. Evaluators must base the rating on reliable data when the patient is at maximum medical impairment and must assess possible impairment from concomitant injuries.

scholarly journals Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

2021 ◽  
Author(s):  
Giuseppe Rovere ◽  
Andrea Perna ◽  
Luigi Meccariello ◽  
Domenico De Mauro ◽  
Alessandro Smimmo ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Sexual Dysfunctions ◽  
Fracture Type ◽  
Ring Fracture ◽  
Male And Female ◽  
Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

scholarly journals Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?

2021 ◽  
Vol 10 (6) ◽  
pp. 1297
Author(s):  
Valerie Kuner ◽  
Nicole van Veelen ◽  
Stephanie Studer ◽  
Bryan Van de Wall ◽  
Jürgen Fornaro ◽  
...  
Keyword(s):  
Clinical Education ◽  
Trauma Center ◽  
Pelvic Ring ◽  
Daily Practice ◽  
Pelvic Trauma ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Unstable Fracture ◽  
Associated Injuries ◽  
Resuscitation Room

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

Magnetic Resonance Imaging to Detect Avascular Necrosis After Open Reduction and Internal Fixation of Talar Neck Fractures

1996 ◽  
Vol 17 (12) ◽  
pp. 742-747 ◽  
Author(s):  
David B. Thordarson ◽  
Mark J. Triffon ◽  
Michael R. Terk
Keyword(s):  
Stainless Steel ◽  
Avascular Necrosis ◽  
The Body ◽  
Type Ii ◽  
Mr Images ◽  
High Quality ◽  
Type D ◽  
Titanium Screws ◽  
Signal Changes ◽  
Talar Neck Fractures

Twenty-one consecutive patients with displaced talar neck fractures (12 Hawkins type II, 9 Hawkins type III) were prospectively evaluated with magnetic resonance (MR) scans performed between 3 days and 12 months after surgery. All patients underwent open reduction and internal fixation with titanium screws, except two who underwent fixation with stainless steel implants that were subsequently removed. All patients had plain radiographs. We classified the scans as follows: type A, no abnormal signal changes in the body of the talus; type B, signal changes in less than 25% of the body; type C, signal changes in 25% to 50% of the body; and type D, signal changes in greater than 50% of the body. Plain anteroposterior radiographs correlated well with MR scans in patients with type D scans, but an inconsistent correlation was noted with lesser degrees of signal changes (types A–C), with the MR scans being more accurate in displaying the volume of avascular bone. Scans obtained less than 3 weeks after injury were not helpful in assessing for avascular necrosis. We found that high-quality MR images of the talus were consistently obtained in the presence of titanium screws in contrast to images obtained with stainless steel implants. We use titanium screws in all talar neck fracture repairs, because they permit high-quality MR images. We believe that further study of patients with Hawkins type III fractures and Hawkins type II fractures with equivocal radiographic evidence of avascular necrosis is warranted to try to identify those patients at risk for collapse and perhaps to guide weightbearing recommendations.

scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Posterior Pelvic Ring ◽  
Sf 36 ◽  
One Year ◽  
Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

scholarly journals Failure of Internal Fixation of The Anterior Ring For Unstable Pelvic Fractures, The Experience of A Single Institute

2021 ◽  
Author(s):  
Sheng Zhang ◽  
Huagui Mo ◽  
Yucheng Liu ◽  
Guohua Zhu ◽  
Bin Yu
Keyword(s):  
Internal Fixation ◽  
Pelvic Ring ◽  
Treatment Strategies ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Fixation Failure ◽  
Initial Surgery ◽  
Multidisciplinary Cooperation ◽  
Preoperative Plan ◽  
Anterior Ring

Abstract Background: This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies. Materials: From January 2009 to December 2018, 93 patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system.Results: According to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5-28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients were fixed with a plate. Five patients undergoing revision surgery were followed up for 6-36 months with an average of 18 months. According to Majeedscore at the last follow-up, there were 2 cases of excellent, 2 cases of good, 1 case of fair, and the excellent and good rate reached 80%.Conclusion: The treatment of complicated unstable pelvic fractures requires early multidisciplinary cooperation, proper management of hemodynamic stability and other comorbidities, and performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.

scholarly journals Surgical Hemostasis for Severe Multisystem Pelvic Injuries

2020 ◽  
Vol 8 (4) ◽  
pp. 396-408
Author(s):  
I. V. Kazhanov ◽  
A. Y. Demko ◽  
V. A. Manukovsky ◽  
S. I. Mikityuk ◽  
V. A. Reva ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Anterior Part ◽  
Treatment Algorithm ◽  
Pelvic Trauma ◽  
Balloon Occlusion ◽  
The Body ◽  
Military Surgery ◽  
Transfusion Therapy ◽  
Homogeneous Groups ◽  
Military Medical Academy

For the treatment of patients with severe multysistem pelvic trauma accompanied by pelvic bleeding, many algorithms have been proposed that have different procedures for the use of various methods of surgical hemostasis, but none of them may guarantee the complete arrest of pelvic bleeding. The purpose of this study was to estimate clinical efficacy and developed algorithm, aimed at timely diagnosis of intrapelvic bleeding and its complete arrest with the help of different methods of surgical hemostasis in patients with severe concomitant injury of the pelvis. The article analyzes the results of treatment of 168 patients with unstable pelvic ring injuries and signs of intrapelvic bleeding, who were treated in two trauma centers of the first level in St. Petersburg: I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine and Military Surgery Clinic of S.M. Kirov Military Medical Academy in 2010-2018. The victims were divided into two statistically homogeneous groups. In the comparison group (75 people), the pelvic ring was mechanically stabilized with the Ganz C-clamp or the anterior part of the pelvis was fixed with an external fixation device (EFD), and the arrest of the ongoing pelvic bleeding was expected due to occur due to the effect of biological tamponade. In the main group (93 people), after mechanical stabilization of the pelvic ring, various methods of surgical hemostasis were used: balloon occlusion of the aorta, pelvic tamponade, angiography with embolization. The choice of method for surgical haemostasis after trauma depended on the severity of the affected condition of hemodynamic parameters, availability of life-threatening consequences of damage to other areas of the body and the efficacy of previously applied method for intrapelvic bleeding arrest. The introduction of modern diagnostic and treatment algorithm, aimed at complete hemostasis in patients with ongoing intrapelvic bleeding reduced the overall mortality rate by 1.7 times, mortality within 24 hours of admission by 2.3 times, as well as the duration and the volume of blood transfusion therapy by 3 and 1.8 times.Authors declare lack of the conflicts of interests.

Sign in / Sign up

Export Citation Format

Share Document