A Water Slide Accident Resulting in an Open Book Pelvic Injury and Subsequent Pulmonary Embolus: A Case Report

Obesity and pelvic injuries are well-known independent risk factors for developing a pulmonary embolus; however, there is minimal literature with regard to obesity being a risk factor for suffering a pelvic injury from descending a water slide. We believe that obese patients are potentially at increased risk of receiving open book pelvic injuries on modern-day high-velocity water slides. To our knowledge, there are no other reports of a patient suffering an open book pelvic injury and a subsequent pulmonary embolus due to a water slide accident. We also propose a mechanism of injury for an obese person developing an open book pelvic injury from a water slide. An obese 46-year-old female descended on a thrill ride at a popular water park and sustained an open book pelvic injury. She subsequently developed a pulmonary embolus while awaiting open reduction and internal fixation of the anterior pelvic ring. One month post-injury, she had uneventful open reduction and internal fixation and went on to have an uneventful postoperative course. Patrons and amusement park owners should be aware of the increased risk an obese person is at when using a high-velocity water slide. There should be appropriate emergency personnel and equipment on site in anticipation of a possible high-energy injury.

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Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00324 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Jennifer Liu ◽

Junho Ahn ◽

Dane Wukich ◽

Katherine Raspovic

Keyword(s):

Diabetes Mellitus ◽

Internal Fixation ◽

Ankle Fracture ◽

Open Reduction ◽

Large Scale ◽

Ankle Fractures ◽

Unplanned Readmission ◽

Diabetic Patients ◽

Acs Nsqip ◽

Increased Risk

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

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Surgical treatment of the unstable type C pelvic injury

Acta chirurgica iugoslavica ◽

10.2298/aci1302053m ◽

2013 ◽

Vol 60 (2) ◽

pp. 53-58 ◽

Cited By ~ 2

Author(s):

Sasa Milenkovic ◽

Milorad Mitkovic ◽

Jordan Saveski ◽

Ivan Micic ◽

Milan Mitkovic ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Fixation ◽

Open Reduction ◽

Pelvic Ring ◽

Posterior Pelvic Ring ◽

Pelvic Ring Injuries ◽

Pelvic Injuries ◽

Ring Complex ◽

Type C ◽

Stable Internal Fixation

Rotationally and vertically unstable injuries to the pelvic ring (Type C) require stabilisation of the anterior and posterior pelvic ring complex. Inadequate treatment of these injuries leads to chronic instability of the pelvic ring, which can finally cause permanent disability. Open reduction and stable internal fixation of the anterior and posterior complex of unstable pelvic ring injuries are standard procedures in the treatment of hemodynamically stable patients with (Type C) pelvic injuries. Our aim is to show that this type of treatment achieves excellent and good results. All patients were operated on using the method of open reduction and anterior plate fixation of sacroiliac complex as well as fixation of the pubic symphisis. We present a retrospective study of the results concerning the treatment of 19 patients with (Type C ) unstable pelvic injuries. The average age of the patients was 43,21 years old. The final functional results, 2 years post-surgery according to the Majeed scoring system and the results were excellent in 11 (57.89%) and good in 8 (42.1%) patients. There were no bad results to report. Type C pelvic ring injuries are unstable and unless they are adequately treated, they can lead to permanent consequences. Surgical treatment that includes open reduction and stable internal fixation of the anterior and posterior pelvic ring complex leads to excellent and good results. The patients that were treated surgically by fixation of the anterior and posterior pelvic ring complex return to their everyday lives and work activities.

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Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000286 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Andrew Matson ◽

Stephen Barchick ◽

Samuel Adams

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Wound Complications ◽

Complication Rates ◽

Percutaneous Fixation ◽

Open Injury ◽

Increased Risk ◽

Significant Difference

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.

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Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

Foot & Ankle International ◽

10.1177/10711007211058163 ◽

2021 ◽

pp. 107110072110581

Author(s):

Alisa Malyavko ◽

Theodore Quan ◽

William T. Stoll ◽

Joseph E. Manzi ◽

Alex Gu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Internal Fixation ◽

Operative Treatment ◽

Ankle Fracture ◽

Open Reduction ◽

Bleeding Disorder ◽

Ankle Fractures ◽

Bleeding Disorders ◽

Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

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Reoperation in Zygomatico-orbital Trauma: A Review of Patients With Suboptimal Outcomes Following Initial Repair

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520923924 ◽

2020 ◽

Vol 13 (3) ◽

pp. 205-210

Author(s):

Richard Taylor ◽

Deepshikha Kumar ◽

Jai Ghelani ◽

Iain Varley

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Preoperative Imaging ◽

Surgical Approaches ◽

Orbital Fractures ◽

Orbital Trauma ◽

Factors Affecting ◽

Intraoral Approach ◽

Increased Risk ◽

Operative Notes

Introduction: Treatment to restore anatomy, function, and aesthetics after trauma should involve as little surgical insult as possible. As such, repeated procedures may suggest failed initial management. To date, no predictive factors for failure of primary surgery have been identified. Objectives: The aim of this review was to identify factors affecting the requirement for reoperation following treatment of zygomatico-orbital injuries. Study Design and Methods: A retrospective review of patients undergoing surgery for zygomatico-orbital fractures between 2011 and 2019 in a single UK major trauma center was undertaken. All operative notes and imaging were reviewed independently by 2 authors to classify the fracture patterns for both zygomatic and orbital components of the injury. For all cases, the mode of preoperative imaging the grade of operating surgeon, materials used for fixation, and the surgical approaches were recorded. Results: Coding data identified 432 patients who underwent surgery for zygomatico-orbital fractures. In total, 116 cases were treated with closed reduction and 316 with open reduction and internal fixation; 20 cases required reoperation. There were no significant differences identified between cases requiring reoperation and those who did not. Conclusions: A need for repeated surgery is rare. However, this review identified an increased risk of infection of fixation when an intraoral approach was used and highlights the potential benefits that can be achieved by open reduction and internal fixation when more conservative approaches fail to achieve the desired outcome.

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What is the best internal fixation in pelvic fracture models with open-book injury and anterior sacroiliac joint disruption?

Medical Journal of Indonesia ◽

10.13181/mji.v24i4.1233 ◽

2015 ◽

Vol 24 (4) ◽

pp. 239-44

Author(s):

Ismail H. Dilogo ◽

Immanuel P. Sitorus

Keyword(s):

Internal Fixation ◽

Sacroiliac Joint ◽

Pelvic Injury ◽

Open Book ◽

Fixation Technique ◽

Pelvic Bones ◽

Iliosacral Screws ◽

Sacroiliac Joint Disruption ◽

Load To Failure ◽

Joint Disruption

Background: The best operative management for open-book pelvic injury with anterior sacroiliac disruption (OTA/AO B1.1 classification) is still debated. This biomechanical study aimed to find the best internal fixation technique for such injury. Methods: Open-book injury with anterior sacroiliac joint disruption was simulated on 25 artificial pelvic bones. Twenty five artificial pelvic bones were divided into 5 groups (n=5 /group) and fixated with five different fixation techniques: 1). 1SP+1IS; 2). 2SP; 3). 2SP+2SIP; 4). 1SP+2IS S1, and 5). 1SP+1IS S1+S2. Biomechanical properties of each fixation technique were assessed using Tensilon® RTF-1310 to measure the resistance to translation and load to failure. Data were statistically analyzed using one-way ANOVA followed by post-hoc Bonferroni test.Results: The highest mean load to failure of axial forces (1490.36 N) was achieved by the fixation technique using one symphyseal plate and two iliosacral screws located at S1 dan S2. The addition of one iliosacral screw significantly increased the mean load to failure for axial compression (p<0.05).Conclusion: The addition of sacroiliac joint posterior fixation, either with plate or screw, will increase the fixation biomechanical strength. Single symphyseal plate and two iliosacral screws on S1 and S2 provided the best mechanical resistance to axial loading. Thus, it can be concluded that such fixation technique is best for open-book pelvic injury with anterior sacroiliac disruption.

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Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00093 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0009

Author(s):

Matthew Anderson ◽

Aaradhana J. Jha ◽

Sameer M. Naranje ◽

Gean C. Viner ◽

Haley McKissack ◽

...

Keyword(s):

Postoperative Complications ◽

Internal Fixation ◽

Revision Surgery ◽

Open Reduction ◽

Illicit Drugs ◽

Standard Procedure ◽

Case Series ◽

Ankle Fractures ◽

Increased Risk

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age. Methods: All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities. Results: Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication. Conclusion: Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.

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