scholarly journals Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center

2021 ◽  
Vol 28 ◽  
pp. 221049172110068
Author(s):  
Jeffrey M Henstenburg ◽  
Joseph A Larwa ◽  
Christine S Williams ◽  
Mitesh P Shah ◽  
Susan P Harding
Keyword(s):  
Risk Factors ◽  
Pelvic Ring ◽  
Smoking Status ◽  
Infection Risk ◽  
Acetabular Fractures ◽  
Ilioinguinal Approach ◽  
Pelvic Injuries ◽  
Urban Level ◽  
Operative Fixation ◽  
Level 1 Trauma Center

Background: Pelvic ring and acetabular fractures are some of the most morbid in orthopedic trauma. They commonly require large exposures for fixation and are associated with significant morbidity and mortality. This study attempts to identify risk factors for complications following operative fixation of pelvic injuries. Methods: 126 patients treated for pelvic injuries were reviewed retrospectively. Demographics, procedure characteristics, and outcomes were recorded. Variables associated with complications were analyzed using logistic regression analysis. Results: Complications occurred in 12 patients. Higher BMI, longer length of stay, and ilioinguinal approach were significantly associated with increased infection risk. Co-morbid heart disease and concurrent smoking status showed a trend for increased infection risk. Higher BMI and ilioinguinal approach were significantly associated with an increased likelihood of re-operation. Positive psychiatric history and Medicaid payer status showed a trend toward higher reoperation risk. Conclusion: Knowledge of these risk factors can help guide management and predict outcomes following pelvic fracture fixation.

Intraoperative Imaging in Pelvic Surgery

2018 ◽  
Vol 157 (04) ◽  
pp. 367-377 ◽  
Author(s):  
Holger Keil ◽  
Sara Aytac ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
General Condition ◽  
Pelvic Ring ◽  
Intraoperative Imaging ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
Posterior Pelvic Ring ◽  
Data Set ◽  
Intraoperative 3D Imaging ◽  
Pelvic Injuries ◽  
Preoperative Ct

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

scholarly journals Risk Factors for Surgical Site Infection after Operative Fixation of Acetabular Fractures: Is Psoas Density a Useful Metric?

2020 ◽  
Vol 478 (8) ◽  
pp. 1760-1767
Author(s):  
Kyle H. Cichos ◽  
Khalid H. Mahmoud ◽  
Clay A. Spitler ◽  
Ahmed M. Kamel Abdel Aal ◽  
Sarah Osman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Acetabular Fractures ◽  
Site Infection ◽  
Operative Fixation

scholarly journals Use of Cannulated Screws in Pelvic Injury Surgery

2016 ◽  
pp. 25-34
Author(s):  
A. V. Bondarenko ◽  
I. V. Kruglykhin ◽  
A. N. Voitenko
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Surgical Techniques ◽  
Pelvic Injury ◽  
Acetabular Fractures ◽  
Treatment Technique ◽  
Cannulated Screws ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries ◽  
Osteosynthesis Techniques

Osteosynthesis with cannulated screws is one of low invasive osteosynthesis techniques that does not aggravate the condition of polytraumatized patients and can be used at the early stages of treatment. The purpose of the study was to determine the peculiarities of cannulated screws application in pelvic ring and acetabular injuries. Cannulated screws were used at surgical treatment of 368 patients, aged 14–77 years, with pelvic injuries. The overwhelming majority of patients were with severe polytrauma (17 and more points by ISS score). Pelvic ring injuries (61st segment) were diagnosed in 259 (70.4%) patients, acetabular fractures (62nd segment) — in 75 (20.4%), pelvic ring injuries associated with acetabular fractures (61st and 62nd segments) — 34 (9.2%) patients. The screws were mainly used as the basic treatment technique, rarely — in combination with internal plate osteosynthesis and more rarely — in combination with external fixation device. Analysis of the results and complications was performed. Treatment results by Majeed pelvic score at terms 1 to 3 years were studied in 207 patients. Poor results were observed in 15 (7.2%) cases. Pelvic fracture osteosynthesis with cannulated screws has a number of advantages and can be referred to as one of the basic surgical techniques for pelvic fractures.

scholarly journals Thromboembolic complications among multiple injured patients with pelvic injuries: identifying risk factors for possible patient-tailored prophylaxis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tim Kirchner ◽  
Rolf Lefering ◽  
Richard Sandkamp ◽  
Helge Eberbach ◽  
Klaus Schumm ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Injury Severity ◽  
Acetabular Fractures ◽  
Thromboembolic Risk ◽  
Pelvic Injuries ◽  
Multiple Injured ◽  
Independent Risk Factors ◽  
Injured Patients ◽  
Multiple Injured Patients

Abstract Background Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the potential negative effects of concomitant pelvic or acetabular injuries in multiple injured patients according to pelvic/acetabular injury severity and fracture classification. Methods The TraumaRegister DGU® was analyzed between 2010 and 2019. Multiple injured patients with pelvic and/or acetabular fractures with ISS ≥ 16 suffering from TE complications were identified. We conducted a univariate and multivariate analysis with TE events as independent variable to examine potential risk factors and contributing factors. Results 10.634 patients met our inclusion criteria. The overall TE incidence was 4.9%. Independent risk factors for the development of TE complications were sepsis, ≥ 10 operative interventions, mass transfusion (≥ 10 PRBCs), age ≥ 65 years and AISAbdomen ≥ 3 (all p < 0.001). No correlation was found for overall injury severity (ISS), moderate traumatic brain injury, additional injury to lower extremities, type B and C pelvic fracture according to Tile/AO/OTA and closed or open acetabular fracture. Conclusions Multiple injured patients suffering from pelvic and/or acetabular fractures are at high risk of developing thromboembolic complications. Independent risk factors for the development of thromboembolic events in our study cohort were age ≥ 65 years, mass transfusion, AISAbdomen ≥ 3, sepsis and ≥ 10 surgery procedures. Among multiple injured patients with acetabular or pelvic injuries the severity of these injuries seems to have no further impact on thromboembolic risk. Our study, however, highlights the major impact of early hemorrhage and septic complications on thromboembolic risk in severely injured trauma patients. This may lead to individualized screening examinations and a patient-tailored thromboprophylaxis in high-risk patients for TE. Furthermore, the number of surgical interventions should be minimized in these patients to reduce thromboembolic risk.

scholarly journals Financial impact of electric scooters: a review of injuries over 27 months at an urban level 1 trauma center (cost of e-scooter injuries at an urban level 1 trauma center)

2021 ◽  
Vol 6 (1) ◽  
pp. e000634
Author(s):  
Ophelie Lavoie-Gagne ◽  
Matthew Siow ◽  
William E Harkin ◽  
Alec R Flores ◽  
Carey S Politzer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Care ◽  
Trauma Center ◽  
High Energy ◽  
Financial Impact ◽  
Hospital Charges ◽  
Level Of Evidence ◽  
Urban Level ◽  
Level 1 ◽  
Level 1 Trauma Center

BackgroundElectric scooters (e-scooters) have become a widespread method of transportation due to convenience and affordability. However, the financial impact of medical care for sustained injuries is currently unknown. The purpose of this study is to characterize total billing charges associated with medical care of e-scooter injuries.MethodsA retrospective review of patients with e-scooter injuries presenting to the trauma bay, emergency department or outpatient clinics at an urban level 1 trauma center was conducted from November 2017 to March 2020. Demographic and clinical data were collected. Primary outcomes of interest were total billing charges and billing to insurance (hospital and professional). Multivariable models were used to identify preventable risk factors associated with higher total billing charges.ResultsA total of 63 patients were identified consisting of 42 (66.7%) males, average age 40.19 (SD 13.29) years and 3.2% rate of helmet use. Patients sustained orthopedic (29%, n=18), facial (48%, n=30) and cranial (23%, n=15) injuries. The average total billing charges for e-scooter clinical encounters was $95 710 (SD $138 215). Average billing to insurance was $86 376 (SD $125 438) for hospital charges and $9 334 (SD $14 711) for professional charges. There were no significant differences in charges between injury categories. On multivariable regression, modifiable risk factors independently associated with higher total billing charges included any intoxication prior to injury ($231 377 increase, p=0.02), intracranial bleeds ($75 528, p=0.04) and TBI ($360 898, p=0.006).DiscussionMany patients sustain high-energy injuries during e-scooter accidents with significant medical and financial consequences. Further studies may continue expanding the financial impact of e-scooter injuries on both patients and the healthcare system.Level of evidenceIII

scholarly journals Results of Modified Ilioinguinal Approach in Management of Acetabular and Pelvic Fractures (A Systematic Review and meta-analysis of Literature)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H A Fahmy ◽  
A M Sallam ◽  
M M A Abdelsamad
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Clinical Outcome ◽  
Outcome Assessment ◽  
Pelvic Ring ◽  
Meta Analysis ◽  
Acetabular Fractures ◽  
Ilioinguinal Approach ◽  
Pelvic Ring Fractures ◽  
Satisfactory Outcome

Abstract Background Modified ilioinguinal approach was introduced to manage anterior acetabular fractures to reduce the morbidity & complications of the classic ilioinguinal approach, a less invasive anterior approach consisting of a medial window combined with the lateral window of the ilioinguinal approach. Aim of the Work a systematic review to determine whether the modified ilioinguinal approach is better the classic ilioinguinal approach in managing traumatic acetabular fractures by comparing the results in each study. Materials and Methods 5 studies(from 2010-2017) were included & reviewed the results of 147 patients operated by modified ilioinguinal approach in terms of: operative details, intraoperative & postoperative complications, postoperative reduction quality & final clinical outcome assessment, & results was analyzed & pooled together to reach a satisfactory outcome. Results Modified ilioinguinal approach showed operative time (123.2±6.83 minute), relatively small amount of blood loss (200-1000 ml) & better quality of reduction (84.8% had anatomical reduction, 10.9% had fair reduction, and 4.3% had poor reduction). However there were no significant differences in terms of postoperative complications & final clinical outcome assessment between different studies. Conclusion It was concluded that the modified ilioinguinal approach allowed reduction of anterior column and pelvic ring fractures without requiring dissection through the inguinal neurovascular structures. Results showed that its possible with this approach to reach safe reduction and stable fixation.

Lifestyle-Related Risk Factors, Smoking Status and Cardiovascular Disease

2012 ◽  
Vol 19 (2) ◽  
pp. 85-92
Author(s):  
Renata Giudice ◽  
Raffaele Izzo ◽  
Maria Virgina Manzi ◽  
Giampiero Pagnano ◽  
Mario Santoro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Smoking Status ◽  
Related Risk
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