scholarly journals Revisiting Nonoperative Treatment of Lateral Compression Pelvic Fractures. Analysis of Rehabilitation and Radiologic Outcomes in a Historical Cohort Using Today's AO Stability Criteria.

2021 ◽  
Author(s):  
Claudio Rojas ◽  
ERNESTO EWERTZ ◽  
Jose Miguel Hormazabal
Keyword(s):  
Treatment Strategies ◽  
Operative Management ◽  
Additional Treatment ◽  
Pelvic Fractures ◽  
Type I ◽  
Lateral Compression ◽  
Historical Cohort ◽  
Ao Classification ◽  
Historical Series ◽  
Fracture Consolidation

Abstract Background: Type I lateral compression pelvic fractures (LC-I) have historically been treated conservatively. Inferior outcomes in a distinctive subset of these injuries has been reported, therefore their management has shifted towards surgery. Revisiting historical series of LC-I allows us to determine whether non-operative management of these unstable patterns result in poorer outcomes. The objective was to evaluate the differences in the rehabilitation progress, fracture consolidation and displacement in non-operatively treated LC-I fractures that would be considered unstable using today´s AO criteria.Methods: We conducted a retrospective review of conservatively treated LC-I injuries in a single level I trauma center, between June 2010 and June 2014. Patients were distributed in Stable (Group A) and unstable (Group B) groups according to 2018 AO classification. Time to walk independently (TWI), time to return to work (TRW), fracture consolidation and displacement were analyzed. Results: 34 patients, mean aged 45.5 ±14.5 years, were included. Mean TWI in groups A and B were 71.2 ±31.9 and 105.9 ±50.9 days (p=0.027). Mean TRW was 106 ±51.3 and 157 ±84 days in Groups A and B respectively (p=0.038). A difference in mean TWI and TRW of 34.7 and 51.3 days between groups was observed. No significant differences in fracture consolidation or displacement were observed.Conclusion: Unstable fractures presented significantly longer TWI and TRW. The revised AO classification contributes in the identification of fracture patterns that correlate with prolonged rehabilitation in which additional treatment strategies might be considered.

Magnetic Resonance Imaging in Pelvic Fractures – Part 2: Gaining Information and Clinical Therapeutic Relevance

2019 ◽  
Vol 158 (04) ◽  
pp. 360-368 ◽  
Author(s):  
Carsten Hackenbroch ◽  
Charlotte Merz ◽  
Hans-Georg Palm ◽  
Benedikt Friemert ◽  
Fabian Stuby ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Information Gain ◽  
Pelvic Fractures ◽  
Type I ◽  
Type Ii ◽  
Mri Imaging ◽  
Concomitant Injuries ◽  
Ao Classification ◽  
Exact Test ◽  
Therapeutic Relevance

Abstract Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy. Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting. Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisherʼs Exact Test found that the parameters “adequacy of trauma” and “fracture type change” by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma. Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.

scholarly journals Crosstalk between MicroRNA and Oxidative Stress in Primary Open-Angle Glaucoma

2021 ◽  
Vol 22 (5) ◽  
pp. 2421
Author(s):  
Saray Tabak ◽  
Sofia Schreiber-Avissar ◽  
Elie Beit-Yannai
Keyword(s):  
Oxidative Stress ◽  
Transforming Growth Factor Beta ◽  
Transforming Growth Factor ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Additional Treatment ◽  
Type I ◽  
Open Angle ◽  
Outflow Resistance ◽  
Stress Injury

Reactive oxygen species (ROS) plays a key role in the pathogenesis of primary open-angle glaucoma (POAG), a chronic neurodegenerative disease that damages the trabecular meshwork (TM) cells, inducing apoptosis of the retinal ganglion cells (RGC), deteriorating the optic nerve head, and leading to blindness. Aqueous humor (AH) outflow resistance and intraocular pressure (IOP) elevation contribute to disease progression. Nevertheless, despite the existence of pharmacological and surgical treatments, there is room for the development of additional treatment approaches. The following review is aimed at investigating the role of different microRNAs (miRNAs) in the expression of genes and proteins involved in the regulation of inflammatory and degenerative processes, focusing on the delicate balance of synthesis and deposition of extracellular matrix (ECM) regulated by chronic oxidative stress in POAG related tissues. The neutralizing activity of a couple of miRNAs was described, suggesting effective downregulation of pro-inflammatory and pro-fibrotic signaling pathways, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), transforming growth factor-beta 2 (TGF-β2), Wnt/β-Catenin, and PI3K/AKT. In addition, with regards to the elevated IOP in many POAG patients due to increased outflow resistance, Collagen type I degradation was stimulated by some miRNAs and prevented ECM deposition in TM cells. Mitochondrial dysfunction as a consequence of oxidative stress was suppressed following exposure to different miRNAs. In contrast, increased oxidative damage by inhibiting the mTOR signaling pathway was described as part of the action of selected miRNAs. Summarizing, specific miRNAs may be promising therapeutic targets for lowering or preventing oxidative stress injury in POAG patients.

scholarly journals The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Huang ◽  
Bin-Fei Zhang ◽  
Ping Liu ◽  
Hong-Li Deng ◽  
Peng-Fei Wang ◽  
...  
Keyword(s):  
Pelvic Fractures ◽  
Definitive Treatment ◽  
Lateral Compression ◽  
Level Of Evidence ◽  
Conservative Group ◽  
Medical Records System ◽  
The Stability ◽  
And Function ◽  
Compression Type

Abstract Background It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. Methods Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. Results In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). Conclusions The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. Level of evidence Level III.

scholarly journals Management of a spontaneous supra-aortic arterial dissection: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Omar M. Sharaf ◽  
Tomas D. Martin ◽  
Eric I. Jeng
Keyword(s):  
Innominate Artery ◽  
Operative Management ◽  
Computed Tomographic Angiography ◽  
Artery Dissection ◽  
Term Therapy ◽  
Type I ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Aortic Dissections ◽  
Isolated Innominate Artery

Abstract Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

(deleted)

2021 ◽  
Author(s):  
MV Osikov ◽  
EV Davydova ◽  
KS Abramov
Keyword(s):  
Bone Healing ◽  
Standard Therapy ◽  
Type I Collagen ◽  
Femoral Shaft ◽  
Control Group ◽  
Blood Levels ◽  
Type I ◽  
Mineral Density ◽  
Fracture Consolidation ◽  
To Receive

Efferent physical therapy holds promise as an adjunct to the combination treatment of femoral fractures in young, working-age individuals. The aim of the study was to investigate the dynamics of bone turnover markers at different stages of femoral fracture consolidation in patients undergoing ozone therapy. The study enrolled 20 men (group 2, 47.8 ± 3.5 years) with a femoral shaft fracture (AO/ASIF 32А, 32В). The control group (group 1, 46.8 ± 3.7 years) comprised 10 healthy males. Subgroup 2a (n = 10) was assigned to receive standard therapy; subgroup 2b (n = 10) was assigned to receive standard therapy complemented by minor autohemotherapy (MAHT) at 20 mg/L ozone concentrations. On days 7, 30 and 90, fracture consolidation was assessed on the RUST scale and blood levels of С-terminal telopeptides of type I collagen (bCTx, pg/ml) and procollagen type I carboxy-terminal propeptide (PICP, ng/ml) were measured. On day 7, the total RUST score in subgroups 2a and 2b was 4 points; on day 30, it was 6.5 and 8.7 points, respectively, and on day 90, it reached 10 and 11.5 points, respectively. Bone mineral density was as high as 90% in the MAHT subgroup vs. 78% in subgroup 2а, indicating faster bone healing. On day 30, bCTx levels in subgroup 2b were higher than in subgroup 2a (2289.4 [2145.3; 2365.4] vs. 1894.6 [1745.3; 2098.2], respectively. On day 7, PICP was significantly elevated in subgroup 2b in comparison with subgroup 2a; its levels peaked on days 30 and 90 (day 30: 268.3 [231.2; 286.3] vs. 183.2 [174.6; 195.6]; day 90: 584.6 [512.3; 589.3] vs. 351.2 [312.3; 369.4]. Thus, MAHT produces a positive effect on the quality and intensity of bone healing in men with isolated closed femoral shaft fractures.

Lateral compression type I injuries of the pelvic ring: Are they mechanically stable?

Injury ◽  
2009 ◽  
Vol 40 (11) ◽  
pp. 1129-1130
Author(s):  
N.K. Kanakaris ◽  
C. Tzioupis ◽  
V.S. Nikolaou ◽  
P.V. Giannoudis
Keyword(s):  
Pelvic Ring ◽  
Type I ◽  
Lateral Compression ◽  
Compression Type

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 The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

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