One sacroiliac screw for posterior ring fixation in unstable pelvic fractures

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.

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Extending the multistage surgical strategy for recurrent initially low-grade gliomas: functional and oncological outcomes in 31 consecutive patients who underwent a third resection under awake mapping

Journal of Neurosurgery ◽

10.3171/2021.3.jns21264 ◽

2021 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Noor Hamdan ◽

Hugues Duffau

Keyword(s):

High Rate ◽

Karnofsky Performance Scale ◽

Consecutive Series ◽

Low Grade ◽

Oncological Treatment ◽

The Third ◽

Oncological Outcomes ◽

Group 2 ◽

Group 1

OBJECTIVE Maximal safe resection is the first treatment in diffuse low-grade glioma (DLGG). Due to frequent tumor recurrence, a second surgery has already been reported, with favorable results. This study assesses the feasibility and functional and oncological outcomes of a third surgery in recurrent DLGG. METHODS Patients with DLGG who underwent a third functional-based resection using awake mapping were consecutively selected. They were classified into group 1 in cases of slow tumor regrowth or group 2 if a radiological enhancement occurred during follow-up. All data regarding clinicoradiological features, histomolecular results, oncological treatment, and survival were collected. RESULTS Thirty-one patients were included, with a median age of 32 years. There were 20 astrocytomas and 11 oligodendrogliomas in these patients. Twenty-one patients had medical oncological treatment before the third surgery, consisting of chemotherapy in 19 cases and radiotherapy in 8 cases. No neurological deficit persisted after the third resection except mild missing words in 1 patient, with 84.6% of the patients returning to work. The median follow-up duration was 13.1 ± 3.4 years since diagnosis, and 3.1 ± 2.9 years since the third surgery. The survival rates at 7 and 10 years were 100% and 89.7%, respectively, with an estimated median overall survival of 17.8 years since diagnosis. A comparison between the groups showed that the Karnofsky Performance Scale score dropped below 80 earlier in group 2 (14.3 vs 17.1 years, p = 0.01). Median residual tumor volume at the third surgery was smaller (2.8 vs 14.4 cm3, p = 0.003) with a greater extent of resection (89% vs 70%, p = 0.003) in group 1. CONCLUSIONS This is the first consecutive series showing evidence that, in select patients with progressive DLGG, a third functional-based surgery can be achieved using awake mapping with low neurological risk and a high rate of total resection, especially when reoperation is performed before malignant transformation.

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The transsphenoidal resection of pediatric craniopharyngiomas: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.7.peds09252 ◽

2010 ◽

Vol 5 (1) ◽

pp. 49-60 ◽

Cited By ~ 69

Author(s):

John A. Jane ◽

Daniel M. Prevedello ◽

Tord D. Alden ◽

Edward R. Laws

Keyword(s):

Transsphenoidal Surgery ◽

Pediatric Patients ◽

Pediatric Population ◽

Case Series ◽

High Rate ◽

Subtotal Resection ◽

Consecutive Series ◽

Entire Cohort ◽

Transsphenoidal Resection

Object The majority of pediatric craniopharyngiomas are treated using a transcranial approach. Although there is an increasing acceptance of transsphenoidal resection in adults, there are few reports describing this approach in the pediatric population. The purpose of this study is to report the outcomes after transsphenoidal surgery in a consecutive series of pediatric patients with craniopharyngiomas treated at a single institution with the goal of gross-total resection (GTR). Methods Twenty-three patients with pathologically proven craniopharyngiomas were identified who were 18 years of age or less at the time of surgery. The medical records and imaging studies of the patients were retrospectively reviewed. One patient who was lost to follow-up after surgery was excluded. Results Among the 22 patients included in the study, 11 underwent transsphenoidal surgery as the primary procedure and 11 underwent transsphenoidal surgery as a secondary procedure after a previous procedure. All patients had at least some sellar component to their tumor and all had either anterior or posterior pituitary dysfunction at presentation. In the entire cohort, a GTR was achieved in 15 (68%) of 22 patients, a radical subtotal resection in 4 (18%) of 22 patients, a subtotal resection in 1 patient, and a partial resection in 2 patients. The degree of resection was higher in the primary transsphenoidal group. After a mean follow-up of 82 months, 4 patients (18%) experienced recurrence. Recurrence occurred in 13% after GTR compared with 28.5% after all other degrees of resection. Tumor recurred in 9% of the primary transsphenoidal group and in 30% of patients who had undergone other therapies prior to the transsphenoidal operation. No patient who had panhypopituitarism experienced a gain of function postoperatively, 67% developed new panhypopituitarism, and 56% experienced new diabetes insipidus. Vision improved or normalized in 9 (64%) of 14 patients presenting with visual loss. Complications included 1 death 3 weeks postoperatively, 2 CSF leaks, and new obesity in 37%. Conclusions Transsphenoidal resection of pediatric craniopharyngiomas results in a high rate of both visual improvement and GTR with a low associated risk of recurrence. The transsphenoidal approach should be considered in selected pediatric patients with craniopharyngioma, especially those with infradiaphragmatic origin.

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Evaluation of outcome following clamp assisted mini open reduction and internal fixation with intramedullary nailing of subtrochanteric femoral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194818 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1126

Author(s):

Chirag G. Prajapati ◽

Rasik B. Dabhi ◽

Nikunj D. Maru

Keyword(s):

Intramedullary Nailing ◽

Femoral Fractures ◽

The Elderly ◽

High Energy ◽

High Rate ◽

Excellent Outcome ◽

Subtrochanteric Fractures ◽

Femur Fractures ◽

Subtrochanteric Femur Fractures

Background: Subtrochanteric fractures of the proximal femur have been defined as the fractures extending from lesser trochanter distally for 5 cm. These fractures usually occur in two age distributions. In the elderly osteopenic population resulting from trivial trauma as fall from standing height or in the younger ones as a result of high energy trauma. Incidence has been on the rise and they comprise about 7 to 10% hip fractures and could lead quickly to large amount of blood loss and other complications.Methods: This is a multicentric prospective prognostic study level 1 consisting of 25 patients admitted in government civil hospital, Ahmedabad during April 2013 to May 2015 having high subtrochanteric femur fractures treated by clamp assisted reduction and intramedullary nailing. Out of these, 20 patients (80%) came for final follow up with average follow up of 11.5 months and evaluated for union, complication and functional outcome.Results: In our study final outcome is assessed based on hip outcome score (modified) based on which 85% had excellent outcome, 10% had good outcome and 5% had fair outcome with none of the patient having poor outcome.Conclusions: We found that clamp-assisted reduction and intramedullary nail fixation provides excellent reduction quality, high rate of fracture union, with no apparent increase in complications in subtrochanteric fractures of the femur.

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‘Within Ring’ Concept Treatment for Displaced H-Shaped Type IVb Fragility Fractures of the Pelvis

Case Reports in Orthopedics ◽

10.1155/2021/6864910 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Yohei Yanagisawa ◽

Yusuke Eda ◽

Shotaro Teruya ◽

Hisanori Gamada ◽

Masashi Yamazaki

Keyword(s):

Pelvic Ring ◽

Pedicle Screws ◽

Fragility Fractures ◽

Clinical Results ◽

High Energy ◽

Fixation Method ◽

Case Presentation ◽

Pelvic Fixation ◽

Pelvic Ring Fractures ◽

Sacroiliac Rod Fixation

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

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Short – term outcomes of flow diverter stent (Pipeline) for treatment intracranial aneurysms

Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam ◽

10.47972/vjcts.v35i.701 ◽

2022 ◽

Vol 35 ◽

pp. 205-211

Author(s):

Hoang Van

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

High Rate ◽

Consecutive Series ◽

Parent Vessel ◽

Stent Patency ◽

Surgical Clip ◽

Flow Diverter Stent

Background: With the approval of detachable coils in 1995, endovascular treatment of intracranial aneurysms has become an alternative to surgical clip ligation. Despite the introduction of “modified” coils and advanced techniques such as stent-assisted and balloon-assisted coiling, coil embolization has major limitations because of inability to completely and permanently occlude all aneurysms. As stents were being developed for intracranial use, it was hypothesized that stents could be utilized to divert flow “away” from the aneurysm “back” into the parent vessel, and the concept of “endovascular flow diversion” was proposed. This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the ﬂow-diverter stent and follow up (1). Methods: This study was conducted in consecutive series of 23 patients. 23 procedures were performed for treating these patients in Ha Noi heart hospital from January 2019 to January 2020. 23 flow diverter stents (Pipeline) were used. Aneurysms morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3–6 months and 12 months were recorded. Results: In 23 patients (8 men, 15 women), aneurysms of internal carotid artery were mostly common (95.7%), especially in cavernous segments. 13 cases (74%) had saccular aneurysms, and 2 cases (9%) had multiple aneurysms, and only 3 cases (13%) had fusiform aneurysms. Endovascular treatment was successfully performed at rate of 100%.. Mortality and morbidity rates were 0% and 0%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 26.1% or 34.8%, respectively. Conclusions: Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications

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The fate of positive intraoperative cultures following conversion total hip arthroplasty

Hip International ◽

10.1177/1120700020936628 ◽

2020 ◽

pp. 112070002093662

Author(s):

Kyle H Cichos ◽

Maxwell Detweiler ◽

Javad Parvizi ◽

Gerald McGwin ◽

Alex R Heatherly ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Fracture ◽

High Rate ◽

Consecutive Series ◽

Total Hip ◽

Displaced Femoral Neck Fractures ◽

Irrigation And Debridement ◽

History Of

Introduction: The objectives of this study are to report the rates of positive intraoperative cultures obtained during conversion total hip arthroplasty (THA) according to index surgery, and to describe the natural history of treatment for a consecutive series of patients with unexpected positive intraoperative cultures during conversion THA. Methods: We reviewed all patients at 2 institutions undergoing conversion THA from prior open reduction and internal fixation (ORIF) of acetabular and hip fractures or hemiarthroplasty for displaced femoral neck fractures from 2011 to 2018. Intraoperative cultures were taken in 105 patients. Positive intraoperative cultures during conversion were recorded and managed with an infectious diseases consult. The outcomes including PJI at 90 days and 1 year follow-up were documented. Results: Overall, 19 of 105 patients (18%) undergoing conversion THA had positive intraoperative cultures, with the highest rates in the hemiarthroplasty 7/16 (44%) and acetabular ORIF 9/48 (19%) groups. All 19 patients were initially treated conservatively: 8 received IV antibiotics, 10 received no additional therapy, and 1 received oral antibiotics. 4/9 acetabular fracture conversions developed PJI at 1 year, with 3 requiring multiple irrigation and debridement/polyethylene exchanges to control the infection while the 4th patient required 2-stage exchange. There were no 1-year PJI from any of the other index procedures after conversion. All 7 hemiarthroplasty patients with positive cultures were treated to resolution with 4–8 weeks IV antibiotics alone. Conclusions: Patients undergoing conversion THA from prior hip or acetabular fracture have a high rate of positive intraoperative cultures. As such, all patients undergoing conversion THA from prior hip or acetabular fracture fixation should undergo thorough diagnostic workup prior to surgery, and have intraoperative cultures obtained during surgery if infection remains suspicious. Further work should be performed to develop MSIS criteria for preoperative management of patients undergoing conversion THA.

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Fracture progression in fragility fractures of the pelvis: A case report

Trauma ◽

10.1177/14604086211015065 ◽

2021 ◽

pp. 146040862110150

Author(s):

Roos HE Kolk ◽

Sverre AI Loggers ◽

Jelle P van der List ◽

Ditmar Schakenraad ◽

Linda de Nooij ◽

...

Keyword(s):

Case Report ◽

Surgical Intervention ◽

Pelvic Ring ◽

Fragility Fractures ◽

Unstable Fracture ◽

Recurrent Pain ◽

Invasive Treatment ◽

Additional Imaging ◽

Posterior Ring

Introduction Fragility fractures of the pelvis (FFP) are becoming increasingly common as our population ages. Usually treated conservatively the concept of fracture progression is little recognized but can have important consequences for the patient if missed. Case report A patient with a FFP presented with increase of pain after initial conservative treatment. Additional imaging revealed extensive fracture progression resulting in an unstable pelvic ring, requiring surgical intervention. Most FFPs are currently treated conservatively. However, initially stable FFPs can progress into more unstable fracture patterns that may require invasive treatment. Conclusion Physicians should be aware of fracture progression and concomitant posterior ring fractures in case of prolonged or recurrent pain or mobilization difficulties. Careful follow-up and awareness might help to prevent or treat debilitation in an early phase and improve outcomes.

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Prehospital Stabilization of Pelvic Dislocations: A New Strap Belt to Provide Temporary Hemodynamic Stabilization

Swiss Surgery ◽

10.1024/1023-9332.5.2.43 ◽

1999 ◽

Vol 5 (2) ◽

pp. 43-46 ◽

Cited By ~ 45

Author(s):

Vermeulen ◽

Peter ◽

Hoffmeyer ◽

Unger

Keyword(s):

Pelvic Ring ◽

High Energy ◽

Early Mortality ◽

High Rate ◽

External Fixators ◽

Early Complications ◽

External Compression ◽

Vascular Structures ◽

The Cost ◽

Accident Site

High energy pelvic fractures or dislocations are associated with a high rate of early complications, due to the associated intrapelvic organs. The high rate of early mortality is mostly due to the intrapelvic, retroperitoneal bleeding caused by the laceration of vascular structures located in the presacral area. External compression of the pelvic ring, using such devices as PASG or external fixators may prevent the intrapelvic collection of large hematomas by providing indirect tamponade. Unfortunately, these devices are either unavailable on the accident site, or the complexity of their handling is discouraging for the primary care-taker. A simple system of external pelvic compression which could be applied on the scene of trauma consisting of a pelvic strap-belt was therefore developed. The application of the device is easy, quick (30 seconds) and straightforward. Its use does not induce any known complications and requires minimal training. The cost and transportability of the system are further advantages. The system has already been used in 19 patients equipped on accident scene. Our first experiences using this device are reviewed.

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Periprosthetic Fracture following Partial Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1672204 ◽

2018 ◽

Vol 32 (10) ◽

pp. 947-952 ◽

Cited By ~ 1

Author(s):

Nicholas M. Brown ◽

Gerard Engh ◽

Kevin Fricka

Keyword(s):

Knee Arthroplasty ◽

Periprosthetic Fracture ◽

Flexion Contracture ◽

High Rate ◽

Ligament Injury ◽

Consecutive Series ◽

Complication Rates ◽

Partial Knee Arthroplasty ◽

Medial Collateral Ligament Injury

AbstractPartial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed. We identified 16 patients with early periprosthetic fracture, with an incidence of 0.6%. All of these were tibial fractures, which occurred at a mean of 35 days postoperatively. There were 5 males and 11 females, with an average age of 70 years at the time of surgery. Average follow-up was 62 months. Two patients had contralateral compartment insufficiency fractures that were successfully treated nonoperatively, five patients immediately underwent total knee arthroplasty (TKA), and nine patients underwent open reduction internal fixation (ORIF). Two of these cases had a failed ORIF and required conversion to TKA. Seven patients were successfully treated with a medial buttress plate in compression. Average Knee Society Score at final follow-up was 81, and average flexion was 115 degrees, with no patients having greater than 5-degree flexion contracture. Periprosthetic fracture following partial knee arthroplasty resulted in a high rate of conversion TKA. However, ORIF in select patients resulted in fracture healing and retention of the partial knee replacement. All patients were successfully treated with low complication rates, excellent range of motion, and acceptable knee scores at final follow-up.

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Surgical management of complex humerus head fractures

Orthopedic Reviews ◽

10.4081/or.2010.e14 ◽

2010 ◽

Vol 2 (1) ◽

pp. 14 ◽

Cited By ~ 3

Author(s):

Mohamed M.H. El-Sayed

Keyword(s):

Proximal Humerus ◽

Age Groups ◽

Osteoporotic Fractures ◽

Scoring Systems ◽

High Energy ◽

High Rate ◽

Trauma Patients ◽

Fracture Dislocations ◽

Philos Plate

The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients’ age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%). The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of polytrauma patients.

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