The Radiological and Functional Outcomes of Pelvic Fractures Treated by External Fixator

Objective: To determine the radiological and functional outcomes of pelvic fracture’s patients treated by external fixator. Methods: A case series was done at orthopaedics unit of Jinnah Postgraduate Medical Center in Karachi from January to July 2013. All patients with either gender age range from 20 to 50 years pelvic fracture of type A2 or B of less than 1 week duration were enrolled in this study. Patients were given spinal anaesthesia and the A.O external fixator was applied. Patients were followed for 3 months for final outcome. To assess the radiological outcome X-Rays pelvis AP view was done and for functional outcome was assessed in terms of severity of pain using Visual Analogue Score. The presence of acceptable radiological and functional outcome was taken as a satisfactory outcome as per operational definition. Results: Mean age of the patients was 36.39±7.89 years, duration of symptoms 3.58±1.01 days, weight 67.70±7.67Kg, Height 1.56±0.058-meter, average BMI 23.36±4.05 Kg/m2. There were 65 (67%) males and 32(33%) females. Acceptable radiological outcome was found in 89 (91.80%) patients while acceptable functional outcome was found in 76 (78.40%) patients. A satisfactory outcome was found in 73(75.30%) patients. Conclusion: Radiological and functional outcome in patients with pelvic fractures treated by external fixator was found to be acceptable in most of the patients. Keywords: Pelvic Fracture, satisfactory outcome, radiological and functional outcomes, external fixator

Download Full-text

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 ◽

10.3390/medicina57030204 ◽

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.

Download Full-text

ARTHROSCOPIC LATARJET TECHNIQUE COMBINED WITH ENDOBUTTONS: FUNCTIONAL OUTCOMES IN 26 CASES

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182605208650 ◽

2018 ◽

Vol 26 (5) ◽

pp. 328-331 ◽

Cited By ~ 2

Author(s):

Alexandre Tadeu do Nascimento ◽

Gustavo Kogake Claudio ◽

Pedro Bellei Rocha ◽

Juan Pablo Zumárraga ◽

Olavo Pires de Camargo

Keyword(s):

Shoulder Instability ◽

Functional Outcomes ◽

Short Form ◽

Case Series ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Glenohumeral Instability ◽

Duration Of Symptoms ◽

Arthroscopic Latarjet ◽

Arthroscopic Latarjet Procedure

ABSTRACT Objective: The cause of anterior shoulder instability is not fully understood and surgical management remains controversial. The objective of this study was to evaluate the results of patients undergoing arthroscopic Latarjet procedure with endobuttons. Methods: A retrospective study of 26 patients undergoing arthroscopic Latarjet procedure with endobuttons to treat anterior shoulder instability. Patients with previous glenohumeral instability, failure of Bankart procedure or Instability Severity Index Score (ISIS) greater than or equal to 6, were included. Patients were assessed by: DASH, UCLA, Rowe, Visual Analog Scale (VAS) of pain and Short-Form 36 (SF36) scores. Correct position and consolidation of the graft were evaluated. Results: Mean age was 31.5 years (16 to 46). Preoperative duration of symptoms was 1.7 years (1 month to 10 years). Mean follow-up was 14.3 (6 to 24) months. Mean postoperative scores were: 10 points in DASH; 1.6 in VAS, where 23 (88%) patients experienced mild pain and 3 (12%) moderate pain; 89 in Rowe; 32 in UCLA and 78 in SF-36. Positioning of the graft was correct in 25 (96%) cases, and was consolidated in 23 (88%). We had two cases of graft fracture (7%) and postoperative migration (7%). Conclusion: Surgical treatment using arthroscopic Latarjet with endobuttons is safe and effective, producing good functional outcomes in patients. Level of Evidence IV, Case Series.

Download Full-text

Military experience in the management of pelvic fractures from OIF/OEF

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001469 ◽

2020 ◽

pp. bmjmilitary-2020-001469

Author(s):

William Parker ◽

R W Despain ◽

J Bailey ◽

E Elster ◽

C J Rodriguez ◽

...

Keyword(s):

Lower Extremity ◽

Pelvic Fracture ◽

External Fixator ◽

Injury Severity ◽

Fracture Pattern ◽

Injury Pattern ◽

Pelvic Fractures ◽

Vertical Shear ◽

Treatment Modalities ◽

Pelvic Binder

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.MethodsWe conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.ResultsOf 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.ConclusionsPelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

Download Full-text

Association of Acute Inflammatory Cytokines, Fracture Malreduction, and Functional Outcome 12 Months After Intra-articular Ankle Fracture – A Prospective Cohort Study of 46 Patients with Ankle Fractures

10.21203/rs.3.rs-129841/v1 ◽

2020 ◽

Author(s):

That Minh Pham

Keyword(s):

Cohort Study ◽

Functional Outcome ◽

Inflammatory Cytokines ◽

Functional Outcomes ◽

Joint Space Narrowing ◽

Weight Bearing ◽

Joint Space ◽

X Rays ◽

Ankle Surgery ◽

Cytokine Levels

Abstract Background Several malreduction criteria have been proposed for ankle surgery, but the criteria of most importance for functional outcome remain undetermined. Furthermore, the acute inflammatory response in the ankle joint after fracture is hypothesized to result in osteoarthritis development, but no study has investigated the correlation between the levels of these inflammatory cytokines and post-surgical functional outcomes. We aimed to identify malreduction criteria and inflammatory cytokines associated with functional outcome after ankle surgery.MethodsDuring surgery, synovial fluid from the fractured and healthy contralateral ankles of 46 patients was collected for chemiluminescence analysis of 22 inflammatory cytokines and metabolic proteins. The quality of fracture reduction was based on 9 criteria on plain X-rays and 5 criteria on weight-bearing computed tomography (WBCT) scans. After 3 and 12 months, we recorded scores on American Orthopedic Foot and Ankle Society (AOFAS) scale, the Danish version of Foot Function Index (FFI-DK), EQ-5D-5L index score, the Kellgren Lawrence score, and joint space narrowing. ResultsTibiofibular (TF) overlap (p=0.02) and dime sign (p=0.008) correlated with FFI-DK. Tibiotalar tilt correlated positively with joint space narrowing at 3 months (p=0.01) and 12 months (p=0.03). TF widening correlated with FFI-DK (p=0.04), AOFAS (p=0.02), and EQ-5D-5L (p=0.02). No consistent correlations between synovial cytokine levels and functional outcomes were found at 12 months.ConclusionsMalreduction of TF overlap, TF widening, and tibiotalar tilt were the most important criteria for functional outcome after ankle surgery. Increased inflammatory cytokine levels after fracture did not affect functional outcome at 12 months.Trial registration: This cohort study is registered the 10th of December 2018 at ClinicalTrials.gov (NCT03769909, https://clinicaltrials.gov/ct2/show/NCT03769909), was approved by the local committee on health ethics (The Regional Committees on Health Research Ethics for Southern Denmark: J.No. S-20170139), and was reported to the National Danish Data Protection Agency (17/28505).

Download Full-text

Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221501140 ◽

2012 ◽

Vol 94 (2) ◽

pp. 112-115 ◽

Cited By ~ 9

Author(s):

D Marsland ◽

AP Sanghrajka ◽

B Goldie

Keyword(s):

External Fixation ◽

External Fixator ◽

Case Series ◽

X Rays ◽

Site Infection ◽

Study Support ◽

Pin Site ◽

The Mean ◽

Joint Incongruity ◽

Mean Time

INTRODUCTION Rolando fractures are often difficult to manage because of their inherent instability. We describe a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, two-pin external fixator spanning the trapeziometacarpal joint, and present the results of a single-surgeon case series. METHODS Eight consecutive patients (mean age: 32.8 years) with Rolando fractures were treated using a Hoffmann II® Micro small bone external fixator using blunt ended 2.0mm half pins, inserted into the trapezium and diaphysis of the first metacarpal. Functional outcome was assessed with the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at a mean time of 2.7 years following the fracture (range: 4 months – 6.0 years). The mean time to frame removal was 28 days. RESULTS There were three cases of superficial pin site infection. Follow-up x-rays at four months did not demonstrate significant joint incongruity or malunion in any case. The mean QuickDASH score was 7.95 and all patients returned to their previous levels of activity. CONCLUSIONS Although external fixation risks pin site infection, the results of this study support the use of spanning trapeziometacarpal external fixation for Rolando fractures as it reliably gives excellent functional outcomes.

Download Full-text

Open Pelvic Fractures: Review of 30 Cases

The Open Orthopaedics Journal ◽

10.2174/1874325001610010772 ◽

2016 ◽

Vol 10 (1) ◽

pp. 772-778 ◽

Cited By ~ 13

Author(s):

Vincenzo Giordano ◽

Hilton Augusto Koch ◽

Savino Gasparini ◽

Felipe Serrão de Souza ◽

Pedro José Labronici ◽

...

Keyword(s):

Pelvic Fracture ◽

Significant Relationship ◽

Trauma Center ◽

Outpatient Visit ◽

Statistical Significance ◽

Pelvic Fractures ◽

Classification Systems ◽

Satisfactory Outcome ◽

Level 1 ◽

Level 1 Trauma Center

Background: Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval. Patients and Methods: In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%. Results: Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the last outpatient visit, the Faringer classification showed statistical significance on the need of colostomy (p = 0.001) in the acute phase of treatment. Conclusion: We suggest the routine use of the Jones classification for the emergency room assessment and management of all open fractures of the pelvic ring. We believe the Faringer classification seems to be useful for the abdominal surgeons for the indication of gut transit derivation but not for the acute management of the bony component of an open pelvic fracture.

Download Full-text

Association of acute inflammatory cytokines, fracture malreduction, and functional outcome 12 months after intra-articular ankle fracture—a prospective cohort study of 46 patients with ankle fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02473-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

That Minh Pham ◽

Emil Bjoertomt Kristiansen ◽

Lars Henrik Frich ◽

Kate Lykke Lambertsen ◽

Søren Overgaard ◽

...

Keyword(s):

Cohort Study ◽

Functional Outcome ◽

Inflammatory Cytokines ◽

Functional Outcomes ◽

Joint Space Narrowing ◽

Joint Space ◽

X Rays ◽

Link Type ◽

Ankle Surgery ◽

Cytokine Levels

Abstract Background Several malreduction criteria have been proposed for ankle surgery, but the criteria of most importance for functional outcome remain undetermined. Furthermore, the acute inflammatory response in the ankle joint after fracture is hypothesized to result in osteoarthritis development, but no study has investigated the correlation between the levels of these inflammatory cytokines and post-surgical functional outcomes. We aimed to identify malreduction criteria and inflammatory cytokines associated with functional outcome after ankle surgery. Methods During surgery, synovial fluid from the fractured and healthy contralateral ankles of 46 patients was collected for chemiluminescence analysis of 22 inflammatory cytokines and metabolic proteins. The quality of fracture reduction was based on 9 criteria on plain X-rays and 5 criteria on weight-bearing computed tomography (WBCT) scans. After 3 and 12 months, we recorded scores on American Orthopedic Foot and Ankle Society (AOFAS) scale, the Danish version of Foot Function Index (FFI-DK), EQ-5D-5L index score, the Kellgren-Lawrence score, and joint space narrowing. Results Tibiofibular (TF) overlap (p = 0.02) and dime sign (p = 0.008) correlated with FFI-DK. Tibiotalar tilt correlated positively with joint space narrowing at 3 months (p = 0.01) and 12 months (p = 0.03). TF widening correlated with FFI-DK (p = 0.04), AOFAS (p = 0.02), and EQ-5D-5L (p = 0.02). No consistent correlations between synovial cytokine levels and functional outcomes were found at 12 months. Conclusions Malreduction of TF overlap, TF widening, and tibiotalar tilt were the most important criteria for functional outcome after ankle surgery. Increased inflammatory cytokine levels after fracture did not affect functional outcome at 12 months. Trial registration This cohort study is registered the 10th of December 2018 at ClinicalTrials.gov (NCT03769909), was approved by the local committee on health ethics (The Regional Committees on Health Research Ethics for Southern Denmark: J.No. S-20170139), and was reported to the National Danish Data Protection Agency (17/28505).

Download Full-text

A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194821 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1150

Author(s):

Parag M. Tank ◽

Yash S. Shah ◽

Rutvik D. Dave ◽

Vijay J. Patel

Keyword(s):

Functional Outcome ◽

Intramedullary Nailing ◽

Functional Outcomes ◽

Bone Fractures ◽

Case Series ◽

Functional Results ◽

Dash Score ◽

Retrospective Case ◽

Non Union ◽

Case Series Study

Background: The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.Methods: This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.Results: Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.Conclusions: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

Download Full-text

CURRENT MANAGEMENT OF JERSEY FINGER IN RUGBY PLAYERS: CASE SERIES AND LITERATURE REVIEW

Hand Surgery ◽

10.1142/s0218810410004710 ◽

2010 ◽

Vol 15 (02) ◽

pp. 103-107 ◽

Cited By ~ 10

Author(s):

A. Goodson ◽

M. Morgan ◽

G. Rajeswaran ◽

J. Lee ◽

E. Katsarma

Keyword(s):

Functional Outcome ◽

Case Series ◽

Positive Outcome ◽

Flexor Digitorum Profundus ◽

Type I ◽

Tendon Lengthening ◽

Satisfactory Outcome ◽

Rugby Players ◽

Jersey Finger

We discuss a combination of established and modern techniques in the investigation and management of traumatic flexor digitorum profundus rupture ('Rugger Jersey Finger') in seven cases (male rugby players ranging from 15 to 30 years of age; mean = 26). We discuss the use of X-ray and ultrasound investigation followed by various surgical repairs including intraosseous sutures, suture anchors, tendon lengthening and "pull-through suture over button" repairs. Functional outcome at outpatient follow-up is discussed in each case. Type I, II and Vb injuries were identified. Patients presenting early attained good functional outcome. Six patients received surgery within ten days of injury and attained satisfactory outcome at follow-up. One patient presented late and required a tendon lengthening procedure to manage myostatic contracture. Ultrasound imaging proved valuable in diagnosis and pre-operative planning. Numerous surgical repairs were used and all associated with a positive outcome providing there is adequate patient compliance.

Download Full-text

Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures

World Journal of Surgery ◽

10.1007/s00268-021-06386-9 ◽

2022 ◽

Author(s):

Chih-Yang Lai ◽

Po-Ju Lai ◽

I-Chuan Tseng ◽

Chun-Yi Su ◽

Yung-Heng Hsu ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Pelvic Fracture ◽

Functional Outcomes ◽

Injury Severity ◽

Multiple Logistic Regression Analysis ◽

Pelvic Fractures ◽

New Injury Severity Score ◽

Management Protocol ◽

Diverting Colostomy

Abstract Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.

Download Full-text