scholarly journals A Study on Mode of Injury, Types of Fractures and Associated Trauma in Unstable Pelvic Fractures

2020 ◽  
pp. 86-91
Author(s):  
A. R. Arshad ◽  
M. R. Rajashekar ◽  
. Srinivasan
Keyword(s):  
Soft Tissue Injuries ◽  
Pelvic Fractures ◽  
External Fixators ◽  
Type B ◽  
Tile Type ◽  
Early Mobility ◽  
Surgical Interventions ◽  
Pelvic Injuries ◽  
Anatomic Reduction ◽  
Excellent Stability

Aim: The present study was aimed to analyze the mode of injury, different type of fractures and associated injuries in patients with unstable pelvic fractures who are later managed by surgical interventions. Materials and Methods: The study involved 21 cases of unstable pelvic injuries (Tile type B and C) managed surgically patients. Results: The result showed that out of 21 patients, 6 patients (28.6%) had associated skeletal and/or soft tissue injuries. Of which 9.4% (n=2) patients had nerve injury. Despite aggressive resuscitation including application of external fixators, the mortality of 10-20% remain unchanged. Conclusion: Anatomic reduction and internal fixation of unstable pelvic injuries gives excellent stability, allows for early mobility with good functional outcome.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

2021 ◽  
Vol 19 (3) ◽  
pp. 47-54
Author(s):  
A. F. LAZAREV ◽  
◽  
E. I. SOLOD ◽  
YA. G. GUDUSHAURI ◽  
E. I. KALININ ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Ring ◽  
Metal Structure ◽  
Complex Problem ◽  
Long Term Results ◽  
Fixation Method ◽  
Surgical Interventions ◽  
Anterior Section ◽  
Pelvic Injuries ◽  
Study Results

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

scholarly journals HYBRID INTERVENTIONS IN EMERGENCY ANGIOSURGERY

2021 ◽  
Vol 29 (2) ◽  
pp. 250-256
Author(s):  
S.V. Mshar ◽  
◽  
V.N. Zasimovich ◽  
V.A. Asanovich ◽  
E.Ya. Nikolenko ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Perioperative Complications ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Primary Patency ◽  
Complete Revascularization ◽  
Type B ◽  
Hybrid Surgery ◽  
Surgical Interventions ◽  
Results Of Treatment

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

Trauma

2020 ◽  
pp. 151-282
Author(s):  
Ian Greaves ◽  
Keith Porter
Keyword(s):  
Soft Tissue Injuries ◽  
Neck Injuries ◽  
Chest Injuries ◽  
Traumatic Cardiac Arrest ◽  
Joint Injuries ◽  
Pelvic Injuries ◽  
Assessment And Treatment ◽  
Secondary Survey ◽  
Animal Bites ◽  
Time Critical

This chapter starts with assessment and treatment of the time-critical trauma patient. It describes the primary survey in detail, with clear highlighted sections on areas of express concern or danger. The ‘two Hs’ and ‘two Ts’ of traumatic cardiac arrest are fully covered. The secondary survey is outlined, before moving on to specific forms of trauma and management. Head and neck injuries, maxillofacial injuries, chest injuries, abdominal and genitourinary trauma, bone and joint injuries are all covered, including causes, treatment, and potential problems. Regional injuries are then covered, including the upper limb, the wrist, finger fractures, pelvic injuries, and the lower limb. Complications of fractures are explained. Soft tissue injuries are also covered by region. Human and animal bites and tetanus-prone wounds, spinal injuries, amputation, blast and gunshot injuries, burns, and inhalation injuries are also explained.

scholarly journals Fractures of The Tibial Plafond: Does the Presence or Absence of a Fibular Fracture Predict Future Morbidity?

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Henry Boateng ◽  
Chinenye Nwachuku ◽  
Kempland C. Walley ◽  
Justin W. Walker ◽  
Rhett MacNeille ◽  
...  
Keyword(s):  
Outcome Measurement ◽  
Statistical Significance ◽  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Type B ◽  
Inclusion Criteria ◽  
Patient Counselling ◽  
Anatomic Reduction ◽  
Type C ◽  
Pilon Fractures

Category: Trauma Introduction/Purpose: Surgical management pilon fractures continue to be a challenge for orthopedic surgeons. Despite a staged protocol, anatomic reduction, and stable fixation, many patients will require secondary procedures including ankle arthrodesis to treat painful post-traumatic arthritis. Some investigators have correlated the absorbed energy at the time of the injury with the natural history of the pilon fracture despite the quality of the surgical reconstruction. We hypothesize that the presence of an intact fibula in association with an OTA Type C pilon fracture may be a marker for a strict axial compression mechanism resulting in more severe cartilage compression and a poor late outcome. No studies to date have correlated the presence of an intact fibula to pilon fracture outcome. Methods: An IRB approved 7-year retrospective study was performed at three Level I Trauma Centers. Inclusion criteria included all adult patents (=18) with isolated OTA type B or C pilon fractures from 2008 through 2014. All patients were treated in a staged fashion with initial external fixation by fellowship-trained orthopedic traumatologists. The primary outcome measurement was ankle arthrodesis. Secondary measurements included infection. Binary logistic regression models were used to evaluate prognostic factors of arthrodesis and infection. A total of 239 patients met inclusion criteria for a complete case analysis. Results: It was found that OTA Type C pilon fractures (OR (95% CI): 6.34 (0.80, 49.98), p=0.08), intact fibulas (OR (95% CI): 1.39 (0.43, 4.53), p=0.58), and open injuries (OR (95% CI): 2.19 (0.56, 8.55), p=0.26) were more likely to result in eventual arthrodesis compared to OTA Type B pilon fractures, fractured fibulas, and closed injuries, respectively. However, none of these unadjusted bivariate associations were statistically significant. An intact fibula was significantly less likely to result in infection compared to having a fractured fibula (OR (95% CI): 0.26 (0.08, 0.90), p=0.03), however this effect was no longer significant after accounting for open versus closed injury status (Adjusted OR (95% CI): 0.35 (0.10, 1.26), p=0.11). Conclusion: The results of this study suggest an adverse relationship for closed complex pilon fractures with an intact fibula. This was especially pronounced in C type injuries in comparison to type B injuries with a 6.34 odds ratio of subsequent fusion. The data approached statistical significance and may have clinical relevance in the decision making and patient counselling for managing these fractures. Pilon fractures historically have had poor outcomes and a higher rate of secondary surgeries which was surprisingly low in our current study. Further study needs to determine if this observation correlates with improved patient outcomes.

scholarly journals Efficacy of Various Arrangements of Pelvic External Rod Fixators in Polytraumatized Patients at Resuscitation Step

2014 ◽  
Vol 21 (1) ◽  
pp. 12-18
Author(s):  
P. A Ivanov ◽  
N. N Zadneprovskiy
Keyword(s):  
Comparative Analysis ◽  
External Fixation ◽  
Pelvic Fractures ◽  
External Fixators ◽  
High Efficacy ◽  
Fixation Technique ◽  
Pelvic Fixation ◽  
Fixation Methods ◽  
Advantages And Disadvantages ◽  
Fixation Techniques

Application of external fixators (EF) in pelvic fractures is one of the important components of antishock therapy in patients with polytrauma. However various fixation techniques possess certain advantages and disadvantages. Comparative analysis of 4 most commonly used variants of pelvic EF mounting, i.e. classic - via upper flaring portion of the ilium, supra-acetabular, orthogonal - combination of screws passes through the wings and supra-acetabular region, and subcristal, that were applied in 32, 48, 13 and 3 patients, was performed. Results of the analysis showed that supra-acetabular pelvic fixation technique a preferable one due to its high efficacy and lower rate of complications as compared to other external fixation methods.

scholarly journals Non-Traumatic Tile Type B3 Pelvic Fracture Combined With Garden Type III Femoral Neck Fracture Caused By Hypocalcaemia-Induced Convulsions

2021 ◽  
Author(s):  
Minghan Dou ◽  
Guangkai Ren ◽  
Baoming Yuan ◽  
Chuangang Peng ◽  
Dankai Wu
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Pelvic Fracture ◽  
Pelvic Fractures ◽  
Maintenance Hemodialysis ◽  
Tile Type ◽  
Conventional Radiograph ◽  
Type Iii ◽  
Neck Fracture

Abstract BACKGROUND Non-traumatic fractures caused by convulsions are relatively rare and are often overlooked due to the lack of obvious evidence of injury. Non-traumatic fractures due to convulsions are diverse, but the concomitant of pelvic and femoral fractures has not been reported previously. CASE SUMMARY A 47-year-old woman with a no significant medical history, was taken to the nearest hospital after one episode of generalized tonic-clonic seizure that had occurred during sleep. After the postictal phase, the patient regained consciousness and experienced diffuse pain in the inguinal regions bilaterally with inability to stand or walk. The entire attack was witnessed by the family members who confirmed that there was not external trauma. Blood investigations revealed high creatinine and uric acid levels, along with a low calcium level. Conventional radiograph of the pelvis was performed to detect the cause of pain. The patient was noted to have a pelvic fracture and unilateral fracture of the neck of the femur. She was then transferred to our hospital for further management. The patient was diagnosed as having Tile type B3 pelvic fractures combined with a Garden type III femoral neck fracture on three-dimensional computed tomography (3D-CT). In view of her blood results, nephrology consultation was sought. The patient was identified as having a stage 5 chronic kidney disease (CKD), hypocalcemia, and hyperphosphatemia. However, neurological examination showed no abnormalities. No surgical intervention was adopted for her pelvic fractures. In addition to complete bed rest, closed reduction and percutaneous cannulated screw fixation was performed for the treatment of the right femoral neck fracture. An arteriovenous fistula was created for maintenance hemodialysis on the tenth postoperative day. At follow-up, twelve months follow-up after the operation, the patient had a normally gait and was satisfied with the outcome. CONCLUSION Patients who present with convulsive seizures especially patients with ion metabolism disorder should be examined thoroughly to ensure that no injury is missed.

scholarly journals Characteristics of Patients with Pelvis injury in General Hospital of Haji Adam Malik Medan

2020 ◽  
Vol 13 (2) ◽  
pp. 103-109
Author(s):  
Irfan Ritonga ◽  
Chairiandi Siregar
Keyword(s):  
High School ◽  
General Hospital ◽  
Medical Record ◽  
Demographic Data ◽  
Secondary Data ◽  
Pelvic Injury ◽  
Common Mechanism ◽  
Tile Type ◽  
Distribution Diagram ◽  
Pelvic Injuries

Objective- Fractures and injuries to the pelvic ringmay be associated with severe trauma and other associated injuries. This study aims to determine the characteristics of patients with pelvic injury in Adam Malik Haji General Hospital Medan. Material and Method-The type of research conducted is a retrospective descriptive research method. This study was conducted in Medan Haji Adam Malik Hospital based on medical records of traumatic pelvic injury patients during the period of January 2016 - December 2017. The data used is secondary data taken from the records in the patient's medical record. The collected medical and demographic data is tabulated and presented in the form of a frequency distribution diagram or table and analyzed descriptively using total sampling. Results- During the period of research found from the medical record data of Medan Haji Adam Malik Hospital, there were 59 subjects with women as many as 18 subjects (30.5%) and 41 people (69.5%). . From the data collected, it was found that patients with a kindergarten background of 2 (16.9%), SD as many as 10 (16.9%) people, SMP as many as 8 (13.6%) people, high school as many as 25 (42, 4%) people, 10 (16.9%) people, and 4 (6.8%) people who don't go to school. Patients with tile type A1 total 12 patients (20.3%), tile type A2 as many as 18 people (30.5%), tile type B1 as many as 10 (16.9%), type tile B2 as many as 9 people (15.3 %), C1 tile type as many as 6 people (10.2%), C2 tile type as much as 1 (1.7%), and C3 tile type as much as 1 (1.7%). Patients with APC 1 compression type as many as 7 (11.9%) people, APC 2 as many as 13 (22%) people, APC 3 as many as 3 (5.1%) people, LC1 as many as 21 (35.6%) people, LC2 11 (18.6%) people, LC3 as many as 1 (1.7%) people, undefined as many as 2 (3.4%) people, and VS as many as 1 (1.7%) people. Conclusion- Patients who experience pelvic injuries are mostly male with an age range of 4-80 years. In terms of level of education, most patients are at the level of high school education. The most common mechanism of injury in pelvic injuries is lateral compression. The most common for tile classification is A2. Other most frequent injuries are lower limb fractures and the most common treatment for pelvic injuries are conservatives treatment.

Primary Surgical Care of Pelvic Fractures Associated to a Perineal Laceration

Swiss Surgery ◽  
1999 ◽  
Vol 5 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Michel ◽  
Peter ◽  
Roche ◽  
Vermeulen ◽  
Morel
Keyword(s):  
Surgical Care ◽  
Pelvic Fractures ◽  
Prise En Charge ◽  
Perineal Laceration ◽  
Type B ◽  
Revue De La Littérature

Les fractures instables de l'anneau pelvien, associées à des dilacérations périnéales sont des lésions très graves, toujours observées dans le cadre d'un traumatisme à haute énergie. Des taux de complications et de mortalité élevés ont été rapportés en association avec ces lésions. L'attitude thérapeutique adéquate est décrite, basée sur une revue de la littérature actuelle et sur notre propre expérience. 55 Fractures instables de type B et C de l'anneau pelvien ont été traitées par ostéosynthèse dans notre institution entre 1991 et 1997. 20% de ces patients (11 cas) présentaient une lacération périnéale associée. Simultanément à l'ostéosynthèse initiale, une colostomie de dérivation a été pratiquée immédiatement, durant le même temps opératoire, chez ces 11 patients, suivis de débridements itératifs de plaie et d'une antibioprophylaxie. Dix patients sur ces 11 ont survécu (91%) et évolué vers la consolidation de pelvis sans complication infectieuse locale. Un patient est décédé de complications septiques pelviennes 3 semaines après l'accident. Une prise en charge chirurgicale agressive, d'emblée multidisciplinaire, s'impose en cas de fracture-luxation pelvienne ouverte. Une colostomie immédiate, suivie de débridements de plaie itératifs doivent toujours être associés à l'ostéosynthèse initiale.

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