The diagnostic and management challenge for concomitant fragility fractures of pelvis and hip - a Case series with literature review.

BACKGROUND: Fragility fractures of hip and pelvis in the elderly population are common. They do co-exist but are frequently missed and undertreated. METHODS AND RESULTS: 3 cases of concomitant fragility fractures of hip and pelvis were identified. Hip fractures were treated with cemented hemiarthroplasty or cephalomedullary nail fixation, while pelvic fractures were treated with percutaneous screw fixation in same general anesthesia session. Anti-osteoporotic treatments were offered. Subjects were followed up for 1 year. CONCLUSION: Surgical treatment of fragility hip and pelvic fractures improves fracture stability, achieves better pain relief and allows earlier mobilization. Anti-osteoporotic treatment is essential as secondary prevention in fragility fractures.

Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis.

BACKGROUND: Three-dimensional (3D)-guided navigation percutaneous screw fixation of pelvi-acetabular fractures has been reported in patients with high-energy trauma. Its use in fragility fractures of the pelvis is expanding and its results are promising. METHODS: We report a series of 17 consecutive patients with fragility fractures of the pelvis treated with 3D-guided navigation percutaneous screw fixation from 2016 to 2017. Percutaneous screw trajectories were planned preoperatively for the majority of patients. Closed reduction was performed prior to fixation in grossly displaced fractures. RESULTS: The mean time to surgery was 8.6 ± 2.4 days, and the mean intraoperative blood loss was 94.1 ± 26.6 mL. One early surgical complication occurred involving an infected pelvic external fixator iliac pin track site, and there were no cases of neurological deficits after fixation. In total, 7 of the 14 patients had screw backout, and the mean backout distance was 8.3 ± 4.4 mm. Cortical perforation was seen in one patient involving an anterior column screw by 5.7 mm; 14 patients were followed up for a mean of 18.7 ± 2.8 months; 13 patients achieved complete fracture union, and 1 patient had a fracture non-union. Premorbid ambulatory function was restored in 8 of the 14 patients. The mean visual analogue scale for pain severity at follow-up was 0.36 ± 0.50. There were no cases of 30-day and 1-year mortality. CONCLUSION: 3D-guided navigation percutaneous screw fixation is a safe, precise, and effective surgical technique for managing fragility fractures of the pelvis.

Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma centre.

BACKGROUND: Navigation assisted minimally invasive percutaneous screw fixation (MIS) for pelvi-acetabular fracture was recently advocated. METHODS: We report 38 consecutive cases of pelvi-acetabular fractures treated with 3D navigation-guided MIS from 2015 to 2016. Ohe hundred and forty-three screws were inserted (59 sacroiliac, 45 retrograde anterior column, 34 supra-acetabular, three antegrade posterior-column and two subcristal). Navigation planning was mainly performed pre-operatively. RESULTS: The mean operative blood loss and time was 179 ml and 141 mins, respectively. The distance (deviation) between the planned and executed screw entry and tip measured by the navigation computer were 1.91 and 1.94 mm, respectively. There were no immediate or early surgical complications. Patients were followed for at least 6 month; 79% had fracture healing at 4.3 months on average, and 53% walked unaided by the six month follow-up. The average visual analogue scale for pain was 2.69. CONCLUSION: We believe 3D navigation-guided MIS is a safe and effective surgical alternative in most pelvi-acetabular fractures.

Radiofrequency ablation for hepatocellular carcinoma: a survival analysis of 117 patients.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world especially in Asia. Radiofrequency ablation is now commonly use as either first line or in combination with other treatment modality for patients with HCC. It is the objective of this article to report our experience in a tertiary referral hospital. METHODS: Patients who diagnosed with HCC and underwent RFA in Queen Elizabeth Hospital during the period from May 2002 to February 2009 were included and analyzed. RESULTS: During this period, 138 sessions of RFA were performed in 117 consecutive patients with HCC. The calculated rate of primary (single attempt) successful ablation during this entire period was 89.2%. The in-hospital/30-day mortality rate was zero, and morbidity was 24.1%. Hospital stays were significantly longer in the open group (4.4 days versus 8.9 days, P = 0.000). Median follow-up in this study was 21 months. 11 (9.4%), 10 (8.5%) and 49 (41.0%) patients developed local tumor progression (LTP), systemic recurrence and Intrahepatic distant recurrence (IDR), respectively. The mean and median times to recurrence were 15.4 and 11 months, respectively. Most patients (91%) with LTP developed in the first 24 months. Disease-free survival was 65% at 1 year, 40% at 3 years and 25% at 5 years. Overall survival at 1, 3 and 5 years was 85, 66 and 40%, respectively. Alpha fetoprotein, aFP > 1,000 ng/ml and multiple tumor ablation predicted increased risk of recurrence. CONCLUSION: Radiofrequecy ablation is useful tool in treating patients with HCC with high successful rate. However, intrahepatic recurrence is common and a well designed post ablation follow up protocol based on a sound knowledge of recurrence pattern is vital.