Minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws connected to a transverse rod.

PURPOSE: The goal was to evaluate the clinical outcomes, quality of reduction and complications of pelvic fractures treated by minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws connected to a transverse rod. METHODS: Retrospective analysis of prospectively collected data in a consecutive patient series with pelvic fractures treated by minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws between January 2010 and January 2016. The functional outcomes evaluated by Majeed scores, and fracture reduction results were evaluated using the Tornetta and Matta standard. As well as recording the duration of the surgical procedure, intraoperative blood loss, the times of intra-operative fluoroscopy and complications. RESULTS: A total of 29 patients (15 men and 14 women; age range, 21-72 years; mean, 40.8 years) could be followed-up after an average of 38.2 ± 21.3 months (range, 12-84 months). According to the AO/OTA classification, there were 24 patients with B2 injury and five patients with C1 injury of the pelvic ring. For the sacral fractures, according to Denis classification, four cases were zone I fractures and 25 cases were zone II fractures. The duration of the surgical procedure, intra-operative blood loss and the times of intra-operative fluoroscopic of the posterior-ring surgical procedure was 28.2 ± 4.6 minutes (range, 20-38 minutes), 46.7 ± 4.9 ml (range, 39-56 ml), and 13.1 ± 1.6 seconds (range, 10-17 seconds) respectively. Posterior-ring fracture reduction was excellent in 11 patients and 15 were good, three cases were fair; the excellent and good rate was 89.7% (26/29). At the final follow-up, the function result was rated as excellent in ten cases, good in 16, fair in three, and poor in zero cases; the excellent and good rate was 89.7% (26/29). There was no incision infection, intra-operative neurovascular injury, pedicle screw loose or breakage, and non-union of the posterior arch did not occur. Two patients requested removal of the fixator: one patient with breakage of the anterior pelvic ring internal fixator, and the pedicle screw was also taken out in the same operative session; another one with moderate pain on the posterior pelvic ring. CONCLUSIONS: Minimally invasive stabilisation of posterior-pelvic-ring instabilities with pedicle screw connected to a transverse rod may be a good alternative to sacroiliac screw fixation because it is quick, safe and associated with a good functional outcome; thus being a useful option in patients who do not qualify for sacroiliac screw fixation.

The Effect of Integrity of Lateral Wall on the Quality of Reduction and Outcomes in Elderly Patients with Intertrochanteric Fracture: A Controlled Study.

OBJECTIVE: The study is aimed at evaluating the effect of the integrity of lateral wall on the quality of reduction and outcome in intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA). METHODS: Medical record systems for elderly patients with intertrochanteric fracture treated with PFNA were included. The patients were divided into incompetent and intact lateral wall groups. Patients' baseline characteristics, quality of reduction, and Harris Hip scores (HHS) were collected. RESULTS: The study included 115 patients with intertrochanteric fractures, with 59 in the incompetent lateral wall group and 56 in the intact group. Lateral wall thickness was 16.47 ± 2.46 mm and 23.68 ± 1.59 mm in the incompetent group and intact group (t = -18.766, P < 0.001), respectively. There was no significant difference in the quality of reduction (P = 0.646) between intact and incompetent groups. Mean HHS at final follow-up were 83.02 ± 13.89 in the incompetent group and 86.04 ± 3.39 in the intact group, with no significant difference (P = 0.123). In addition, there was no significant difference in weight-bearing or clinical healing between intact and incompetent groups. The partial weight-bearing with crutches was allowed at 2.71 ± 0.93 and 2.66 ± 1.01 weeks after the operation in the incompetent and intact groups. Time to clinical healing was 5.83 ± 0.99 and 6.00 ± 0.92 months in the incompetent and intact groups, respectively. However, the operative time in the incompetent group (58.54 ± 18.14 mins) were longer than that in the intact group (51.79 ± 17.77 mins). CONCLUSIONS: In conclusion, it seems that lateral wall thickness does not affect the quality of reduction and outcome in patients with intertrochanteric fracture receiving PFNA.

Feasibility of anterior pelvic ring fixation alone for treating lateral compression type 1 pelvic fractures with nondisplaced complete sacral fractures: a retrospective study.

PURPOSE: The aim of this study was to evaluate the feasibility of anterior pelvic ring fixation alone for treating lateral compression type 1 (LC-1) fractures with nondisplaced complete sacral fractures. METHODS: Patients with LC-1 type pelvic fractures with nondisplaced complete sacral fractures in the Xi'an Honghui Hospital were screened. Those who underwent surgical treatment for the anterior pelvic ring fractures and conservative treatment for the sacral factures were included in the analysis. The Majeed and Short Form-12 (SF-12) functional scores were used to evaluate these patients. RESULTS: Of the 123 patients enrolled, 108 (88%) responded to our enquiries regarding the outcome. The mean follow-up period was 18.37 months for the 108 patients who responded. The mean SF-12 functional score was 48.22 ± 9.68. The mean Majeed score was 83.47 ± 9.23, including 52 with excellent, 47 with good, seven with fair, two with poor outcomes. The SF-12 functional and Majeed scores were significantly higher in those aged <45 years or without lower limb injury than in those aged ≥45 years or with lower limb injury (P < 0.05). CONCLUSION: Acceptable functional outcomes can be obtained for LC-1 pelvic fractures with nondisplaced complete sacral fractures by using anterior pelvic ring fixation alone.

Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study.

PURPOSE: The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. METHODS: The clinical data of patients with femoral neck fractures treated at Xi'an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. RESULTS: The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. CONCLUSIONS: The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.

A retrospective pilot study of high-quality nursing care for cervical cancer.

This retrospective pilot study investigated the feasible effect of high-quality nursing care (HQNC) for patients with cervical cancer (CC). A total of 58 patients with CC were included in this study. All patients were treated with routine care, and were divided into a treatment group and a control group, according to the different interventions they received. In addition, patients in the treatment group also received HQNC. The primary outcome of anxiety was measured by Beck Anxiety Inventory (BAI). The secondary outcomes were rumination, as measured by ruminative responses scale (RRS); and emotion, as measured by the Emotion Regulation Questionnaire (ERQ). All outcomes were measured before and after 4-week treatment. After treatment, patients in the treatment group showed better outcomes in anxiety, as evaluated by BAI scale (minimal, P = .04), rumination, as measured by RRS (P < .01), and emotion, as assessed by ERQ (P < .01), compared with patients in the control group. The results of this study demonstrated that HQNC might have positive effect in patients with CC after 4-week treatment.

Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures.

PURPOSE: To determine perioperative incidence and locations of deep vein thrombosis (DVT) in injured and uninjured lower extremities following isolated lower extremity fractures (ILEFs). METHODS: Retrospective analysis of a prospectively collected data of a consecutive patient series with ILEFs who underwent surgical treatment between September 2014 and September 2017 was performed. Patients' bilateral lower extremities were screened for DVT with duplex ultrasonography (DUS) before and after surgery. DVT occurrence was analyzed by location of DVT and fracture site. All patients received pharmacologic thromboprophylaxis while hospitalized. Data on demographics, time to surgery, time of DUS examinations, length of hospital stay and symptomatic pulmonary embolism (PE) was collected. RESULTS: 1825 patients were included in the study. The incidence of symptomatic PE was 1.6%. All patients were screened with DUS of the bilateral lower extremities in a mean of 3.5 days (range: 0-18 days) after injury, and a mean of 3.6 days (range: 1-11 days) after surgery. Preoperative DUS detected DVT in 547 patients (30.0%), including 3.7% of patients with proximal DVT. 792 patients (43.4%) were found to have a DVT postoperatively, but only 6.2% of patients with proximal DVT. Proximal DVT was detected postoperatively of the represented fractures: 6.5% of the hip, 14.5% of the femoral shaft, 4.5% of the tibial plateau, 4.6% of the tibial shaft, 1.7% of the patellar, and 2.0% of the peri-ankle. Interestingly, the rate of DVT in an uninjured lower limb was significantly higher postoperatively compared to preoperatively (16.4% vs. 4.9%), however, only 0.2% of patients had proximal DVT. CONCLUSIONS: While the perioperative incidence of overall DVT is high following ILEFs, the majority were distal DVT, and the rate of symptomatic PE was low. Femoral shaft fractures were associated with the highest incidence for proximal DVT. The incidence was lower in more distal fractures. The majority of patients diagnosed with DVT postoperatively had already shown symptoms of DVT prior to surgery. DVT can occur in both the injured and uninjured leg, with an obviously higher incidence in the injured leg. The incidence of proximal DVT in an uninjured leg is rare.

Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement.

PURPOSE: To evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only. METHODS: We conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D'Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification). RESULTS: The study showed no significant differences in all preoperative variables (P>0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P>0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8±2.5mm (range: 24-35mm), 71.5±5.4% (range: 65-88%), 23.0±2.3mm (range: 17-28mm). The mean posterior wall fracture displacement is 5.0±3.2mm (range: 0-11mm). There was no difference regarding the quality of reduction between the two groups (P>0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P>0.05). There was no difference in rate of complications between the two groups (P>0.05). CONCLUSIONS: Lag screws fixation of posterior wall through single ilioinguinal approach in associated both column fractures of acetabulum is a safe and effective method. Our results shown that the presence of posterior wall fracture in cases of associated both column fractures does not compromise the clinical outcomes.

The role of ultrasonography in examination of the stability of Tile-B2 pelvic fractures: 7 case reports and a literature review.

BACKGROUND: Determining whether a Tile-B2 pelvic fracture is stable is very challenging. We sought to identify the role of ultrasonography in determining the stability of Tile-B2 pelvic fractures. METHODS: We collected the clinical data of patients with Tile-B2 pelvic fractures who presented at Xi'an Hong-Hui Hospital between June 1, 2016, and August 5, 2016. The treatment strategy of each patient was determined by a team of senior surgeons in the department. A single sinologist observed the movement of the fracture sites in patients during rest, under compression, and during separation to determine fracture stability. According to the pelvic fracture stability assessment, an appropriate treatment strategy was redetermined. Overall, 7 patients, including 5 women and 2 men, with Tile-B2 pelvic fractures were included in this case series. RESULTS: During the initial examination, senior surgeons recommended that 2 patients should undergo internal fixation and 4 patients, conservative treatment; treatment was undecided for 1 patient. After ultrasonography examination, 4 patients underwent surgery via the Stoppa (n = 2) or ilioinguinal approach (n = 1) or cannulated screw fixation (n = 1). The rest of the patients (n = 3) received conventional treatment. Follow-up ranged from 6 to 10 months. Most of the patients showed excellent functions based on their last Majeed grading scores. There were no complications during the follow-up. Using ultrasonography examination, the preoperative treatment plan in 1 patient was changed, and the uncertain preoperative plan in 1 patient was identified. CONCLUSION: Preoperative assessment of stability using ultrasonography may assist surgeons in making appropriate treatment choices for patients with Tile-B2 pelvic fractures.

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia.

The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20-55 years). All patients previously undergone an average of 2.9 operations (range: 1-6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3-12 cm), and all patients were suffering from soft tissue defects (range: 5-17 cm). The mean external fixator time (EFT) was 48 weeks (range: 30-62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33-62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0-3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.