What are the patterns of injury and displacement seen in lateral compression pelvic fractures?

BACKGROUND: Lateral compression (LC)-type pelvic fractures encompass a wide spectrum of injuries. Current classification systems are poorly suited to help guide treatment and do not adequately describe the wide range of injuries seen in clinical practice. QUESTIONS/PURPOSES: We therefore (1) defined the spectrum of injuries that compose LC fractures with respect to both anterior and posterior ring injuries, with particular focus on the morphology of sacral fractures, and (2) identified fracture patterns associated with displacement at presentation. METHODS: We retrospectively reviewed 318 LC pelvic fractures. Displacement of the anterior pelvic ring was identified and measured on plain radiographs and posterior displacement was identified by CT. RESULTS: All 318 patients had an anterior injury and all but 13 (4%) had a posterior injury; 263 of the 318 fractures (87%) included a sacral fracture, with 162 of 318 (51%) having an anterior incomplete sacral fracture, 53 (17%) a complete simple fracture, and 48 (15%) a complete comminuted fracture. Forty-two of 318 (13%) had a crescent fracture. One hundred six of 318 (33%) were displaced at presentation. There was a higher incidence of initial displacement observed in fractures including bilateral rami fractures, a comminuted sacral fracture, or a crescent fracture. CONCLUSIONS: LC pelvic fractures represent a heterogeneous group of injuries with a wide range of associated fracture patterns. In particular, there is a wide range of fracture types represented by injuries classified as LC1 (involving any sacral fracture). Fractures with more complex sacral fractures, crescent fractures, or bilateral pubic rami fractures tend to have higher degrees of initial displacement. LEVEL OF EVIDENCE: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip.

BACKGROUND: While recent reports have suggested that hip corticosteroid injections can hasten joint degeneration, there are few published data on the topic. The purpose of the present study was to evaluate for an association between corticosteroid injection and rapidly destructive hip disease (RDHD) and to determine the rate of, and risk factors for, occurrence. METHODS: This study was conducted in 2 parts. First, to assess for a potential association between hip corticosteroid injection and RDHD, a case-control analysis was performed. Patients who developed RDHD between 2013 and 2016 served as cases, whereas those who underwent total hip arthroplasty for diagnoses other than RDHD during the same period served as controls, and the exposure of interest was prior intra-articular hip corticosteroid injection. Second, in a retrospective cohort analysis, we analyzed all patients who received a fluoroscopically guided intra-articular hip corticosteroid injection at our institution from 2013 to 2016. The rate of post-injection RDHD was determined, and logistic regression was used to identify risk factors for occurrence. RESULTS: In the case-control analysis, hip corticosteroid injection was associated with the development of RDHD (adjusted odds ratio, 8.56 [95% confidence interval, 3.29 to 22.3], p < 0.0001). There was evidence of a dose-response curve, with the risk of RDHD increasing with injection dosage as well as with the number of injections received. In the retrospective cohort analysis, the rate of post-injection RDHD was 5.4% (37 of 688). Cases of post-injection RDHD were diagnosed at an average of 5.1 months following injection and were characterized by rapidly progressive joint-space narrowing, osteolysis, and collapse of the femoral head. CONCLUSIONS: This study documents an association between hip corticosteroid injection and RDHD. While the risk of RDHD following a single low-dose (≤40 mg) triamcinolone injection is low, the risk is higher following high-dose (≥80 mg) injection and multiple injections. These findings provide information that can be used to counsel patients about the risks associated with this common procedure. In addition, caution should be taken with intra-articular hip injections utilizing ≥80 mg of corticosteroid and multiple injections. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Abnormal rib number in childhood malignancy: implications for the scoliosis surgeon.

STUDY DESIGN: Retrospective review. OBJECTIVE: To determine if rib anomalies are present in pediatric malignancies in the United States. SUMMARY OF BACKGROUND DATA: Scoliosis surgeons view radiographs of the entire spine, counting the number of ribs. A European study noted that rib anomalies were more common in certain malignancies. We wished to determine if this is also true in the United States. If so, the potential for screening, early detection of malignancy, and a better understanding of tumor biology is possible. METHODS: A retrospective review of 218 children with malignancy and a control group of 200 children with polytrauma or suspected child abuse was performed. Chest radiographs were reviewed to determine the number of ribs, and the presence of rib anomalies. 24 ribs was considered normal, <24 or >24 was considered abnormal. P < 0.05 was considered significant. RESULTS: The average age was 6.8 +/- 5.5 years and number of ribs was 23.8 +/- 0.6. Rib number was normal in 86.8%. There were significant differences between the malignancy and control groups in age (control, 5.7 +/- 5.1 years; malignancy, 7.8 +/- 5.7 years, P = 0.00007), rib number (control, 23.9 +/- 0.5; malignancy, 23.7 +/- 0.7, P = 0.001), and normal/abnormal rib counts (control, 92% normal; malignancy, 82% normal, P = 0.003). In the malignant group, 50% had a lymphoproliferative malignancy, 33% a solid tumor, and 17.0% a neural tumor. Neural malignancies had a higher incidence of rib abnormalities compared with lymphoproliferative or solid malignancies (P = 0.01). Relative to the control group, those with a neural and lymphoproliferative malignancy were 6.23 (95% CI, 2.7-14.5) and 2.0 (95% CI, 1.0-4.1) times more likely to have an abnormal rib count. CONCLUSIONS: Homeobox genes, important in vertebral and rib sequencing, are abnormally expressed in many different malignancies. This association is a question of great interest. What is the potential for rib number being used as a predictor of childhood malignancy? Can these findings be expanded to adults? These questions require further research. The association noted in this study is interesting but should not yet be used to alarm parents regarding an increased risk of malignancy in their children.