Impact of introducing 3D printing-assisted surgery into clinical practice for traumatic pelvic and acetabular fractures.

Background: Given the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures. Methods: We retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups. Results: In total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6 % (n = 9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8 ± 88.2 vs 309.1 ± 143.1 min), lesser estimated blood loss (706.3 ± 330.0 vs 800.0 ± 584.2 ml), lower transfusion rates (50.0 % vs 52.9 %), lower number of intraoperative fluoroscopy images (62.8 ± 74.5 vs 71.6 ± 47.9 images) and shorter fluoroscopy duration (235.0 ± 79.2 vs 242.3 ± 83.5 min), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively. Conclusion: The introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.

Anterior internal versus external fixation of unstable pelvis fractures was not associated with discharge destination, critical care, length of stay, or hospital charges.

PURPOSE: Determine if anterior internal versus supra-acetabular external fixation of unstable pelvic fractures is associated with care needs or discharge. METHODS: A retrospective cohort study was performed at two tertiary trauma referral centers. Adults with unstable pelvis fractures (AO/OTA 61B/61C) who received operative fixation of the anterior and posterior pelvic ring by two orthopedic trauma surgeons from October 2020 to November 2022 were included. The primary outcome was discharge destination. Secondary outcomes included intensive care unit (ICU) or ventilator days, length of stay, and hospital charges. RESULTS: Eighty-three eligible patients were 38.6% female, with a mean age of 47.2 ± 20.3 years and BMI 28.1 ± 6.4 kg/m2. Fifty-nine patients (71.1%) received anterior pelvis internal fixation and 24 (28.9%) received external fixation. External fixation was associated with weight-bearing restrictions (91.7% versus 49.2%, p = 0.01). No differences in demographic, functional status, insurance type, fracture classification, or injury severity measures were observed by treatment. Internal versus external anterior pelvic fixation was not associated with discharge to home (49.2% versus 29.2%, p = 0.10), median ICU days (3.0 [interquartile range (IQR) 7.8 versus 5.5 [IQR 4.3], p = 0.14, ventilator days (0 [IQR 6.0] versus 0 [IQR 2.8], p = 0.51), length of stay (13.0 [IQR 13.0] versus 17.5 (IQR 20.5), p = 0.38), or total hospital charges (US dollars 180,311 [IQR 219,061.75] versus 243,622 [IQR 187,111], p = 0.14). CONCLUSIONS: Anterior internal versus supra-acetabular external fixation of unstable pelvis fractures was not significantly associated with discharge destination, critical care, hospital length of stay, or hospital charges. This sample may be underpowered to detect differences between groups. LEVEL OF EVIDENCE: Therapeutic Level IV.

Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman.

Surgical fixation of pelvic fractures is often necessary to restore fracture stability and improve patient outcomes. However, early operative management of pelvis fractures is not widely available in many health systems, resulting in conservative treatment approaches. Conservative approaches can lead to uncorrected pelvic deformities, which are challenging to treat and increase the risk of serious complications such as malunion. Treatment of pelvic malunion requires specialized care, access to necessary equipment, and a clearly defined treatment protocol. However, there is a lack of literature describing treatment algorithms for pelvic fracture malunion. This case report aims to incrementally fill this gap in the literature and highlight a logical step-by-step approach for reconstruction of pelvic malunion. This report is a single case of an 18-year-old woman who sustained complex unstable pelvic fracture, indicated for a 3-step reconstruction at a hospital with limited resources but access to computed tomography scan and some specialized pelvis reduction instruments. Postoperative imaging of the pelvis indicated satisfactory reduction and stable fixation of the pelvic reconstruction. After surgery, the patient was able to perform full axial load with no reported pain. This report provides a detailed description of each step of the operative management of a pelvic malunion case with clearly defined sequences, reduction tools, and positioning maneuvers necessary. Demonstrated in this case report, strategic preoperative planning is critical to successfully treating pelvic malunion and improving patient outcomes. This case report provides the necessary information on the management of pelvic reconstruction to inform other surgeons in underserved regions.

Orthopaedic fracture surgery in polytraumatized patients while on extracorporeal membrane oxygenation (ECMO): A report of two cases.

Extracorporeal membrane oxygenation (ECMO) has become a salvage therapy for patients with severe acute respiratory distress syndrome (ARDS). The management of orthopaedic trauma in ECMO-supported patients with ARDS remains an evolving area of interest. Orthopaedic injuries are often temporized with external fixators, skeletal traction, or splints due to hemodynamic instability as well as concerns of exacerbating underlying pulmonary injury. However, patients requiring ECMO support do not rely on their pulmonary system for oxygenation, the need for delayed fixation may not apply. However, patients utilizing ECMO therapy can have external cardiac and pulmonary support depending on their cannulation strategy, bypassing the need for delayed fixation. We present a case series of two polytrauma patients with ARDS who underwent surgical management of pelvic ring and femoral shaft fractures while receiving ECMO support. Both patients underwent surgical management without complication and were able to be weaned from ECMO and ventilator support postoperatively. These cases highlight the potential benefits to orthopaedic fixation and underscore the need for further clinical research.

Comparative analysis of venous thromboembolic complications in diverse groups of orthopaedic patients.

INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE) is one of the most important and life-threatening complications in orthopaedic surgery. According to current scientific reports, there are several variables that can affect the severity of CVD, including the site of the pathology or the type of treatment implemented. The aim of the study was to analyze the risk of VTE depending on the location of the pathology, as well as to evaluate the impact of surgical treatment compared to conservative management. MATERIAL AND METHODS: Analysis of laboratory results and clinical picture of 276 patients hospitalized for orthopaedic reasons, admitted between January 2008 - December 2019, with suspected pulmonary embolism (PE). RESULTS: Among patients diagnosed with PE, the most common location of the disease was in the lower limb 59/116 (50.9%), followed by the pelvis location - 22/116 (19.0%), the spine - 19/116 (16.4%), disseminated lesions in oncological patients - 12/116 (10.3%), and a group of pathologies in the upper limb - 4/116 (3.5%). Significant statistical differences were found between the incidence of PE and the diagnosis of pathology in the lower limb and the pelvis. In the group of patients, there was no statistically significant relationship between the incidence of PE associated with surgical treatment, compared to conservative management. CONCLUSIONS: The group with the highest risk of VTE were lower limb and pelvic pathologies. The results are largely consistent with numerous reports treating the risk of CVD among orthopaedic patient populations.

Management of Pelvic Trauma.

Pelvic fractures are common after blunt trauma with patients' presentation ranging from stable with insignificant fractures to life-threatening exsanguination from unstable fractures. Often, hemorrhagic shock from a pelvic fracture may go unrecognized and high clinical suspicion for a pelvic source lies with the clinician. A multidisciplinary coordinated effort is required for management of these complex patients. In the exsanguinating patient, hemorrhage control remains the top priority and may be achieved with external stabilization, resuscitative endovascular balloon occlusion of the aorta, preperitoneal pelvic packing, angiographic intervention, or a combination of therapies. These modalities have been shown to reduce mortality in this challenging population.

[Effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeâ ¡scapular pelvis fracture].

OBJECTIVE: To analyze the effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeⅡscapular pelvis fracture. METHODS: From January 2016 to June 2021, 26 patients with Ideberg typeⅡglenoid fractures were treated with trans-axillary lag screw combined with supporting plate, including 15 males and 11 females. The age ranged from 21 to 75 years, with an average of (43.12±6.56) years old. The Constant-Murley Shoulder joint Scale and University of California at Los Angeles (UCLA) score were used to evaluate the function and clinical efficacy of shoulder joint. RESULTS: All patients were followed up, and the duration ranged from 19 to 42 months, with an average of (30.6±10.5) months. One year after surgery, the Constant-Murley score increased from preoperative 34.9±2.5(ranged, from 28 to 47) to 87.2±6.8(ranged, from 70 to 95). The UCLA score improved from preoperative 17.9±1.7(9 to 25) to 33.1±2.3(29 to 35). Seventeen patients got an excellent result, with 7 good, and 2 fair. None of the patients had infection, screw, and plate loosening, fracture, and other complications after surgery. Two patients had different degrees of Chronic pain in the shoulder during the follow-up period. CONCLUSION: The treatment of Ideberg typeⅡscapular glenoid fractures through axillary approach with lag screws and supporting steel plates has the advantages of convenient exposure, direct visual restoration of the normal anatomical shape of the scapular glenoid, selection of suitable positions for screw and steel plate placement, achieving better treatment results, and fewer complications. It is an effective and reliable surgical method.

Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries.

PURPOSE: While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. METHODS: The NTDB (2015-2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. RESULTS: 2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03-1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day. CONCLUSION: Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications.

Delayed Presentation of Sciatic Nerve Palsy Due to Post-traumatic Pseudoaneurysm Following Pelvis Fracture: A Case Report.

Introduction: Pseudoaneurysms are vascular lesions occurring after injury to a blood vessel wall. Peripheral artery pseudoaneurysms as a fracture complication are uncommon and typically appear immediately after trauma or surgery. We report a unique case of sciatic nerve palsy associated with external iliac artery pseudoaneurysm arising 20 years after pelvic trauma, presenting within the fracture site as an erosive bone lesion masquerading as a possible malignancy. To the best of our knowledge, no cases of delayed external iliac artery pseudoaneurysm involving sciatic pain have been reported. Case Report: We present a 78-year-old female who sustained an acetabular fracture with an uneventful recovery for 20 years. The patient presented post-injury with symptoms and physical examination findings consistent with sciatic nerve palsy. Computed tomography angiography and duplex imaging revealed a pseudoaneurysm of the external iliac artery. The patient was taken to the operating room for endovascular repair of the external iliac artery using a covered stent. Conclusion: This case of sciatic nerve palsy is a unique contribution to the literature concerning the specific vascular injury observed and the delayed presentation of pseudoaneurysm causing sciatic nerve palsy. Orthopedic surgeons must consider a wide differential when confronted with suspicious pelvic masses. Failure to diagnose these as a vascular etiology could prove catastrophic should the surgeon attempt an open debridement or sampling.

Significant improvement in axial load stability with the pre-tensioned pelvic external fixator: A biomechanical analysis in a model with type C Tile lesion. / Mejora significativa de la estabilidad a carga axial con el fijador externo pélvico pretensado: análisis biomecánico en un modelo con lesión Tile tipo C.

OBJECTIVE: The aim of our work is to check if the use of a pre-tensed bar connected to 2supra-acetabular Schanz pins is more stable in a pelvic with a tile C1 injury. MATERIAL AND METHODS: We used synthetic pelvis (N=5) with a unstable vertical injury, stabilized with both the standard and the pre-tensed system. They both were submitted to axial loading. We measured applied forces and the position of markers that were positioned in the sacroiliac and symphysis joints. We determined the relative movements between injured surfaces, rigidity, resistance and when each system failed. RESULTS: When using the pre-tensed fixator, the rigidity was much higher in the sacro-iliac joint (P=.043) being 3.45 times higher, being also 2.06 times higher in pubic symphysis (P=.043). The resistance against failure was 2 times higher too (P=.043). DISCUSSION: The increased axial stability with the pre-tensed external fixator accords with its ability to make active compression in both posterior and anterior elements of the pelvic ring, which was previously demonstrated. This result supports the preliminary clinic outcomes that were obtained. CONCLUSIONS: The pre-tensed external fixator increases the axial stability of the pelvic ring's posterior elements in a synthethic pelvis with a Tile C1 injury, without decreasing it's capacity to achieve an anterior stability.

[Translated article] Significant improvement in axial load stability with the pre-tensioned pelvic external fixator: A biomechanical analysis in a model with type C Tile lesion.

OBJECTIVE: The aim of our work is to check if the use of a pre-tensed bar connected to 2 supra-acetabular Schanz pins is more stable in a pelvic with a tile C1 injury. MATERIAL AND METHODS: We used synthetic pelvis (N = 5) with a unstable vertical injury, stabilized with both the standard and the pre-tensed system. They both were submitted to axial loading. We measured applied forces and the position of markers that were positioned in the sacroiliac and symphysis joints. We determined the relative movements between injured surfaces, rigidity, resistance and when each system failed. RESULTS: When using the pre-tensed fixator, the rigidity was much higher in the sacro-iliac joint(P=.043) being 3.45 times higher, being also 2.06 times higher in pubic symphysis (P=.043). The resistance against failure was 2 times higher too (P=.043). DISCUSSION: The increased axial stability with the pre-tensed external fixator accords with its ability to make active compression in both posterior and anterior elements of the pelvic ring, which was previously demonstrated. This result supports the preliminary clinic outcomes that were obtained. CONCLUSIONS: The pre-tensed external fixator increases the axial stability of the pelvic ring's posterior elements in a synthethic pelvis with a Tile C1 injury, without decreasing it's capacity to achieve an anterior stability.

Risk factors for loss to follow up of pelvis and acetabular fractures.

INTRODUCTION: Pelvic and acetabular fracture incidence is increasing worldwide for more than four decades. There is currently no evidence examining risk factors for loss to follow up in patients with these injuries. METHODS: Patients presenting with pelvic and/or acetabular fractures at our institution between 2015 and 2020 were included. Demographic, injury, treatment, and follow up information was included. Excluded patients were those who sustained a pathologic fracture, has a course of treatment prior to transfer to our centre, or expired prior to discharge. RESULTS: 446 patients, 263 with a pelvic ring injury, 172 with an acetabular fracture, and 11 with combined injuries were identified. 271 (61%) of patients in our cohort followed up in Orthopaedic clinic (p = 0.016). With an odds ratio of 2.134, gunshot wound mechanism of injury was the largest risk factor for loss to follow up (p = 0.031) followed by male sex (OR= 1.859) and surgery with general trauma surgery (OR=1.841). The most protective risk factors for follow up with Orthopaedic surgery were operatively treated pelvic and acetabular fractures (OR=0.239) and Orthopaedic Surgery as the discharging service (OR=0.372). DISCUSSION: Numerous risk factors exist for loss to follow up including male sex, ballistic mechanism, and discharging service. Investigation into interventions to improve follow up in these patients are warranted.

Association between 3D Printing-Assisted Pelvic or Acetabular Fracture Surgery and the Length of Hospital Stay in Nongeriatric Male Adults.

Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson's correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18−40 and non-major trauma (ISS < 16) patients. In 40−60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS.

Does 3D Printing-Assisted Acetabular or Pelvic Fracture Surgery Shorten Hospitalization Durations among Older Adults?

Acetabular or anterior pelvic ring fractures are rare but extremely complicated and challenging injuries for orthopedic trauma surgeons. Three-dimensional (3D) printing technology is widely used in the management of these two fracture types for surgical benefits. Our study aimed to explore whether 3D printing-assisted acetabular or pelvic surgery is beneficial in terms of shortening the length of hospital stay (LHS) and intensive care unit (ICU) stay (ICU LS) for older patients. This retrospective study included two groups of 76 participants over 60 years old who underwent operations with (n = 41) or without (n = 35) guidance by 3D printing. The Mann-Whitney U test was used to analyze continuous variables. Chi-square analysis was applied for categorical variables. Univariable and multivariable linear regression models were used to analyze the factors associated with LHS. The median LHS in the group without 3D printing assistance was 16 (12-21) days, and the median ICU LS was 0 (0-2) days. The median LHS in the group with 3D printing assistance was 17 (12.5-22.5) days, and the median ICU LS was 0 (0-3) days. There was no significant difference in LHS associated with 3D printing assistance vs. that without 3D printing among patients who underwent open reduction and internal fixation for pelvic or acetabular fractures. The LHS positively correlated with the ICU LS whether the operation was 3D printing assisted or not. For fracture surgery in older patients, in addition to the advancement of surgical treatment and techniques, medical teams require more detailed preoperative evaluations, and more personalized medical plans regarding postoperative care to achieve the goals of shortening LHS, reducing healthcare costs, and reducing complication rates.

Total endoscopic anterior pelvic approach (TAPA) - A new approach to the internal fixation of the symphysis.

This study presents a detailed documentation of a total endoscopic anterior pelvic approach (TAPA) for plate fixation of a symphyseal disruption. The purpose of this work is to describe a minimally invasive technique as a possible method for reducing complications and hospitalization. Other goals included giving technical recommendations and assessing potential pitfalls and problems of this new surgical approach. Surgery was performed in an interdisciplinary setting by an experienced orthopaedic and general surgeon. The first endoscopic approach used to visualize the injury was the same as is used for endoscopic hernia surgery. The repositioning of the symphysial rupture was achieved either through external fixation or indirectly with traction and a pelvic binder. Plate positioning and fixation were achieved through two additional, minimally invasive incisions. The endoscopic approach shows multiple advantages, such as no detachment of the rectus abdominis muscle and smaller skin incisions. Furthermore, this approach could lessen the incidence of hernia and postoperative pain. We see the presented technique as a simple and innovative surgical method for treating symphyseal disruption.

Which general functional outcome measure does a better job of capturing change in clinical status in pelvic and acetabular fracture patients? An analysis of responsiveness over the first year of recovery.

OBJECTIVE: To compare the responsiveness of the Short Form-36 (SF-36) physical component score (PCS) to the Short Musculoskeletal Function Assessment (SMFA) dysfunction index (DI) in pelvic and acetabular fracture patients over multiple time points in the first year of recovery. DESIGN: Prospective cohort study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Four hundred seventy-three patients with surgically treated pelvic and acetabular fractures (Orthopaedic Trauma Association B or C-type pelvic ring disruption or acetabular fracture) were enrolled into the center's prospective orthopaedic trauma database between January 2005 and February 2015. Functional outcome data were collected at baseline, 6 months, and 12 months. MAIN OUTCOME MEASUREMENTS: Evaluation was performed using the SF-36 Survey and Short Musculoskeletal Function Assessment. Responsiveness was assessed by calculating the standard response mean (SRM), the minimal clinically important difference (MCID), and floor and ceiling effects. RESULTS: Three hundred five patients had complete data for both outcome scores. SF-36 PCS and SMFA DI scores showed strong correlation for all time intervals (r = -0.55 at baseline, r = -0.78 at 6 months, and r = -0.85 at 12 months). The SRM of the SF-36 PCS was greater in magnitude than the SRM of SMFA DI at all time points; this was statistically significant between baseline and 6 months (P < .001), but not between 6 and 12 months (P = .29). Similarly, the proportion of patients achieving MCID in SF-36 PCS was significantly greater than the proportion achieving MCID in SMFA DI between baseline and 6 months (84.6% vs 69.8%, P < .001), and between 6 and 12 months (48.5% vs 35.7%, P = .01). There were no ceiling or floor effects found for SF-36 PCS at any time intervals. However, 16.1% of patients achieved the highest level of functioning detectable by the SMFA DI at baseline, along with smaller ceiling effects at 6 months (1.3%) and 12 months (3.3%). CONCLUSIONS: SF-36 PCS is a more responsive measure of functional outcome than the SFMA DI over the first year of recovery in patients who sustain a pelvic ring disruption or acetabular fracture. This superiority was found in using the SRM, proportion of patients meeting MCID, and ceiling effects. Furthermore, the SF-36 PCS correlated with the more disease-specific SMFA DI. LEVEL OF EVIDENCE: Prognostic Level II.

Benefit of continued noninvasive cardiac monitoring in geriatric trauma: A retrospective review of geriatric pelvis, hip, and femur fractures and analysis of cardiac events during immediate post-traumatic course.

OBJECTIVE: The geriatric population suffers from a predisposition to cardiac events due to physiologic changes commonly associated with aging. The majority of the trauma population seen at our facility is within the geriatric population (greater than 65 years old). Therefore, this study was aimed to determine which of those preexisting factors were associated with an increased risk for developing cardiac event. By assessing those risks, we hoped to determine a timeline for the highest risk of cardiac event occurrence, in order to identify a safe period of when cardiac monitoring was indicated. METHODS: A retrospective study performed over 6 months reviewing geriatric trauma patients with hip, pelvis, or femur fractures, n = 125. A list of predetermined risk factors including comorbidities, pathologies, laboratory values, electrocardiogram findings, and surgery was crossed with the patient's records in order to identify factors for increased risk of cardiac event. Once patients who had documented cardiac events were identified, a temporal pattern of cardiac event occurrence was analyzed in order to determine a period when noninvasive cardiac monitoring should remain in place. RESULTS: In 125 patients, 40 cardiac events occurred in 30 patients. The analyzed variables with statistically significant associations for having a cardiac event were comorbidities (p = 0.019), elevated body mass index (p = 0.001), abnormal initial phosphorus (p = 0.002), and an electrocardiogram finding of other than normal sinus rhythm (p = 0.020). Of the identified cardiac events, we found that by hospital day 3 68% of cardiac event had occurred, with 85% by hospital day 4, 95% by day 5, and 100% within the first 7 days of admission. CONCLUSION: Patient history of cardiac comorbidities, elevated body mass index, abnormal phosphorus, and abnormal electrocardiogram findings were found to be significant risk factors for cardiac event development in geriatric trauma. All recorded events in our study occurred within 7 days of the initial trauma.

Bladder incarceration within a displaced pelvic ring nonunion.

Pelvic ring injuries can be challenging to manage and may have a range of associated injuries. When bladder injuries occur in combination with pelvic ring fractures, a multidisciplinary approach may be required to plan the best course of treatment. Acute entrapment or injury to the urinary bladder after a pelvic fracture is well reported. Here, we present an interesting case of chronic bladder incarceration within a lateral compression pelvic ring injury nonunion after failed nonoperative management of the initial pelvis fracture. Treatment of the nonunion was complicated by an incidental diagnosis of lymphoma.

Integrity of the pectineal ligament in MRI correlates with radiographic superior pubic ramus fracture displacement.

BACKGROUND: Estimating the stability of pelvic lateral compression fractures solely by static radiographs can be difficult. In this context, the role of anterior pelvic soft tissues as potential secondary stabilizer of the pelvic ring has hardly been investigated. PURPOSE: To correlate the initial radiographic appearance of the pubic ramus fracture with the integrity of the pectineal ligament, a strong ligament along the pecten pubis. MATERIAL AND METHODS: In total, 31 patients with a pelvic lateral compression fracture (AO/OTA 61- B1.1/B2.1) with 33 superior pubic ramus fractures and available post-traumatic radiographs (pelvis anteroposterior, inlet, outlet) and magnetic resonance imaging (MRI) of the pelvis with fat-suppressed coronal images were reviewed retrospectively. Radiographic superior pubic ramus fracture displacement was measured and correlated to the degree of MR-morphologic alterations of the pectineal ligament (grade 0 = intact, grade 3 = rupture). RESULTS: In the majority of fractures (72.7%), associated MR-morphologic alterations of the pectineal ligament were present. Radiographic displacement and MRI grading showed a strong positive correlation (Spearman rho = 0.783, P < 0.001). The sensitivity and specificity for a radiographic displacement of >3 mm on plain radiographs to detect a structural ligament lesion on MRI (grade 2 and higher) were 73% and 100%, respectively. CONCLUSION: Radiographic displacement of superior pubic ramus fractures >3 mm is a strong indicator for a structural lesion of the pectineal ligament. Future studies should investigate the potential biomechanical importance of this ligament for pelvic ring stability.

Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures.

BACKGROUND: Anterior plating is the treatment of choice in anterior pelvic ring fractures. In certain situations where pelvis fracture is associated with open wound, infection, abdominal injury or bladder injury - internal fixation with plate is contraindicated. Conventionally, external fixation is done in such cases. However, External Fixation is associated with pin tract infection, pin loosening, difficult wound care and less patient compliance. The present study was conducted to evaluate a possible 'middle path' between the two procedures. METHODS: A prospective study was conducted from July 2017 to December 2019.18 adult patients with risk of infection were treated with INFIX. The patients' data was collected on presentation, preoperatively, intra-operatively and post operatively. The patients were followed up with serial radiographs. Functional status was assessed using Iowa Pelvis Score. After radiological union, implant removal was performed. The patients were followed up for a minimum of 6 months after the removal surgery. RESULTS: The average age of patients in present study was 39.55 years with a male predominance. 16 out of 18 patients were polytrauma cases with ISS more than 15.50% patients had Lateral Compression type of fracture. Radiological union was seen at an average of 3.5 months. After removal, 78% patients had excellent outcome and 22% patients had good outcome. The complications observed were LFCN irritation (27.78%) and asymptomatic heterotopic ossification (22%). CONCLUSION: Present study concludes that INFIX produces excellent outcome in pelvis fractures with risk of infection where anterior plating is contraindicated.