Allogeneic umbilical cord mesenchymal stem cell conditioned medium (secretome) for treating posterior cruciate ligament rupture: a prospective single-arm study.

BACKGROUND: Outcomes of the current management of posterior cruciate ligament (PCL) rupture are still unsatisfactory. Recent literature demonstrated the efficacy of the paracrine action of mesenchymal stem cells (MSC) in ligament rupture healing. This study aimed to evaluate the outcome of arthroscopic administration of allogeneic umbilical cord-derived MSC (UC-MSC) conditioned medium (secretome) for the treatment of PCL rupture. PATIENTS AND METHODS: This is a prospective study including 12 individuals with PCL rupture grade 1 or 2 who were performed arthroscopy and secretome administrations. The functional and radiologic outcome of the knee was examined one year following intervention. RESULTS: Preoperatively, posterior drawer test revealed three cases of grade 2+ and nine cases of grade 1+, whereas the final follow-up revealed two cases of grade 2+ and ten cases of grade 1+ PCL rupture. At final follow-up, the mean scores for the IKDC, modified Cincinnati, and Lysholm were 90.58 ± 4.30, 90.90 ± 2.15, and 89.42 ± 3.16, respectively. The means of the serial hop tests were 90.33, 94.16, 93.66, and 95.33 for single, triple, crossover, and time hop tests, respectively. Five patients were able to resume competitive sport after an average of 25.8 weeks (25-38). The final MRI analysis revealed that six knees (50%) regained PCL continuity with low signal intensity, five knees (41.6%) returned near-normal PCL continuity, and one knee (8.3%) regained PCL continuity but with deformed outlines. CONCLUSIONS: Short-term follow-up indicated that the secretome generated from allogenic UC-MSC produces excellent functional and radiographic results in grade I-II PCL rupture.

Comparison of clinical outcomes between isolated ACL reconstruction and combined ACL with anterolateral ligament reconstruction: a systematic review and meta-analysis.

BACKGROUND: To compare the clinical outcomes between isolated cruciate ligament reconstruction (ACLR) and combined ACL with anterolateral ligament reconstruction in chronic ACL injury especially with rotary instability problem. METHODS: Systematic searches were conducted of literature published up to July 2021 on PubMed, Google Search, and Cochrane databases for studies comparing isolated ACLR and ACL with anterolateral reconstruction. Two reviewers independently determined eligibility, extracted outcome data, and assessed the risk of bias of eligible studies. Pooled clinical outcomes used random effects with mean differences and risk ratio for continuous and dichotomous variables, respectively. RESULTS: After excluding 49 articles based on full-text screening, six studies were identified which met the inclusion criteria in the meta-analysis. Clinical outcomes such as residual laxity, rotatory instability, and graft failure were compared between isolated ACLR and combined ACL and anterolateral stability reconstruction. Overall, both clinical outcomes of isolated ACL and combined ACL with anterolateral reconstruction show improvement results in pivot shift test, the absence of residual laxity and incidence of graft failure. Compared to isolated ACLR, the prominent postoperative result was by combined ACL with anterolateral reconstruction which had significant differences in laxity outcome based on (I2 = 89%, p < 0.00001) and (MD = 0.71, 95%CI: 0.33-1.08, p = 0.00002). CONCLUSIONS: The combined ACL with anterolateral reconstruction tended to have superior clinical outcomes, especially in the absence of residual laxity, compared to the isolated ACLR, but the other results were not significantly different statistically. Combined ACL and anterolateral reconstruction were not performed routinely for patients undergoing ACL reconstruction, but more suitable for chronic rotatory instability problem.

Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

INTRODUCTION: Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS: A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS: The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION: The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.

The Banff Patellar Instability Instrument: validity and reliability of an Indonesian version.

BACKGROUND: The Banff Patellar Instability Instrument (BPII) is a valuable scoring tool for assessing patellofemoral instability in patients suffering from patellofemoral pain syndrome (PFPS). The BPII 2.0 is a shortened version of the BPII. However, there is no Indonesian edition of BPII 2.0 that has been validated. This study aimed to determine the validity and reliability of the Indonesian version of the BPII 2.0. MATERIALS AND METHODS: This was a cross-sectional study that used a forward-backward translation protocol to create an Indonesian version of the BPII 2.0. Thirty patients with PFPS were given the questionnaires. The questionnaire's validity was evaluated by analyzing the correlation between score of each subscale and the overall score to the Indonesian version of the Kujala score using Pearson correlation coefficient, while the reliability was evaluated by measuring the internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient). RESULTS: The Indonesian version of BPII 2.0 and the Indonesian version of Kujala score had a strong Pearson correlation coefficient for construct validity. For all subscales, Cronbach α was 0.90-0.98, indicating adequate internal consistency. The test-retest reliability was high, with intraclass correlation coefficient ranging from 0.89 to 0.98 for all subscales. There was no difference in the Indonesian version of BPII 2.0 response between the first and second administration of the questionnaire which was taken 7 days afterward. CONCLUSION: The Indonesian version of BPII 2.0 was determined to be valid and reliable and is therefore an objective instrument to evaluate patellofemoral instability in patients with PFPS in the Indonesian population.

Autologous mesenchymal stem cell implantation, hydroxyapatite, bone morphogenetic protein-2, and internal fixation for treating critical-sized defects: a translational study.

INTRODUCTION: Critical-sized defect (CSD) is one of the most challenging cases for orthopaedic surgeons. We aim to explore the therapeutic potential of the combination of bone marrow-derived mesenchymal stem cells (BM-MSCs), hydroxyapatite (HA) granules, bone morphogenetic protein-2 (BMP-2), and internal fixation for treating CSDs. METHODS: This was a translational study performed during the period of January 2012 to 2016. Subjects were patients diagnosed with CSDs who had previously failed surgical attempts. They were treated with the combination of autologous BM-MSCs, HA granules, BMP-2, and mechanical stabilization. Post-operative pain level, functional outcome, defect volume, and radiological healing were evaluated after a minimum follow-up of 12 months. RESULTS: A total of six subjects were recruited in this study. The pain was significantly reduced in all cases; with the decrease of mean preoperative visual analog scale (VAS) from 4 ± 2.2 to 0 after six month follow-up. Clinical functional outcome percentage increased significantly from 25 ± 13.7 to 70.79 ± 19.5. Radiological healing assessment using Tiedemann score also showed an increase from 0.16 ± 0.4 to 8 ± 3 at one year follow-up. No immunologic nor neoplastic side effects were found. CONCLUSIONS: The combination of autologous BM-MSCs, HA granules, and BMP-2 is safe and remains to be a good option for the definitive treatment for CSD with previous failed surgical attempts. Further studies with a larger sample size are required to be done.

The Effect of Secretome, Xenogenic Bone Marrow-Derived Mesenchymal Stem Cells, Bone Morphogenetic Protein-2, Hydroxyapatite Granule and Mechanical Fixation in Critical-Size Defects of Rat Models.

Background: Recent studies have shown that human bone marrow-derived mesenchymal stem cells (hBM-MSCs) have several drawbacks in treating critical-sized bone defect (CSD). Secretome may offer considerable advantages over living cells in terms of potency, manufacturing and storing easiness, and potential as a ready-to-go osteoinductive agent. However, thus far, there are no studies regarding the efficacy of secretome in bone healing. The objective of this study is to investigate the effect of the secretome in rat models with CSD. Methods: This was an experimental study with post-test only control group design using 60 skeletally mature Sprague Dawley rat which was divided evenly into 5 treatment groups (MSC only, Secretome only, MSC + Secretome, MSC + Secretome + BMP-2, Control group using Normal Saline). We used Bone Marrow derived MSC in this research. The critical-sized bone defect was created by performing osteotomy and defect was treated according to the groups. Rats were sacrificed on 2nd and 4th week and we measured the radiological outcome using Radiographic Union Score for Tibia (RUST) and histomorphometric (callus, osseous, cartilage, fibrous, and void area) evaluation using Image J. Results: There was no difference in the weight of rats between groups before and after the intervention. RUST score in all intervention group is significantly higher than the control group, however, the MSC-only group was not statistically significant higher than the control group. There is no statistically significant difference in RUST Score between intervention groups.Histomorphometric evaluation showed that total callus formation is the widest in the MSC+Secretome+BMP-2 combination group while the osseous area is found highest on the secretome-only group. Conclusion: Secretome, whether used solely or combined with BM-MSC and BMP-2, is a novel, potent bone-healing agent for CSD in rat models.

A rare case of oxidized zirconium - All polyethylene tibia unicompartmental arthroplasty failure: A case report.

Oxidized zirconium (Oxinium) implants has been claimed as the best material in terms of wear reduction. However, longevity of an all polyethylene uni knee arthroplasty (UKA) has been a long debate. We reported a rare case of 74 year old female who was performed all polyethylene UKA 6 years prior and fell 3 months prior. After the incident, patient was wheel-chair ridden afterwards. There was no evidence of fracture upon conventional radiography examination. Conversion of UKA to total knee replacement (TKA) was performed and patient was able to walk with aid after the surgery. The failed Oxinium all polyethylene UKA failure in this case is suspected due osteoarthritis progression.

The Role of Lateral Retinacular Release in Preventing Patellofemoral Malalignment in Double-Bundle Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

Background: Loss of internal rotation stability is the major cause of pain after an anterior cruciate ligament reconstruction (ACLR). Many authors described measures to treat this problem to no avail. This is the first study evaluating the role of lateral release with double-bundle ACLR to prevent patellofemoral malalignment after ACLR. Methods: A total of 100 patients were included in this prospective study between January 2018 and December 2019. We compared single-bundle ACLR (group 1, n = 30), double-bundle ACLR (group 2, n = 30), and double-bundle ACLR with lateral release (group 3, n = 40). Clinical outcome was evaluated with the Kujala score while radiological outcome was evaluated using the tibial tubercle-trochlear groove (TTTG) distance in magnetic resonance imaging. The preoperative and postoperative values were compared. Results: At the final follow-up of 6-18 months, group 3 showed the lowest TTTG value (6.7 ± 4.69) compared to group 2 (9.1 ± 4.83) and group 1 (11.74 ± 1.76) (p = 0.03). The Kujala score was significantly improved in all groups: from 68.83 to 89.90 in group 1, from 70.02 to 91.23 in group 2, and from 69.71 to 95.05 in group 3 (p = 0.03). Group 3 showed the most superior improvement in the Kujala score (25.34) compare to group 1 (21.07) and group 3 (21.21) (p = 0.012). Conclusions: Concomitant lateral retinacular release significantly improved the Kujala score. It may serve as a valuable option to overcome patellofemoral pain syndrome in ACLR.

Patient Height may Predict the Length of the Anterior Cruciate Ligament: A Magnetic Resonance Imaging Study.

PURPOSE: The purpose of this study was to measure the length and width of anterior cruciate ligament (ACL) tibial footprint using magnetic resonance imaging (MRI) and to evaluate correlation between patients' weight and height with the tibial footprint size. METHODS: In total, 207 eligible patients underwent MRI scanning from June 2018 to June 2020. One hundred seventeen knees from patients aged 18 to 40 years old with intact ACL were included in this study. Data of weight, height, body mass index (BMI) from physical examination and tibial footprint length and width from MRI were obtained. Relationship of ACL tibial footprint length <14 mm and association between ACL tibial footprint sizes of MRI with height, weight, and BMI were analyzed. RESULTS: The ACL tibial footprint length and width were, respectively, 11.9 ± 1.8 mm and 10 ± 1.5 mm. Proportion of ACL footprint <14 mm in length was 89.7%. Patient height ≥170 cm was the best predictor of ACL tibial footprint length <14 mm (P = .025). There was a statistically significant relationship between the height of the patients and the length of the ACL tibial footprint. The length of the ACL tibial footprint could be predicted by the formula: length = -7.362 + 11.48 × (height in meters). CONCLUSION: The height of the patients may predict the length of the ACL tibial footprint. Although patient's age, sex, and BMI correlate poorly with ACL tibial footprint width, there was no correlation between patient's weight and ACL tibial footprint size. CLINICAL RELEVANCE: Before ACL reconstruction surgery, an estimation of ACL tibial footprint size might aid in the graft harvesting preparation.

Cyclops lesion - The entity causing loss of knee extension after ACL reconstruction surgery: A case report.

Cyclops is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction surgery that causes loss of knee extension. In this literature, we have discussed about a young gentleman who presented with unresolved swelling and inability to extend knee joint fully 1 year after ACL reconstruction surgery. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). An arthroscopic excision of the cyclops lesion was successfully done on this patient which resulted in a resolution of swelling and progressive improvement of knee extension.

Meniscal bearing dislocation following minimally invasive Oxford medial unicompartmental knee arthroplasty treated with simple open reduction: Case report.

INTRODUCTION: Dislocation of polyethylene insert is one of the most common complications of mobile bearing-medial unicompartmental knee arthroplasty (MUKA). Bearing dislocation was diagnosed by radiograph examination in these cases upon trivial injury. CASE PRESENTATION: We reported one case of meniscal bearing dislocation after an Oxford MUKA treated with a simple open reduction technique. CLINICAL DISCUSSION: Simple open reduction surgery without change of the bearing and the use of knee brace for 6 months was effective in preventing re-dislocation. CONCLUSION: Mobile bearing dislocation is one of the most common complications in mobile-bearing MUKA. Besides the prevention of technical errors, usage of UKA with a frequency of 10-15 per year is recommended to increase the surgeon's learning curve.

Anthropometric study as a predictor of anterior cruciate ligament sizes in Asian Indonesian population.

OBJECTIVES: To evaluate whether anthropometric data can predict anterior cruciate ligament (ACL) sizes on magneti resonance imaging (MRI) in Asian population. BACKGROUND: Reconstruction of ACL has been performed over a decade ago. Recently, more individualized ACL reconstruction is performed taking account of each patient's ACL characteristics. However, there has been limited study regarding ACL sizes in Asian Indonesian population. This study aimed to evaluate the role of anthropometric data in ACL sizes using MRI in Asian Indonesian population. STUDY DESIGN: Retrospective Study. METHOD: A series of 531 knees from 420 patients with knee pain and intact ACL confirmed by MRI study. Length, width and inclination angle of ACL were measured using a T2-weighted sagittal MRI 3.0 Tesla Magnetom Skyra. Height, weight, body mass index (BMI) and age were recorded. Multiple regression analysis was used to determine relationship between the anthropometric data and size of ACL measurements. RESULT: ACL length and width were significantly different between male and female, consecutively. Mean ACL length was 35.36 ± 3.63 mm, male was significantly longer (36.59 ± 3.24 mm) compared to female (32.77 ± 2.99 mm), p < 0.0001. Mean ACL width was 10.23 ± 1.84 mm, male was significantly wider (10.85 ± 1.59 mm) compared to female (8.93 ± 1.64 mm), p < 0.0001. The mean ACL inclination angle was 47.75° ± 3.07° (range 40.17°-57.12°). The strongest correlation for ACL length was height and weight (r = 0.437; r = 0.341 consecutively, p < 0.0001). Females had stronger correlation compared to males for ACL length (R2 = 0.489 vs R2 = 0.418). ACL width showed weak correlation with anthropometric data. The following regression analysis equation was obtained for ACL length: ACL length = 60.697 - 0.11*age + 0.461*weight (kg) - 16.522*height (meter) - 1.093*BMI (R2 = 0.539; p < 0.0001). CONCLUSION: Anthropometric data can be utilized as a predictor of ACL length in Asian Indonesian population. The ACL length in Asian Indonesian population is shorter than that in Western population study.

Evaluation of patellar dimension and Bristol Index in Asian population: An MRI study.

BACKGROUND: Restoration of patellar thickness is pivotal during a total knee arthroplasty (TKA). Several studies showed there are differences in the knee measurements between Asian and Western population. PURPOSE: This study aims to evaluate the patellar dimension and Bristol Index of patellar width to thickness (BIPWiT) using magnetic resonance imaging (MRI) in Asian population. STUDY DESIGN: This is a descriptive epidemiology study. METHODS: 101 MRI scans of young adult patients with normal patellofemoral joint (PFJ) age 17-40 were evaluated from January 2019 to December 2020. Exclusion criteria included patella-femoral pathology and degenerative joint disease. Data of gender, body height and weight were obtained from physical examination, while patella height, width and thickness were obtained using MRI measurement. Descriptive analysis was used to get the mean and standard deviation of patella dimension, whereas correlation between patella thickness with patella width and length were analyzed using Pearson correlation and BIPWiT ratio was obtained by dividing the patellar width and patellar thickness. RESULTS: Mean patellar length was 30.06 ± 2.94 (29.48-30.64); patellar width was 44.13 ± 4.44 (43.26-45.01); and patellar thickness was 23.89 ± 2.33 (23.43-24.35). Patellar dimension in male were significantly larger compared to female (P < 0.001). However, there was no difference in cartilage thickness between male and female (P = 0.305). There was strong correlation between patellar width and patellar thickness (r = 0.66; P < 0.001) with BIPWiT ratio of 1.85 ± 0.15. CONCLUSION: BIPWiT of 1.8:1 between patellar width and patellar thickness was recommended as a guide for patellar thickness restoration during TKA. There is no difference of patellar dimension between Asian and Western population in a healthy knee. CLINICAL RELEVANCE: The result of BIPWiT ratio found in this study may aid upon pre-operative planning prior TKA for surgeons in order to achieve optimal patellar thickness and avoid patellofemoral problem. WHAT IS KNOWN ABOUT THE SUBJECT: Currently there are raising concerns about the different sizes of knee measurements between Asian and Western population which will affect techniques during TKA to achieve optimum result. WHAT THIS STUDY ADDS TO THE EXISTING KNOWLEDGE: This study not only prove that there is no difference between patellar dimension of Asian and Caucasian but also found a similar BIPWiT ratio for patellar resection during TKA with previous literature. LEVEL OF EVIDENCE: Level III.

Management of recurrent hip dislocation in Down Syndrome using modified Ganz periacetabular osteotomy: Follow up after 5 years.

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very rare and challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status, young age and several anatomical variations forces limited option as a treatment. Several literatures mentioned Despite requiring only minimal implant, this technically demanding surgery requires a thorough understanding of the hip anatomy. This is the first case worldwide reporting 5 year follow up of dysplastic hip with DS treated successfully with periacetabular osteotomy (PAO) technique. An eighteen years old female with DS had multiple posterior hip dislocation episodes since 3 years prior our hospital admission. A modified Ganz PAO was performed under image intensifier guide. Patient was able to talk and hip was never dislocated again within 5 years follow up. Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological outcome.

Various Dosages of BMP-2 for Management of Massive Bone Defect in Sprague Dawley Rat.

BACKGROUND: BMP-2 has a crucial role in the treatment of extensive bone defect. However, data about the optimal dosage of BMP-2 in the massive bone defect casesis rare. METHODS: Twenty-five SD rats were randomly allocated into a control group of hydroxyapatite (HA) alone (Group I), HA+BMP-2 1µg/mL (Group II), HA+BMP-2 5 ug/mL (Group III), HA+BMP-2 10 µg/mL (Group IV), and HA+BMP-2 20 ug/mL (Group V). Osteotomies were performed in each group with 10 mm bone defect in the right femur, followed by fixation and filling the defect. The fracture healing was evaluated by histomorphometry, and radiographs using RUST score. RESULTS: We found there were significant differences in the mean total area of callus between the treatment groups (P<0.001); there were significant differences in the mean area of woven bone between group II, III, IV, and V with the control group (respectively P=0.009, P=0.016, P=0.009 and P=0.016), the area of the cartilage between the treatment groups and control group (respectively P=0.009, P=0.009, P=0.009 and P=0.028). A statistically significant difference was found in the average area of fibrosis between group II and control group, group IV and control group (respectively P=0.047 and P=0.009). RUST scores showed significant differences between the control group and group II, III, IV, V (respectively P=0.005, P=0.006, P=0.005 and P=0.006). CONCLUSION: The administration of BMP-2 stimulates the formation of bone bridging in a massive bone defect. The bone bridging filling massive bone defect depends on the dose or concentration of BMP-2. Administration of an optimal dose (10 µg/mL) of BMP-2 demonstrates better result than lower or higher dose for massive bone defect healing in SD rate.

Surgical technique of percutaneous iliosacral screw fixation in S3 level in unstable pelvic fracture with closed degloving injury and morrell lavallee lesion: Two case reports.

INTRODUCTION: Percutaneous screw fixation is considered the best option in unstable pelvic fracture with severe soft tissue injury. However, fixation technique at the level of S3 has not been well established. This paper showed the feasible surgical technique of S3 screw insertion in unstable pelvic fracture with severe soft tissue injury. METHODS: We reported 2 cases of unstable pelvic injury of an 11 years old boy with Marvin-Tile (MT) C1 pelvic fracture with sacroiliac (SI) joint disruption, skin avulsion and Morel-Lavallée lesion. Second case was 30 years old male with open pelvic fracture MTB2 and vertical sacral fracture Denis zone I with Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence. We performed percutaneous screws insertion on both pubic rami and IS screw on S1 and S3 to both cases. Functional outcome was evaluated using Majeed and Hannover pelvic score. RESULTS: All patients survived and had good reduction with no residual displacement on SI joint. The former case at 21-month follow up presented with excellent outcome (100/100) by Majeed score and very good outcome (4/4) by Hannover score; while the latter case, at 18-month, present with good outcome (85/100) Majeed score and fair outcome (2/4) Hannover score. CONCLUSIONS: Percutaneous screw fixation at the level of S3 is feasible and can be inserted in S3 level by sacroiliac type and sacral type with minimal soft tissue intervention and good functional outcome.

Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3).

BACKGROUND: Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. METHODS: Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). RESULTS: The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. CONCLUSIONS: Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.

Minimally invasive plate osteosynthesis on anterior pelvic ring injury and anterior column acetabular fracture.

INTRODUCTION: In performing surgery for fractures of the pelvis and acetabulum, various surgical approaches have been introduced with their own advantages and drawbacks. The extensile nature of ilioinguinal approach gives excellent exposure but was related to wound healing problems. Modified stoppa has a higher difficulty and poses a risk for neurovascular injury. In this study, we elaborate our experience using the Modified Stoppa approach with additional lateral window while adding few modifications to simplify the procedure and facilitate future implant removal. METHODS: A prospective-retrospective cohort involving 30 anterior pelvic ring and/or anterior column acetabulum fracture patients were conducted from 2012-2016. Fifteen cases were prospectively treated using the modified approach since 2014, while the remaining fifteen cases that were treated using Ilioinguinal approach were retrospectively reviewed. Intraoperative parameters such as blood loss, duration of surgery, quality of reduction (Matta) and postoperative functional outcome (Majeed and Hannover score) at 12 months period were recorded and evaluated by a blinded reviewer. RESULT: There were no significant differences between the two groups in mean age, sex and fracture type. The mean blood loss in the MIPO group were 325 ± 225 mL versus 710.67 ± 384.51 mL in the control group (p = 0.002). Duration of surgery were 149.33 ± 91.92 minutes in MIPO group versus 235.71 ± 65.79 minutes in ilioinguinal group (p = 0.014). There were no significant differences noted between the two groups in the quality of reduction and postoperative functional outcome, either by using Majeed or Hannover pelvic score. No complications were found after a 12-months follow up period. Two modified cases already had their implant removed and during the procedure, fibrotic tissue were minimal making the implant removal was less complicated and easier. CONCLUSIONS: Modified stoppa and lateral window technique can be used as a safe and effective alternative approach for anterior pelvic ring fracture and/or anterior column acetabulum fracture. This approach decreased the duration of surgery and blood loss without compromising the quality of reduction and functional outcome in patients.