Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate.

PURPOSE: Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic-ring injuries; however, this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. This study evaluates whether minimally invasive transiliac locked compression plate stabilisation may be an alternative to sacroiliac screw fixation in unstable posterior pelvic-ring injuries. METHODS: We performed a retrospective analysis of patients with unstable pelvic-ring injuries treated with a transiliac locked compression plate at a level I trauma centre. Outcome evaluation was assessed using the Pelvic Outcome Score and analysis of complications, intraoperative fluoroscopic time, and duration of the surgical procedure. RESULTS: Twenty-one patients were available for follow-up after an average of 30 months. The main findings were as follows: Overall outcome for the Pelvic Outcome Score was excellent in 47.6% (ten patients), good in 19% (four patients), fair in 28.6% (six patients), and poor in 4.8% (one patient). Average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 s. No iatrogenic neurovascular injuries were observed. CONCLUSION: Minimally invasive transiliac locked compression plate stabilisation may be a good alternative to sacral screw fixation because it is quick, safe and associated with a good functional outcome.

Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative.

STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. RESULTS: All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93-1.03). Raw mortality associated with this type of injury was 18% (95% CI 9-32%) in 2006. CONCLUSION: In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis.

Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up.

Recent publications have reported encouraging results with a locked plating system in the management of periprosthetic femoral fractures. However, data on mid- or long-term functional outcome is not available. Here we report on the mid-term functional outcome of 16 patients with a periprosthetic femoral fracture following total hip arthroplasty managed with the LISS-system at a 3-year follow-up. Functional outcome was measured using the Harris Hip score and the Karnofsky activity index. The Harris Hip score and the Karnofsky activity index averaged 79.5 points and 81%, respectively. There were a total of two major complications due to screw pullout representing a complication rate of 13%. This series suggests that the management of periprosthetic femoral fractures with the LIS-System results in a good mid-term functional outcome.

Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle.

Anatomic reattachment of the distal biceps tendon is well established but bears the risk of complications including loss of motion and nerve damage. We questioned whether nonanatomic repair by tenodesis to the brachialis muscle is able to accomplish similar results with less risk. We compared the results of anatomic repair with suture anchors (n = 6) with the results of nonanatomic repair (n = 8). Anatomic reattachment of the biceps tendon can restore full power of flexion in most cases as determined by isokinetic muscle tests (mean, 96.8% compared with the contralateral side). Nonanatomic repair also restores flexion strength to a mean of 96%. Supination power averaged 91% after anatomic repair. Supination strength after nonanatomic repair did not improve in 4 of 8 patients (42%-56% of the uninjured arm). The other 4 patients were able to produce 80% to 150% of the strength of the contralateral side. Major complications such as radioulnar synostosis or motor nerve damage were not encountered in either group. Heterotopic ossification was seen in 4 cases after reinsertion to the tuberosity. One of these patients was not satisfied with the procedure because of anterior elbow pain, even at rest. After tenodesis to the brachialis, one patient was unsatisfied because of considerable weakness. We concluded that major complications after anatomic repair are rare but must not be ignored. Tenodesis of the distal biceps tendon is a safe alternative procedure. We inform our patients about the benefits and risks of anatomic and nonanatomic repair as well as those of nonoperative treatment. The decision concerning the type of therapy best suited for an individual patient should be made on an informed consent basis.