Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study.

BACKGROUND: Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture. AIM: To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries. METHODS: A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score. RESULTS: The results revealed a statistically significant difference between both groups (P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (P = 0.513). A lower surgical site infection rate was noticed in the INFIX group (P = 0.007). CONCLUSION: Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

Minimally invasive stabilization of posterior pelvic ring injuries through transiliac internal fixator versus Iliosacral screw: A prospective comparative cohort study.

INTRODUCTION: Longitudinal sacral fractures are usually a matter of controversy regarding decision-making for reduction, fixation, and approach. Percutaneous and minimally invasive techniques present perioperative difficulties, but with fewer postoperative complications compared to open techniques. The objective of this study was to compare the functional as well as radiological outcomes of the Transiliac Internal fixator (TIFI) versus Iliosacral screw (ISS) fixation of sacral fractures applied percutaneously in a minimally invasive technique. METHODS: A Prospective comparative cohort study was conducted in a level 1 trauma center in a university hospital. The study included 42 patients with complete sacral fractures, 21 patients have been allocated to each group (TIFI group & ISS group). The clinical, functional, as well as radiological data, were collected and analyzed for the 2 groups. RESULTS: The mean age was 32 (18 -54 years), and the mean follow-up was 14 (12 -20 months). There was a statistically significant difference in favor of the TIFI group regarding a shorter operative time (P = 0.04) as well as less fluoroscopy time (P = 0.01) whereas there was less blood loss in the ISS group (P = 0.01). Both the mean Matta's radiological score, the mean Majeed score as well as the pelvic outcome score were comparable between the 2 groups with no statistically significant difference. CONCLUSION: This study suggests that both TIFI and ISS through a minimally invasive technique represent valid methods for sacral fracture fixation with a shorter operative time, less radiation exposure in TIFI and less blood loss in the ISS. However, the functional, as well as radiological outcomes, were comparable between the 2 groups.

Salmonella serovars in sheep and goats and their probable zoonotic potential to humans in Suez Canal Area, Egypt.

BACKGROUND: Salmonella is one of the most common and economically important zoonotic pathogens. This study aimed to determine the occurrence of Salmonella serovars in sheep and goats and their probable zoonotic risk to humans in Suez Canal area in Egypt. A total of 320 fecal samples from sheep (n = 120), goats (n = 100), and humans (n = 100) were collected and examined for the presence of Salmonella based on cultural and biochemical characteristics, and serological analysis. Moreover, the virulence of the identified Salmonella isolates was assessed by molecular screening for invA, stn, spvC, and sopB virulence genes using PCR. RESULTS: Overall, the occurrence of Salmonella in sheep feces (23.3%) was higher than that in goat feces (7%) and human stool (13%) in the study area. The identified isolates belonged to 12 serotypes; ten, five, and eight from sheep, goats, and humans, respectively. The most frequently identified serotypes were S. Typhimurium from sheep feces, and S. Enteritidis from both goat feces and human stool, with four serotypes; S. Typhimurium, S. Enteritidis, S. Dublin and S. Saintpaul, were mutually shared between all of them. Demographic data revealed that diarrheic sheep (85.7%) and goats (25%) had a higher risk for Salmonella fecal carriage than non-diarrheic ones (19.5% and 6.25%, respectively). The prevalence of Salmonella infection in humans in contact with sheep and goats (28%) was significantly higher than its prevalence in people having a history of contact with animals other than sheep and goats (10%) and those having no history of animal contact (7.3%) (χ2 = 6.728, P ˂ 0.05). The stn, spvC, and sopB genes were detected in 98.1% of the isolates, with a significant, very strong positive correlation for their mutual presence (P < 0.05). Approximately 40.7% of isolates that carried the invA gene had a non-significant, very weak positive correlation with other virulence genes. The most common genotypic virulence profile for all isolates was stn, spvC, and sopB; however, invA, stn, spvC, and sopB was the frequent virulotype for S. Typhimurium, S. Tsevie, S. Apeyeme, and S. Infantis. CONCLUSIONS: The present study highlights the role of apparently healthy and diarrheic sheep and goats as reservoirs and sources of human infection with virulent Salmonella serovars in the Suez Canal area.

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up.

OBJECTIVES: To evaluate the results of a new plate system using anterior approaches in the management of acetabular fractures. DESIGN: Retrospective case-note review. SETTING: Pelvic and acetabular tertiary center. PATIENTS AND INTERVENTION: A consecutive series of acetabular fractures treated using only anterior approach and anatomical plates, at one tertiary specialist unit, were reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up) were recorded. MAIN OUTCOME MEASUREMENT: Postoperative reduction (measured by postoperative plain radiographs and computed tomography). RESULTS: Thirty-three patients (mean age, 57 years) underwent reconstruction with the anatomical plates using anterior approaches. Associated both columns and anterior column posterior hemitransverse represented most of the patients (85%). The fracture pattern was complex with quadrilateral plate involvement in 79% of cases. Overall, anatomic reduction was seen in 82% on plain radiographs and CT scan evaluation. Increasing age was a statistically significant variable in obtaining anatomical reduction with an age cutoff value of 70 years ( P 0.012). Associated both column fractures were associated with a lower incidence of anatomical reduction ( P = 0.038). Complication rates were comparable with the literature. 22 patients (71%) were symptom free, with 20 patients (62.5%) having excellent radiographic outcomes at the latest follow-up. CONCLUSIONS: The results suggested that using approach-specific instruments and anatomical plates through anterior approaches in a specialized unit led to anatomical reconstruction in 82% with patients demonstrating satisfactory early radiological and functional outcomes at 1 year. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Long-term outcome of patients with primary or secondary tumors of the proximal femur treated by bipolar modular tumor prosthesis.

PURPOSE: The proximal femur is a common area for primary and also metastatic bone tumors. The objective of this study was to assess the long-term functional and oncological outcomes of patients with malignant primary or secondary tumors of the proximal femur, who underwent proximal femoral resection then reconstruction using bipolar modular tumor prosthesis. METHODS: Sixty patients with proximal femoral malignant tumors underwent resection and bipolar modular prosthesis between 2000 and 2016, were retrospectively reviewed. Based on diagnosis and presence or absence of pathological fracture, patients were divided into groups. The functional outcome of the patients was evaluated using the Musculoskeletal Tumor Society (MSTS) functional scoring system for the lower extremities. RESULTS: The mean age was 38 (9-80) years at the time of primary surgery. Pathological fracture was the presentation in 28 patients. The study included 44 patients with primary bone tumor and 16 patients with a secondary bone tumor. The mean MSTS functional score of the patients was 24.3 (range, 18-30) points with no significant difference in patients with primary or secondary tumors. The rate of complications in the present series was 45%. The most frequent complication was an infection in 10 patients (16.7%), followed by aseptic loosening in 7 patients (11.7%). Local recurrence of primary bone tumors occurred in three out of 44 patients (6.8%). CONCLUSION: Modular bipolar tumor prosthesis has a good long-term functional result in both primary and secondary tumors of the proximal femur, with no significant effect of age, presence or absence of pathological fracture or femoral resection length on the functional outcome. It was found that the only statistically significant variable regarding the risk of infection is previous surgeries. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial.

INTRODUCTION: Biomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures. METHODS: Thirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta's radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset. RESULTS: Fifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12-24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups. CONCLUSION: Single poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.

Quadrilateral plate fractures of the acetabulum: Proposition for a novel classification system.

BACKGROUND: Currently, there is no definition or classification system for quadrilateral plate (QLP) fractures; the aim was to anatomically and radiologically characterise the QLP, propose a definition and classify QLP fractures. METHODS: This study included an anatomical component and a radiological component. The anatomical study aimed at defining the characteristics of the QLP; the QLP was identified using four articulating bony pelvis specimens. A titanium mesh was placed on the specimens' quadrilateral surface; standard anteroposterior and oblique views were obtained, and axial CT images, to determine the radiological landmarks. The radiological study included the review of images of patients with QLP fractures; fractures involving the QLP were identified in a series of 609 consecutive patients with acetabular fractures. RESULTS: We considered QLP fractures where the QLP is separated from both columns of the acetabulum; this was found in 16% (98 cases). They were mostly encountered with associated both columns fractures (60 cases; 61%), Separation of the QLP could be complete or incomplete, or simple or comminuted, so QLP fractures were divided into three types: QLP1, simple with incomplete separation; QLP2, comminuted with incomplete separation; QLP3, comminuted with complete separation (QLP4), simple with complete separation. CONCLUSION: The QLP was characterised, and a definition and classification system; Cairo University Hospitals (CUH) Classification was proposed for these fractures. We believe that this classification may prove useful in the future for the identification and management of these fractures.

Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees.

OBJECTIVES: The objective of this study was to evaluate and compare the outcome of the crossed and the lateral pin configurations in the management of supracondylar humeral fractures in children in the hands of junior trainees. DESIGN: Prospective randomized controlled trial. SETTING: Level I Trauma Center. PATIENTS: Sixty children with supracondylar humeral fractures. The mean age was 5.1 years (1.5-9 years). The minimum follow-up period was 6 months, with no patients lost to follow up. INTERVENTION: Thirty patients were managed by crossed and 30 by the lateral method. All surgeries were performed by junior trainees in their first 3 years of training. MAIN OUTCOME MEASUREMENTS: Postoperative stability, ulnar nerve injury, range of motions, and pin tract infection. RESULTS: The crossed configuration was stable in all the patients, whereas the lateral method was less stable in 20% of the cases because the distal fragment rotated in 5 patients and posteriorly displaced in 1 patient. The difference was statistically significant with a P value of 0.031. Ulnar nerve neurapraxia occurred in 1 patient from the lateral group and it recovered in the fourth month, whereas no ulnar nerve injury occurred in the crossed configuration group. Two patients in the lateral group lost approximately 100 of elbow flexion. CONCLUSIONS: This prospective randomized controlled trial showed that the crossed pin configuration method provided more stability than the lateral pin configuration, especially, in the hands of junior trainees in their first 3 years of training, and the difference was statistically significant. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Position of the popliteal artery in revision total knee arthroplasty.

BACKGROUND: Injury to the popliteal artery during total knee arthroplasty is a devastating complication. This topic was studied previously prior to primary total knee arthroplasty. This study aims to demonstrate the position of the popliteal artery in patients prior to revision total knee replacement. METHODS: The ultrasound scan results of the position of the popliteal artery in 23 patients were reviewed. The implant/artery distance at different levels was measured with the knee in extension and 70°-90° of flexion. RESULTS: There was no significant difference in the artery position at the level of the tibial metal base plate (the most critical site) on moving the knee from extension to flexion (P = 0.26). However, the implant/artery distance was found to increase on moving from extension to flexion in relation to the femoral component at the joint line (69%), as well as 15 mm below the level of the tibial base plate representing 69.3%. There was a significant difference at 15 mm above the joint line, where the distance was found to be increased in 84.6% of cases (P = 0.019). CONCLUSION: This study has shown that in a revision knee situation, there is no reliable fall back of the popliteal artery in knee flexion; in fact, implant/artery distance may be decreased and caution must be exercised throughout the procedure. It may be worth considering either ultrasound or arteriography in selected cases.