Systematic Review of Combined Pelvic Ring and Acetabular Injuries: What Do We Know From the Literature?

The purpose of this review is to examine the literature on combined pelvic ring and acetabular fractures. We hope to further define the classifications, severities (ISS & Mortality), healing, radiographic parameters, and functional outcomes of such injuries to report all potential recommendations based on findings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a systematic search on PubMed and Google Scholar was performed. Articles included were in the English Language or through English translation, between the years 1996 and 2022. Articles that had met the inclusion criteria were systematically assessed for the relevance of their content. Eleven articles were identified with a total of 985 patients. All eleven were retrospective case series and the presence of both an injury within the pelvic ring and another injury within the acetabulum, either ipsilateral or contralateral, was the indication of a combination injury. The overall mortality rate averaged over all studies was 7.9% and the Injury Severity Score (ISS) of 22.98. When considering the higher mortality rate seen in pelvic ring injuries compared to the isolated acetabulum, there appears to be survivability beyond reductive means as a reason for reducing and fixing the pelvic ring first. However, accurate reduction of the acetabulum has a greater weight in overall patient recovery compared to the reduction of the pelvic ring and thus surgical emphasis on the anatomic reduction of the acetabulum may be paramount. Despite this good to excellent outcomes can be achieved with careful preoperative planning and surgical execution in patients with fractures of the pelvic ring and acetabulum. Further research as well as uniform radiographic scoring system and outcomes scores should be required to better evaluate and treat these injuries.

Combined Pelvic Ring Disruption and Acetabular Fracture: Outcomes Using a Sequential Reduction Protocol and an Anterior Subcutaneous Pelvic Fixator (INFIX).

OBJECTIVE: The purposes of this article were to (1) compare our combined pelvic ring and acetabular fracture patients' rate of mortality and Injury Severity Score (ISS) to those of patients with isolated injuries at our center and to those with combined injuries as reported in the literature, (2) describe our treatment algorithm using the INFIX for these combination injuries, and (3) report our patients' radiographic and functional outcomes. DESIGN: Retrospective IRB-approved case series and literature review. SETTING: US Level 1 Trauma Center. PATIENTS/PARTICIPANTS: Thousand six hundred ninety-seven with acetabular or pelvic ring injury, 174 patients with combination pelvic ring acetabular injuries, and 39 patients with 41 acetabular injuries treated with a surgical protocol. INTERVENTION: Pelvic ring reduction using INFIX and posterior fixation followed by acetabular reduction fixation. Anterior injury fixed with INFIX. MAIN OUTCOME: Mortality, ISS, pelvic reduction by Keshishyan index, acetabular reduction by the Matta criteria, and functional outcome by the Majeed score. RESULTS: Mortality was 5.7% and ISS was 12.5 for 174 combined injury patients. In the 39 patients with 41 injuries, excellent pelvic reduction was found in 39, and acetabular reduction was anatomic in 25 (61%), imperfect in 12 (29%), and poor in 4 (10%). Clinically 78% of the patients had good or excellent outcome and 22% had a fair or poor outcome. Nonanatomic acetabular reduction, persistent sciatic nerve palsy, and heterotopic ossification associated with poor clinical outcome. CONCLUSIONS: Our treatment protocol resulted in excellent pelvic reduction, anatomic acetabular reduction in 61% of patients, and 78% good to excellent clinical outcome. LEVEL OF EVIDENCE: Case series Level IV.

Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report.

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.

Use of the Mini TightRope® for correction of hallux varus deformity.

The flexible form of acquired hallux varus has historically been treated with a number of applicable soft tissue procedures, most of which combine medial capsular release with adjunct procedures aimed at restoring the transverse plane balance of the digit. In this report, a surgical technique for correction of hallux varus that employs the use of an implanted button and suture device, namely the Mini TightRope(®), is described. Rather than relying on the patient's own soft tissues, this device applies tension to anchor the hallux in the proper alignment. The device is easily adjusted during the course of the surgery and readily enables accurate correction of the hallux in the transverse plane. The indications, technical execution, postoperative care, and potential complications related to our use of the Mini TightRope(®) for correction of hallux varus are described, and the case of an adult woman who underwent the procedure for correction of acquired hallux varus is presented. In the authors' experience, the Mini TightRope(®) is a viable option that mimics restoration of the lateral collateral ligaments of the first metatarsophalangeal joint, and we believe this technique to be superior to other soft tissue surgical procedures used to repair flexible hallux varus.