The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring: a report of technique, indications and complications.

AIMS: The anterior pelvic internal fixator is increasingly used for the treatment of unstable, or displaced, injuries of the anterior pelvic ring. The evidence for its use, however, is limited. The aim of this paper is to describe the indications for its use, how it is applied and its complications. PATIENTS AND METHODS: We reviewed the case notes and radiographs of 50 patients treated with an anterior pelvic internal fixator between April 2010 and December 2015 at a major trauma centre in the United Kingdom. The median follow-up time was 38 months (interquartile range 24 to 51). RESULTS: Three patients were excluded from the analysis leaving 47 patients with complete follow-up data. Of the 47 patients, 46 achieved radiological union and one progressed to an asymptomatic nonunion. Of the remaining patients, 45 required supplementary posterior fixation with percutaneous iliosacral screws, 2 of which required sacral plating. The incidence of injury to the lateral femoral cutaneous nerve (LFCN) was 34%. The rate of infection was 2%. There were no other significant complications. Without this treatment, 44 patients (94%) would have needed unilateral or bilateral open reduction and plate fixation extending laterally to the hip joint. CONCLUSION: The anterior pelvic internal fixator reduces the need for extensive open surgery and is a useful addition to the armamentarium for the treatment of anterior pelvic injuries. It is associated with injury to the LFCN in a third of patients. Cite this article: Bone Joint J 2017;99-B.1232-6.

Comparison of arthroscopic and MRI findings of osteochondral damage in knees.

Magnetic resonance imaging (MRI) scans are widely used in the assessment of knees, often prior to arthroscopic procedures. The reporting of osteochondral damage on MRI scans can be variable. The correlation between MRI reports of osteochondral damage and that found at arthroscopy is often inconsistent. A retrospective case-note review of a single-surgeon series of 175 arthroscopic procedures was performed. Eighty-three patients were included in the study. The remainder were excluded if an MRI scan had not been performed or had been performed more than 3-months before surgery. The condition of the articular cartilage demonstrated by MRI was compared to that found at arthroscopy. Data was analysed for presence and extent of osteochondral damage. Comparison between MRI and arthroscopy findings showed high specificity (90%) and negative predictive values (89%) for osteochondral damage but low sensitivity (46%). Cohen's kappa values < 0.2 revealed very poor correlation for the extent of damage. This study demonstrates MRI as a good identifier of osteochondral damage but an unreliable descriptor for such change.

Investigating meniscal symptoms in patients with knee osteoarthritis--is MRI an unnecessary investigation?

The aim of this study was to evaluate the relationship between radiographic knee osteoarthritis and the presence of a relevant meniscal tear detected on MRI in symptomatic patients over the age of 60. Seventy seven patients over the age of 60 who had been investigated with a knee MRI over a 1-year period were identified. Sixty patients had a full set of data available for analysis. Their plain radiographs were blindly graded for osteoarthritis using the Kellgren-Lawrence (K-L) scale. The indications for the MRI were subdivided into: meniscal symptoms, general knee pain and "other". These indications were correlated with the K-L grade and result of the MRI. Overall, 40% of patients with a K-L grade of 0 had a meniscal tear compared to 89% of patients with a K-L score of 3, and 88% with a K-L score of 4. The indications for an MRI were grouped into meniscal symptoms (49), general pain (6) and other (5). In the group investigated for meniscal symptoms, the incidence of meniscal tears was 92% and 100% with a K-L grade of 3 and 4 respectively. This equated to a positive predictive value of 93% for K-L grade 3 and above, and 100% for K-L grade 4 alone. Given the predictability of the MRI findings in patients with significant osteoarthritis as well as meniscal symptoms, we conclude that this is an unnecessary investigation when used for this indication.