Forces required to dynamize sliding screws in gamma nail and selfdynamizable internal fixator.

BACKGROUND: Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. METHODS: Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) - SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. RESULTS: Positive correlation between Qt and Qa was confirmed (p < 0.05). While performing higher bending moments in all the tested implants, Qa was higher than it could be provided by the body weight. It was the highest in Gamma Nail, and the lowest in SIF-10. CONCLUSIONS: A larger contact surface between a sliding screw and stem results in lower forces required to initiate dynamization of a sliding screw. Patients treated for a pertrochanteric fracture by a sliding screw internal fixation who have longer femoral neck or higher body weight could have different programme of early postoperative rehabilitation than lighter patients or patients with shorter femoral neck.

The Association of Sagittal Spinal Posture among Elementary School Pupils with Sex and Grade.

The objective of this research was to analyze and elucidate the sagittal spinal posture status in older elementary school children, considering their gender and grade differences. The study involved 484 school children (252 males and 232 females) from grades V to VIII, assessed for sagittal spinal posture using the Formetric 4D System. The analysis, employing the Chi-squared test of independence along with the Z-test, did not reveal significant grade-related differences (p < 0.52) in the incidence of normal sagittal alignment or diagnosed outliers. However, within grade levels, no significant difference was observed for male participants (p < 0.80), while a significant difference was identified for females (p < 0.01). Examining gender differences across grades, a disparity was noted only among seventh graders concerning normal spine alignment and outlier existence (p < 0.01), favoring male participants. Regardless of the grade, a significant gender difference emerged in the location of diagnosed outliers: kyphosis (M = 108 vs. F = 72), lordosis (M = 5 vs. F = 14), kypholordosis (M = 18 vs. F = 66), and flatback outlier of the lumbar spine (M = 27 vs. F = 11). These findings suggest potential adjustments to the curriculum and highlight the need to tailor physical education instruction based on this study's outcomes. Consequently, these results imply the importance of a differentiated approach in preventing sagittal plane outliers of the spine in adolescent children.

[The role of capsuloligamentotaxis and minimally invasive percutaneous osteosynthesis with rigid and dynamic unilateral external fixation of the intra-articular pilon fracture]. / Die Rolle der Kapsel-Ligamentotaxis und der minimalen perkutanen Osteosynthese mit starrer und dynamischer einseitiger externer Fixierung bei der intraartikulären Pilonfraktur.

Fractures of the tibial pilon are severe injuries which can be accompanied by articular impaction, comminution and soft tissue injury. Soft tissue injury with already existing skin damage can further complicate the method of treatment. In these cases, the method of unilateral or circular external fixation can be used as an alternative method of treatment. Minimally invasive percutaneous osteosynthesis with spanning rigid and dynamic unilateral external fixation as a one-stage method has been used for the treatment of intra-articular pilon fractures. We report a case of a patient with an intra-articular pilon fracture with chronic venous insufficiency and venous ulcer, who was injured after falling from a height and who had emergency surgery based on capsuloligamentotaxis and percutaneous osteosynthesis with a spanning unilateral external fixator. The patient was mobilized postoperatively for walking without weight bearing on the injured leg. The initial rigid spanning external fixation was transformed into dynamic fixation to enable ankle joint movements 8 weeks after surgery. The external fixator was removed 4.5 months after surgery and the Kirschner wire and screws were removed 7 months after surgery. The final functional result 1 year after the injury was good and motion of upper ankle joint was moderately restricted without pain. Swelling occurred after walking for longer distances.

The Influence of Body Composition on Sagittal Plane Posture among Elementary School-Aged Children.

Proper posture, characterized by the appropriate alignment of the cervical, thoracic, and lumbar segments of the spine, enables these regions to maintain their normal curvature. Body composition is recognized as one of the factors that can influence overall postural alignment of the spine. The objective of this study was to determine the influence of the parameters of body composition on the prevalence of postural disorders in the sagittal plane. The cross-sectional study was conducted on 152 children of both genders (78 boys), at a mean age of 11 years ± 6 months. In order to evaluate postural disorders, the Formetric 4D System, a tool manufactured by Diers, Schlangenbad, Germany was used. Based on its output data, the following variables were obtained: hyperkyphosis, hyperlordosis, kypholordosis, flatback, and normal alignment of the body in the sagittal plane. The evaluation of body composition parameters was conducted using the InBody 770 device. To determine how body composition influences the postural status of the spinal column, a discriminant analysis was employed. The results showed that approximately 65.8% of children exhibit various types of postural disorders when assessing the alignment of the spine in the sagittal plane. The most prevalent disorder observed was hyperkyphosis, affecting 34.2% of the subjects, followed by kypholordosis at 16.4%. Moreover, the results demonstrated that body composition significantly influences body posture (p = 0.004). An increase in fat mass corresponds to a deviation from normal body posture, whereas an increase in the percentage of skeletal muscle mass and fat-free mass is associated with a reduction in postural abnormalities in the sagittal plane. Considering the results, it is clear that body composition parameters serve as more reliable predictors of the influence on body posture compared to simply calculating the body mass index. Furthermore, it can be concluded that there are consistent patterns of influence by specific body composition parameters, including fat mass, percentage of skeletal muscle, and fat-free mass, on body posture among children from various climates. These results underscore the significance of implementing strength exercises in children, particularly during periods of rapid growth and development, as a means of preventing and correcting postural disorders.

Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture.

PURPOSE: Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN. METHODS: We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38 years in Group A, 5.59 years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes. RESULTS: In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12 h after injury, we had AVN in one (4.34%) patient, with reduction 12-24 h, AVN was present in two (8.69%), while in hip reduction done after 24 h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05). CONCLUSION: An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.

Influence of coronavirus disease 2019 pandemic state of emergency in orthopaedic fracture surgical treatment.

PURPOSE: After the appearance of first COVID-19 cases in Serbia, state of emergency was declared on 15 March 2020 and lasted for 54 days. The aim of this report is to compare orthopaedic fracture frequencies in this period, when the walk was limited at the home mostly, with those during the same part in the previous year with regular state, thus to examine staying at home as a factor influencing the frequency of different fracture types. METHODS: There were 86 patients during the state of emergency in year 2020 and 106 patients during the same part of year 2019 with a regular state, having orthopaedic trauma surgery. Number of fractures, gender distribution, and age of patients have been compared between these periods. RESULTS: Total number of fractures decreased for about 19% during the state of emergency. There was nonsignificant difference in fracture frequency for all skeletal areas (p > 0.05), except for distal femoral fractures which occurred more often during the state of emergency (p < 0.05). Female ratio was higher during state of emergency than in regular state for femoral neck fractures. CONCLUSION: Restricted going outside the home for 54 days has the influence in total number of fractures and gender distribution in femoral neck fractures. The method of external fixation used could be assumed as a reducing factor of intraoperative virus pandemic propagation among medical staff.

Lateral tibial plateau fractures-functional outcomes and complications after open reduction and internal fixation.

PURPOSE: Tibial plateau fractures are severe intra-articular injuries; their treatment is accompanied by numerous complications and requires extensive surgical experience. In this manuscript, we compared our experiences with data from the literature. METHODS: Retrospectively, we analyzed 41 patients with closed lateral tibial plateau fracture (Schatzker's I-III). All fractures were treated surgically with open reduction and internal plate fixation. Post-operative complications and final outcomes were monitored according to the Tegner Lysholm Knee Scoring System. The average follow-up was 5.7 years (2-10). RESULTS: We analyzed 41 patients (Schatzker I-III), average age 46.7 ± 13.0 years. Traumatic lesion of the lateral meniscus was present in 15 (36.58%) patients. Post-traumatic knee osteoarthritis was present in all (100%) patients after lateral meniscectomy and in 20% of patients it occurred after meniscus repair (p = 0.007). Post-traumatic knee osteoarthritis was present in 12 (29.68%) patients. Infection occurred in five (12.19%) patients, DVT in three (7.3%) patients, and we had one (2.43%) case of non-lethal PE. Final functional outcomes were excellent in 13 (31.7%), good in 21 (51.21%), moderate in five (12.19%), and poor in two (4.87%) patients. CONCLUSION: Lateral tibial plateau fractures are severe intra-articular injuries which can leave lasting consequences, regardless of the restoring of the articular surface and stable internal fixation. Local skin condition and associated soft tissue injuries, comminution, degree of dislocation, and depression can significantly affect the development of post-traumatic osteoarthritis and poor outcomes.

Total hip arthroplasty after acetabular fracture surgery.

PURPOSE: Acetabular fractures are accompanied by complications such as post-traumatic osteoarthritis (OA) of the hip and avascular necrosis (AVN) of the femoral head. The aim of the study was to evaluate improvement of life quality and functional recovery after total hip arthroplasty (THA) in patients with post-traumatic OA and AVN. METHODS: We retrospectively reviewed 23 patients with post-traumatic OA of the hip and AVN of the femoral head who undergone THA, out of 63 patients who were previously surgically treated for acetabular fractures. Final functional outcomes are defined according to the Merle d'Aubigné score, and the pain intensity according to VAS from 0 to 10. RESULTS: Out of 63 patients with acetabular fractures from 2008 to 2018, we analyzed 23 (36.5%) patients, with an average age of 51.5 ± 13.8 years, who required THA due to post-traumatic OA and AVN of the femoral head. THA was done after the average of 4.28 years (range 1 to 8) from previous acetabular osteosynthesis. According to Merle d'Aubigné score, final functional outcomes before THA were moderate with average points of 4.86 (4-6). Post-THA final functional outcomes were excellent with an average point of 10.04 (10-12) (p < 0.001). The ratio of VAS before and after THA was 9.04:1.95(p < 0.001). CONCLUSION: THA is a method which gives the best results in the treatment of post-traumatic OA of the hip and AVN of the femoral head after previous osteosynthesis of the acetabular fracture. After THA, life quality and functional status of a patient are significantly improved.

External fixation of segmental tibial shaft fractures.

PURPOSE: Tibial shaft fractures are the most common type of large long-bone fractures. Segmental tibial shaft fractures are severe injuries and its treatment can be followed by a high incidence of complications, nonunion, delayed union, malunion, infection or compartment syndrome. The most common treatment strategy is intramedullary fixation. Results of the unilateral external fixation treatment for segmental tibial shaft injuries are presented in this paper. METHODS: Patients with segmental tibial shaft fractures, AO/OTA 42-C2 were treated as urgent cases by unilateral external fixation. Mitkovic-type external fixator was used in all of these fractures. RESULTS: There were 32 patients with segmental tibial shaft fractures (AO/OTA 42-C2), 20 males and 12 females, average age of 43.5 years. Average time of union was 5.9 (4.1-7.4) months for closed and 6.2 (5.1-7.9) months for open fractures. Average follow-up was 18 (26-60) months. Nine patients (28.12%) had open segmental tibial shaft fracture (2 Grade I, 2 Grade II, 1 Grade IIIA, 4 Grade IIIB). Union rate was 81.25% (26 cases). Nonunion rate was 18.75% (6 cases) and malunion 3.12% (1 case). Nonunion was higher in patients with open fractures (4). Compartment syndrome had been diagnosed in 6 cases (18.75%) with closed fracture and fasciotomy was performed when external fixator was applied. There were no deep infections. Pin tract infection was present in 7 cases (21.85%). CONCLUSION: Treatment of segmented tibial shaft fractures can be followed by a number of complications. Unilateral external fixation with convergent orientation of pins provides three-dimensional stability of the fracture and good biomechanical conditions for fracture healing, with lower complications rate.

First experiences with the Fitmore® hip stem: Early results of the 16-month monitoring.

Background/Aim: Fitmore® hip stem belongs to the group of short stem prostheses with the metaphysar stabilization, with its shape and form that protects the bone mass in the greater trochanter region and the distal part of the femur. The aim of this paper was to present the early postoperative results in patients with implanted Fitmore® hip stem and point out some of the advantages. Methods: A series of 10 patients with implanted Fitmore® hip stem, was included in this study. The average age of the patients was 54.5 (48­65) years. There were 5 women and 5 men. The total monitoring time was 16 months. To rate the condition of the hip joint we used The Western Ontario and Mc Master Universities Arthritis Index (WOMAC) score. We also monitored the degree of hip pain, hip flexion, heterotopic ossification and indentation in the stem of the prosthesis. Results: After 12 months of monitoring 9 (90%) of the patients had no pain in the thigh region, and only 1 (10%) experienced mild pain. The hip flexion rose from the average 89° to postoperative 114°. WOMAC score rose as well, from 49 to 94 average points. Indentation in the stem was registered 3 months after the operation in 2 (20%) of the patients ­ in one of the patients the indentation was 3 mm and in the other patient 5 mm. After the 16-month monitoring, the results were excellent. The monitoring period was short though it should be continued and the results should be presented after 5 and then after 10 years. Conclusion: Early results of the implantation Fitmore stem showed good bone ingrowth with excellent functional result.

Influence of disease activity on functional capacity in patients with rheumatoid arthritis.

BACKGROUND/AIM: Progressive erosive changes in cartilage and bone in rheumatoid arthritis (RA) ultimately lead to joint deformities and disability which may be early, severe and permanent. Consequently, there is the reduction of functional ability and changes in the quality of life. The aim of this study was to estimate the impact of disease activity on functional status of patients with RA. METHODS: A prospective investigation included 74 patients with RA who were treated in the Rheumatology Clinic of the "Niska Banja" Institute. Assessment of functional status (capacity) was measured by the Health Assessment Questionnaire (HAQ) with the values from 0 to 3 that patients fill out on their own. The patients were then divided into three groups: the group I with the HAQ values from 0.125 to 1.000, the group II with the values from 1.125 to 2.000 and the group III with the values from 2.125 to 3.000. Disease activity was measured by Disease Activity Score (DAS28). The assessment also included sedimentation rate (SE) influence, IgM rheumatoid factor (RF) and C-reactive protein (CRP) positivity, age, and disease duration. RESULTS: The patients with the most severe functional damage estimated by the HAQ--the group III, had the highest values of DAS28 SE (7.4 ± 0.8) compared to the group II (6.5 ± 1.2) and the group I (3.4 ± 1.2). The group III also showed the highest values of DAS28 CRP (7.1 ± 0.8) compared to the group II (6.7 ± 0.8) and the group I (3.6 ± 0.4). Compared with the patients with small and moderate functional damage, the patients in the group III had positive IgM RF and CRP as well as higher SE values more frequently and the difference was statistically significant. In the univariate logistic model, the tested parameters of DAS28 SE, DAS 28 CRP, SE, RF and CRP represent significant predictors of functional disability. The most significant factors that increase the odds of patient having the most severe functional damage include DAS28 SE which increases the odds by 5.5 times (OR = 5.450, 95% CI = 3.211-7.690, p = 0.001), DAS28 CRP by 5.1 times (OR = 5.111, 95% CI = 2.123-10.636, p < 0.01), and the presence of increased CRP (OR = 5.219, 95% CI = 1.305-18.231, p = 0.019) by 5.2 times. CONCLUSION: Functional status evaluated by the HAQ is a standard for as- sessment of RA due to its convenience and good correlation with parameters of disease activity. The most significant factors that increase the odds that the patient has the greatest functional damage are DAS28 SE, DAS28 CRP and the pres- ence of CRP.

Relation between bone mineral density and IL-17 serum levels in Serbian patients with early Rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation and destruction of joint cartilage and bone. Different cytokines play important role in the processes that cause articular destruction and extra-articular manifestations in RA. The contribution of cytokines representing the Th1 (INF-γ), Th2 (IL-4) and IL-17A to the pathogenesis of early RA and bone mineral density (BMD) loss in still poorly understood. Serum samples of 38 early RA patients were evaluated for erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide antibodies (anti-CCP) and for the tested cytokines (IL-17A, IL-4 and INF-γ). BMD was evaluated by dualenergy X-ray absorptiometry (DXA). Disease activity score (DAS28) calculation was assessed for all patients. Control serum samples were obtained from 34 healthy volunteers. The levels of tested cytokines were significantly higher (IL-17A, p<0.001; INF-γ, P<0.001; IL-4, P<0.01) in patients with early RA, compared to the healthy controls. In early RA patients, strong correlation of serum IL-17A was found with DAS28, ESR and CRP. Also, a significant negative correlation was found between serum INF-γ levels and the DAS28 score. Significantly positive correlation of BMD values and CRP, DAS28 IL-17A were also demonstrated. DXA analysis revealed that the most common site for osteoporosis was the lumbar spine followed by the femoral neck. BMD values significantly correlated with CRP, DAS28 score and IL-17A serum levels. The mean serum IL-17A levels, in patients with early RA, corresponded with disease activity, severity and BMD loss, indicating the potential usefulness of serum IL-17A in defining the disease activity and bone remodeling.

Early clinical results of surgical treatment of patients with femoroacetabular impingement.

INTRODUCTION: Surgical treatment is the treatment of choice in patients with symptoms and radiological signs of femoroacetabular impingement. OBJECTIVE: Our experience and early results of surgical treatment of patients with signs of femoroacetabular impingement and early hip osteoarthritis are reported. METHODS: The results of treatment of 21 patients aged 23-54 years with different types of femoroacetabular impingement are presented. Safe open surgical dislocation of the hip was performed in all patients. Before and after surgery, the WOMAC score was performed, clinical and radiographic data of the operated hips were evaluated and t-tests were used for statistical analyzes of data. RESULTS: The WOMAC score improved from 70.5 points (range 56.3 to 89.8 points) to 90.3 points (range 70.3 to 100 points) at one year of follow-up (p < 0.0001), anterior impingement test was negative in all operated cases, average hip internal rotation improved significantly, no complications were found, except trochanteric nonunion at the site of osteotomy, which was reaffixed. CONCLUSION: Postoperative results have shown that the surgical approach to treating patients with femoroacetabular impingement is the method of choice. Three operated patients, with advanced osteoarthritis of the hip, had to be converted to total hip replacement.

Serum levels of IL-17, IL-4, and INFγ in Serbian patients with early rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease with autoimmune etiology, characterized by synovial inflammation and destruction of joint cartilage and bone. There are controversial data about the profile of interleukin-17 (IL-17A), interleukin-4 (IL-4), and interferon-gamma (INFγ), indicating in some studies the key role of IL-17, while in others the Th1 cytokines. MATERIALS AND METHODS: Serum samples of 31 early RA patients were evaluated for erythrocytes sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide antibodies (anti-CCP), and for the tested cytokines (IL-17A, IL-4, and INFγ). Disease activity score (DAS28) calculation was done for all patients. Control serum samples were obtained from 29 healthy volunteers. RESULTS: The levels of tested cytokines were significantly higher (IL-17A, p < 0.001; INFγ, p < 0.001; IL-4, p < 0.01) in patients with early RA, compared to the healthy controls. In early RA patients, a strong correlation of serum IL-17A was found with DAS28, ESR, and CRP. Also, significant negative correlation was found between serum INFγ levels and the DAS28 score, indicating that INFγ may play a key role in maintaining immune homeostasis in patients with RA. CONCLUSION: The mean serum IL-17A levels in patients with early RA, corresponded with the disease activity and severity. This might highlight the usefulness of the serum IL-17A level in defining the activity and predictive patterns, for aggressive disease therapy, and it might express specific therapeutically targets.

Urinary tract injury associated with pelvic fractures.

INTRODUCTION: Pelvic trauma associated with urinary tract injury is a severe trauma, mostly caused by traffic accidents and falls from heights. These injuries require urgent treatment and close teamwork between urologic and orthopaedic surgeons. MATERIAL AND METHODS: In this retrospective study there were analyzed patients with pelvic trauma and extraperitoneal injury of urinary tract, treated surgically at Clinic for Ortopaedic Surgery and Traumatology and Urology Clinic in Clinical Center Nis. Surgical intervention in these patients had been realized as the synchronized work of both orthopaedic and urologic surgeons. The pelvis was treated by external and internal fixation. Mitkovic type external fixator was used for pelvic external fixation. Plating was used for pelvic internal fixation. Pelvic fractures were classified using Tile's classification system. The final functional results had been scored using Majeed score system. RESULTS: There were 42 patients with the injury of pelvic ring, treated at Clinic for Ortopaedic Surgery and Traumatology and at Urology Clinic, Clinical Center Nis, in the period of 01.01.2011. to 31.12.2013, 30 males and 12 females, with average age of 53.69 (19-84) years old. In 80% of cases pelvic fractures were caused by high energy trauma in traffic accidents. According to Tile's classification, 9 patients (21,42%) had pelvic fracture type A, 23 patients (54,46%) had pelvic fracture type B and 10 patients (23,80%) had pelvic fracture type C. Urinary tract injury was diagnosed in 9 patients (21,42%): 5 patients (11,9%) with bladder injury, 3 patients (7,14%) with posterior urethra injury and 1 patient (2,38%) with both bladder and posterior urethra injury. CONCLUSION: Urgent repair of extraperitoneal urinary tract injury by urologic surgeons and synchronized pelvic reduction and fixation using external or internal fixation by ortopaedic surgeon, in the same surgical procedure, is the standard method for treatment of this severe injury.

Nature and results of treatment of war wounds caused by cluster bombs.

The aim of this study is to describe the nature of war wounds with fracture caused by cluster bombs and to suggest treatment options for such injuries. The nature of wounds caused by cluster bombs differs from those caused by conventional arms (they are more severe). The sides of the wounds are represented by conquasated soft tissues (such as fat and muscle) with thick dead tissues, ordinarily with a thickness of 0.5-4.5 cm. Another main characteristic of such injuries is the high percentage of amputations needed due to the high rate of neurovascular damage. This paper investigates the cases of 81 patients who sustained a total of 99 war wounds with fractures. The average age of the patients was 32.7 years while the youngest was 20 and the oldest, 77. According to The International Committee of the Red Cross (ICRC) classification of war wounds, 14 patients had grade I injuries, 48 patients grade II, and 29 patients, grade III. Mitkovic external fixation system, known also as the "War Fixator" was used for all fractures fixation. One protocol, which was a modification of the ICRC's protocol adapted to our specific conditions, was used throughout the study. For solving soft tissue defects, a rotator fasciocutan flap was the most frequently used. For solving of bones defect Mitkovic reconstructive external fixation device was used. All fractures we treated healed. We concluded that shortening the procedural time and being a very simple, immediate using of Mitkovic versatile external fixator ("War Fixator") is, leads to desirable results.

Surgical treatment of the unstable type C pelvic injury.

Rotationally and vertically unstable injuries to the pelvic ring (Type C) require stabilisation of the anterior and posterior pelvic ring complex. Inadequate treatment of these injuries leads to chronic instability of the pelvic ring, which can finally cause permanent disability. Open reduction and stable internal fixation of the anterior and posterior complex of unstable pelvic ring injuries are standard procedures in the treatment of hemodynamically stable patients with (Type C) pelvic injuries. Our aim is to show that this type of treatment achieves excellent and good results. All patients were operated on using the method of open reduction and anterior plate fixation of sacroiliac complex as well as fixation of the pubic symphisis. We present a retrospective study of the results concerning the treatment of 19 patients with (Type C) unstable pelvic injuries. The average age of the patients was 43,21 years old. The final functional results, 2 years post-surgery according to the Majeed scoring system and the results were excellent in 11 (57.89%) and good in 8 (42.1%) patients. There were no bad results to report. Type C pelvic ring injuries are unstable and unless they are adequately treated, they can lead to permanent consequences. Surgical treatment that includes open reduction and stable internal fixation of the anterior and posterior pelvic ring complex leads to excellent and good results. The patients that were treated surgically by fixation of the anterior and posterior pelvic ring complex return to their everyday lives and work activities.