Clinical Analysis of Single and Double Sacroiliac Screws in the Treatment of Tile C1 Pelvic Fracture.

We investigated the difference between fixation of single and double sacroiliac screws in the treatment of Tile C1 pelvic fractures. The data of 54 patients with Tile C1 pelvic fractures who were admitted to the trauma center of the Red Society Hospital Affiliated to Xi'an Jiaotong University between August 2016 and August 2020 were retrospectively analyzed. All patients with posterior pelvic ring injuries underwent fixation with sacroiliac screws assisted by a percutaneous robotic navigation system. The operative time, amount of intraoperative blood loss, and postoperative follow-up time between the two groups (single sacroiliac and double sacroiliac screw groups) were compared. The Matta and Majeed scores at the last follow-up were compared between the groups to evaluate fracture reduction and functional recovery. Forty-nine patients were followed up for 17.2 (±4.5) months and 16.2 (±3.4) months in the single and double sacroiliac screw groups, respectively. All patients had excellent fracture reduction immediately after surgery, according to the Matta score. All fractures healed without complications. There was no statistically significant difference in preoperative general information, amount intraoperative blood loss, intraoperative anterior ring fixation method, and postoperative follow-up time between the two groups (P > 0.05). The operative time of the single sacroiliac screw group was shorter than that of the double sacroiliac screw group (P < 0.05). At the last follow-up, the Matta score of the double sacroiliac screw group was significantly better than that of the single sacroiliac screw group (P < 0.05), and there was no statistically significant difference in the Majeed functional scores (P > 0.05). For Tile C1 pelvic fractures, double sacroiliac screw fixation of posterior ring injuries can provide a more stable treatment with no statistically significant difference in functional recovery.

The Effect of Integrity of Lateral Wall on the Quality of Reduction and Outcomes in Elderly Patients with Intertrochanteric Fracture: A Controlled Study.

OBJECTIVE: The study is aimed at evaluating the effect of the integrity of lateral wall on the quality of reduction and outcome in intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA). METHODS: Medical record systems for elderly patients with intertrochanteric fracture treated with PFNA were included. The patients were divided into incompetent and intact lateral wall groups. Patients' baseline characteristics, quality of reduction, and Harris Hip scores (HHS) were collected. RESULTS: The study included 115 patients with intertrochanteric fractures, with 59 in the incompetent lateral wall group and 56 in the intact group. Lateral wall thickness was 16.47 ± 2.46 mm and 23.68 ± 1.59 mm in the incompetent group and intact group (t = -18.766, P < 0.001), respectively. There was no significant difference in the quality of reduction (P = 0.646) between intact and incompetent groups. Mean HHS at final follow-up were 83.02 ± 13.89 in the incompetent group and 86.04 ± 3.39 in the intact group, with no significant difference (P = 0.123). In addition, there was no significant difference in weight-bearing or clinical healing between intact and incompetent groups. The partial weight-bearing with crutches was allowed at 2.71 ± 0.93 and 2.66 ± 1.01 weeks after the operation in the incompetent and intact groups. Time to clinical healing was 5.83 ± 0.99 and 6.00 ± 0.92 months in the incompetent and intact groups, respectively. However, the operative time in the incompetent group (58.54 ± 18.14 mins) were longer than that in the intact group (51.79 ± 17.77 mins). CONCLUSIONS: In conclusion, it seems that lateral wall thickness does not affect the quality of reduction and outcome in patients with intertrochanteric fracture receiving PFNA.

Use of ultrasonography for evaluation of stability of lateral compression type 1 (LC-1) pelvic fractures to assist determination of treatment strategy.

BACKGROUND: Lateral compression type1 (LC-1) pelvic fractures represent a wide spectrum of heterogeneous injuries. These include both stable and unstable patterns; however, determining whether a LC-1 fracture is stable or unstable is a challenge, and the method used to evaluate fracture stability is complicated. METHODS: We prospectively collected and analyzed data from 22 patients with LC-1 pelvic fractures, who underwent ultrasonography and a pelvic compression and separation test, in order to evaluate the role of ultrasonography in determining fracture stability and assist decision-making for treatment strategy. RESULTS: Twenty-two patients (15 men and 7 women) were included in the study. Following an ultrasound examination, 10 patients were classified into the stable group and 12 into the unstable group. In total, 13 patients received conservative treatment and 9 underwent surgery. At follow-up, there were no differences in fracture healing times or fracture-related complications between the two groups. The Majeed score was comparable between the two groups and most patients recovered well. There was a moderate degree of consistency in Kappa values (Kappa = 0.571, P = 0.01) between the classification of stability and the final treatment received. In addition, the sensitivity of ultrasonography was 66.67% and the specificity was 76.92%. CONCLUSIONS: In conclusion, ultrasonography is a useful tool for diagnosing the stability of LC-1 pelvic fractures and assists the determination of treatment strategy. Left-right mobility ≥ 0.3 cm may be used as the criterion for determining instability. TRIAL REGISTRATION: ChiCTR-DDD-16008722.

Minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws connected to a transverse rod.

PURPOSE: The goal was to evaluate the clinical outcomes, quality of reduction and complications of pelvic fractures treated by minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws connected to a transverse rod. METHODS: Retrospective analysis of prospectively collected data in a consecutive patient series with pelvic fractures treated by minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws between January 2010 and January 2016. The functional outcomes evaluated by Majeed scores, and fracture reduction results were evaluated using the Tornetta and Matta standard. As well as recording the duration of the surgical procedure, intraoperative blood loss, the times of intra-operative fluoroscopy and complications. RESULTS: A total of 29 patients (15 men and 14 women; age range, 21-72 years; mean, 40.8 years) could be followed-up after an average of 38.2 ± 21.3 months (range, 12-84 months). According to the AO/OTA classification, there were 24 patients with B2 injury and five patients with C1 injury of the pelvic ring. For the sacral fractures, according to Denis classification, four cases were zone I fractures and 25 cases were zone II fractures. The duration of the surgical procedure, intra-operative blood loss and the times of intra-operative fluoroscopic of the posterior-ring surgical procedure was 28.2 ± 4.6 minutes (range, 20-38 minutes), 46.7 ± 4.9 ml (range, 39-56 ml), and 13.1 ± 1.6 seconds (range, 10-17 seconds) respectively. Posterior-ring fracture reduction was excellent in 11 patients and 15 were good, three cases were fair; the excellent and good rate was 89.7% (26/29). At the final follow-up, the function result was rated as excellent in ten cases, good in 16, fair in three, and poor in zero cases; the excellent and good rate was 89.7% (26/29). There was no incision infection, intra-operative neurovascular injury, pedicle screw loose or breakage, and non-union of the posterior arch did not occur. Two patients requested removal of the fixator: one patient with breakage of the anterior pelvic ring internal fixator, and the pedicle screw was also taken out in the same operative session; another one with moderate pain on the posterior pelvic ring. CONCLUSIONS: Minimally invasive stabilisation of posterior-pelvic-ring instabilities with pedicle screw connected to a transverse rod may be a good alternative to sacroiliac screw fixation because it is quick, safe and associated with a good functional outcome; thus being a useful option in patients who do not qualify for sacroiliac screw fixation.

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia.

The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20-55 years). All patients previously undergone an average of 2.9 operations (range: 1-6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3-12 cm), and all patients were suffering from soft tissue defects (range: 5-17 cm). The mean external fixator time (EFT) was 48 weeks (range: 30-62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33-62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0-3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

The role of ultrasonography in examination of the stability of Tile-B2 pelvic fractures: 7 case reports and a literature review.

BACKGROUND: Determining whether a Tile-B2 pelvic fracture is stable is very challenging. We sought to identify the role of ultrasonography in determining the stability of Tile-B2 pelvic fractures. METHODS: We collected the clinical data of patients with Tile-B2 pelvic fractures who presented at Xi'an Hong-Hui Hospital between June 1, 2016, and August 5, 2016. The treatment strategy of each patient was determined by a team of senior surgeons in the department. A single sinologist observed the movement of the fracture sites in patients during rest, under compression, and during separation to determine fracture stability. According to the pelvic fracture stability assessment, an appropriate treatment strategy was redetermined. Overall, 7 patients, including 5 women and 2 men, with Tile-B2 pelvic fractures were included in this case series. RESULTS: During the initial examination, senior surgeons recommended that 2 patients should undergo internal fixation and 4 patients, conservative treatment; treatment was undecided for 1 patient. After ultrasonography examination, 4 patients underwent surgery via the Stoppa (n = 2) or ilioinguinal approach (n = 1) or cannulated screw fixation (n = 1). The rest of the patients (n = 3) received conventional treatment. Follow-up ranged from 6 to 10 months. Most of the patients showed excellent functions based on their last Majeed grading scores. There were no complications during the follow-up. Using ultrasonography examination, the preoperative treatment plan in 1 patient was changed, and the uncertain preoperative plan in 1 patient was identified. CONCLUSION: Preoperative assessment of stability using ultrasonography may assist surgeons in making appropriate treatment choices for patients with Tile-B2 pelvic fractures.

Anti-high mobility group box-1 (HMGB1) antibody attenuates kidney damage following experimental crush injury and the possible role of the tumor necrosis factor-α and c-Jun N-terminal kinase pathway.

BACKGROUND: Inflammation plays a crucial role in kidney damage after crush syndrome (CS). Several researchers report that high mobility group box-1 protein (HMGB1) may be the vital trigger in kidney damage, and tumor necrosis factor-α (TNF-α) and c-Jun N-terminal kinase (JNK) are involve in this pathophysiological process, but their biological roles are unclear. This study aimed to explore the relationship between HMGB1, JNK, and TNF-α in kidney damage. METHODS: The crush injury model was established using weight compression. The reliability of the crush injury model was determined by hematoxylin-eosin (HE) staining. Western blot was used to detect the expression of HMGB1, JNK, and TNF-α, and TUNEL was used to mark apoptotic cells in the renal cortex. RESULTS: The results showed that the highest expression of HMGB1 in muscle was 12 h after CS. JNK and TNF-α increased and peaked at 1 day after CS in kidneys. Western blot analysis revealed that anti-HMGB1 antibody could downregulate the expression of JNK and TNF-α. Anti-TNF-α could downregulate activation of JNK, and SP600125 could downregulate expression of TNF-α in the kidneys. In addition, anti-HMGB1 antibody, anti-TNF-α antibody, and SP600125 could reduce cellular apoptosis in the renal cortex. CONCLUSIONS: It is possible that JNK and TNF-α commonly contribute to kidney damage by assembling a positive feedback cycle after CS, leading to increased apoptosis in the renal cortex. HMGB1 from the muscle may be the trigger.

Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement.

PURPOSE: To evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only. METHODS: We conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D'Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification). RESULTS: The study showed no significant differences in all preoperative variables (P>0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P>0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8±2.5mm (range: 24-35mm), 71.5±5.4% (range: 65-88%), 23.0±2.3mm (range: 17-28mm). The mean posterior wall fracture displacement is 5.0±3.2mm (range: 0-11mm). There was no difference regarding the quality of reduction between the two groups (P>0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P>0.05). There was no difference in rate of complications between the two groups (P>0.05). CONCLUSIONS: Lag screws fixation of posterior wall through single ilioinguinal approach in associated both column fractures of acetabulum is a safe and effective method. Our results shown that the presence of posterior wall fracture in cases of associated both column fractures does not compromise the clinical outcomes.

A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures.

PURPOSE: The goal of this study was to evaluate the safety and efficacy of a new technique for posterior column fixation through the standard ilioinguinal approach. METHODS: We conducted a retrospective review involving 33 consecutive patients with complex acetabular fractures treated using a short buttress plate fixation of posterior column through single ilioinguinal approach. Radiographic evaluation was performed using criteria described by Matta. Functional outcome was assessed using modified Postel Merle D'Aubigné score. RESULTS: Between 2008 and 2013, 33 adult patients with mean age of 46 years and mean follow up of 37.5 months were enrolled. Anatomic reduction was obtained in 61 % of cases, imperfect reduction in 24 % of cases and poor reduction in 15 % of cases. The average modified Merle d'Aubigné score was 15: categorized as excellent in seven, good in 18, fair in three, and poor in four. One patient died at 15 days because of pulmonary embolism. Four patients sustained temporary lateral femoral cutaneous palsy. At final follow up, two patients had severe post-traumatic arthritis; one of them underwent a total hip arthroplasty at 93 months. None of the patients had loss of reduction. CONCLUSIONS: A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures is a safe and effective method.

Surgical treatment of acetabulum top compression fracture with sea gull sign.

OBJECTIVE: To investigate surgical procedures and their efficacy for acetabulum top compression fractures with sea gull sign. METHODS: Data of 14 patients (five women, nine men); aged from 28 to 71 years (mean, 49.9 years) who had undergone surgery for acetabulum top compression fractures with sea gull sign and been followed up were retrospectively analyzed. The time from injury to surgery was 4-14 days (mean, 9 days). All patients underwent open reduction and bone graft and internal fixation through an ilioinguinal or ilioinguinal plus Kocher-Langenbeck approach. Quality of fracture reduction was assessed according to Matta reduction criteria and hip function according to Matta acetabular fracture criteria. RESULTS: Fourteen patients were followed up for 6-60 months (mean, 36 months). All achieved bone healing within 3-4 months (mean, 3.4 months); the excellent and good rate being 78.5% (11/14). The Matta acetabular fracture scores were 10-18 scores (mean, 16.4); the excellent and good rate being 71.4% (10/14). Traumatic arthritis occurred in three patients. Pain was serious in two patients and relieved by total hip joint replacement and mild in one. One patient developed asymptomatic heterotopic ossification postoperatively. CONCLUSION: The appropriate delay between injury and surgery with acetabular roof compression fracture with sea gull sign is from 5 to 10 days. Through an ilioinguinal or ilioinguinal plus Kocher-Langenbeck approach, excellent reduction of the articular surface can be achieved and sufficient bone graft material obtained. The clinical efficacy is satisfactory.