Complex Pelvic Fractures Research Articles

Exploring 3D Modeling for Enhanced Visualization and Analysis of Pediatric Pelvic Ring Fractures: A Pilot Study

Introduction Pediatric pelvic fractures are high energy injuries that present substantial treatment challenges due to their propensity for plastic deformation, complex fracture patterns, and lack of consensus on surgical indications. There is potential for negative long-term outcomes in patients with residual deformity, but our understanding of acceptable alignment is limited. Plain radiographs and computed tomography (CT) are frequently employed for pre- and post-operative assessment of injury patterns, but are limited to two-dimensional analysis. Three dimensional (3D) modeling offers an opportunity for improved assessment of pelvic anatomy. Methods Two pediatric patients who sustained unstable pelvic ring injuries requiring operative fixation, with both pre- and post-operative CT scans, were identified from an existing IRB-approved trauma database. Utilizing 3D Slicer, 3D segmentations were rendered from DICOM data and specific landmarks were identified to calculate deformity pre- and post-operatively including displacement at the sacroiliac (SI) joints, pubic symphysis, and iliac crest. A modified Keshishyan deformity index was also calculated. Mesh overlay was performed using Autodesk Maya in x, y and z planes to provide visual representation of post-operative changes. Results 3D renderings successfully illustrated complex pelvic fractures in a 9 year old female and 12 year old. Measurements made on 3D models showed similar improvements in diastasis and symmetry to measurements made in standard 2D imaging, but with generally smaller magnitudes. Graphic overlap allow for sophisticated representation of improvement in deformity. Measurements on plain radiographs and 2D CT differed from 3D measurements by anywhere from 0.1 mm to 6.7 mm. Conclusion This proof-of-concept pilot study demonstrates that 3D renderings enhance the ability to measure displacement and deformity in pediatric pelvic trauma for both pre-operative planning and post-operative evaluation. Future applications of this technology include evaluation of pelvic deformity remodeling after trauma in both operative and non-operatively treated pediatric patients.

Preoperative Imaging-Guided Surgical Planning in Complex Pelvic Fractures - Innovations in Traumatology and Radiology for Enhanced Clinical Outcomes: A Systematic Review

This systematic review will explore role of preoperative imaging-guided surgical planning for the management of complex pelvic fractures. Pelvic fractures occurs in high-energy trauma and cause challenges for intricate anatomy and have a high association with vascular, visceral injuries. Traditional imaging methods frequently fail to capture injury complexity while increasing surgical risks. Recent advancements of imaging technology CT, MRI, 3D reconstructions along with and AI-based predictive models offer enhanced precision in diagnosing and planning surgical interventions with detailed insights into fracture patterns, bone density, and soft tissue damage which enable accurate surgical planning to reduce intraoperative complications and shorten recovery times. We aim to systematically investigate effectiveness of modern imaging techniques with potencies in clinical outcomes, with an emphasis on improved surgical accuracy and patient safety. Analyzing range of studies, we have established evidence-based recommendations for integrating advanced imaging technologies into routine trauma care showing critical role these innovations play in improving both short-term recovery and long-term clinical outcomes for patients having complex pelvic fractures.

Functional reliability of means of fixation for complex pelvic fractures. Part 3. Experimental studies under cyclic loads

Fixation of fragments of human pelvic bones by standard and new means of osteosynthesis, in addition to clinical indicators, should have sufficiently high mechanical characteristics. In particular, the “bone with a fracture - osteosynthesis system” system must be sufficiently strong, rigid and stable during long-term treatment, which may be accompanied by certain physiological loads. Today, in traumatology and orthopedics, two methods of fixation are used to fix complex fractures of the pelvic bones caused by high-velocity wounding projectiles: parallel insertion of spongy screws (osteosynthesis of the posterior pelvic ring) and stabilization with a rod apparatus of external fixation and fixation by means of reinforced with application of extramedullary reconstructive plate (osteosynthesis of the anterior pelvic ring). The anterior pelvis is stabilized more often because this technique is simpler, does not require much time and high qualification of the surgeon. However, this method of fixation does not provide sufficient stability of the connection of the pelvic ring bone fragments. This work is devoted to the study of the processes of occurrence and development of mutual displacements of fracture points of pelvic bones under the action of long-term cyclic loads. Experimental studies were carried out under the action of bending cyclic loads, which are close to physiological ones. Calculated creep deformations and irreversible displacements of fracture points. The stiffness characteristics of pelvic fracture fixation systems were studied.

Management of Complex Pelvic Fractures Associated With Acetabulum Injury: Case Series

Management of Complex Pelvic Fractures Associated With Acetabulum Injury: Case Series

Functional reliability of means of fixation for complex pelvic fractures. Part 2. Experimental studies under static loads

Fracture fixation devices should ensure reliable fixation of bone fragments, preventing their mutual displacement during transportation and treatment of patients. Today, in traumatology and orthopedics, two methods of fixation are used to fix complex fractures of the pelvic bones caused by high-velocity wounding projectiles: parallel insertion of spongy screws (osteosynthesis of the posterior pelvic ring) and stabilization with a rod apparatus of external fixation and fixation by means of reinforced with application of extramedullary reconstructive plate (osteosynthesis of the anterior pelvic ring). The anterior pelvis is stabilized more often because this technique is simpler, does not require much time and high qualification of the surgeon. However, this method of fixation does not provide sufficient stability of the connection of the pelvic ring bone fragments. For further improvement of the configuration of fixation systems, it is necessary to conduct comparative experimental studies of the stiffness and stability of fixation on natural specimens under real types and levels of loads with modeled damage to the anterior and posterior parts of the pelvic ring. This work is devoted to the study of the characteristics of stiffness and reliability of fixation of complex pelvic fractures with pelvic ring damage under static loads. A methodology for determining the deformation characteristics was developed and full-scale studies of fixation devices for complex pelvic fractures were performed. The processes of occurrence and development of mutual displacements of fracture points under tension and bending were studied.

Progress of anterior subcutaneous internal fixation in the treatment of anterior pelvic ring injury

Anterior subcutaneous internal fixation (INFIX) is one of the current representatives of minimally invasive fixation of injuries to the anterior pelvic ring. The nail insertion point of this technique is located at the anterior inferior iliac spinous screw, with an angle of 30° outward and 20° backward. Screw in at an angle, and note that the screw head should be above the deep fascia and maintain a safe distance of 20 to 25 mm from the bone surface. Its improved versions include 3 or 4 nails INFIX with added pubic tubercle screws, unilateral INFIX, short-rod INFIX, and double INFIX. These improvements further enhance stability. The lateral femoral cutaneous nerve (LFCN) is relatively easy to be damaged during anatomy, so special attention should be paid during the operation. Biomechanical stability has advantages over external fixation, and its application is flexible. It is not limited to pubic ramus fracture, symphyseal separation, etc. It also plays an important role in combined anterior and posterior ring fixation. It can be combined with posterior sacroiliac screws, iliac lumbar screws, etc. Fixed etc. Good clinical results have also been reported in children, pregnant women, and people with contraindications for subcutaneous connecting rods. In addition, the current application of robots, reduction frames and other technologies has greatly reduced the difficulty of reduction and improved the quality of closed reduction, making it possible to fix complex pelvic fracture. This technique has high reduction quality and is as effective as traditional steel plates. A common complication is LFCN injury. Careful exposure and adjustment of the position and depth of internal fixation during surgery can effectively avoid this complication.

Anterior peri-sacroiliac joint osteotomy in the treatment of malunion and nonunion of complex pelvic ring fracture: techniques and preliminary results

PurposeTo introduce anterior peri-sacroiliac joint osteotomy (APSJO) through the lateral-rectus approach (LRA) for treating pelvic fracture malunion and nonunion, and to evaluate the safety, feasibility, and potential effectiveness.MethodsData of 15 patients with pelvic fracture malunion and nonunion who underwent treatment by APSJO were selected and analyzed. The reduction quality was assessed using the Mears and Velyvis criteria, while the pre-operative and post-operative function was revealed by the Majeed scoring system. The British Medical Research Council (BMRC) grading system was recruited for the evaluation of lumbosacral plexus function.ResultsThe average operative duration was 264.00 ± 86.75 min, while the intra-operative blood loss was 2000 (600, 3000) mL. Anatomical reduction was complete in three cases, satisfactory in ten cases, and unsatisfactory in two cases. Among the seven patients with lumbosacral plexus injury, the pre-operative Majeed grades were good in two cases, fair in two cases, and poor in three cases, while the post-operative Majeed grades were excellent in three cases, good in three cases, and fair in one case. Muscle strength recovered to M5 in two cases, M4 in three cases, and showed no recovery in two cases. The pre-operative Majeed grades were good in five cases, fair in two cases, and poor in one case of the series without lumbosacral plexus injury, while the post-operative Majeed grades were excellent in seven cases and good in one case.ConclusionAPSJO through LRA may be a feasible strategy for treating pelvic fracture malunion and nonunion with promising application.

Functional reliability of means of fixation for complex pelvic fractures. Part 1: Materials and methods

Due to the military aggression of the Russian Federation against Ukraine, a large number of soldiers and civilians were wounded and injured. Along with fractures of the long bones of the limbs, skull injuries, limb amputations, the number of injuries in the pelvic area with fractures of the pelvic bones as a result of being hit by high-velocity projectiles (shrapnel, bullets) has increased.This work is devoted to the preparation and research of the characteristics of stiffness and reliability of fixation of complex fractures of the pelvic bones in the area of the sacroiliac joint and the upper and lower branches of the pubic bone, which may occur as a result of injury by high-velocity projectiles that injure.The sacroiliac area was fixed with two cancellous screws with a parallel arrangement at the intersection of the horizontal and vertical planes (a typical technique for stabilizing the posterior parts of the pelvis). The anterior parts of the pelvic bones were stabilized with rod devices of external fixation with a typical location of the rods in the upper anterior iliac spine. The upper branch of the pubic bone was synthesized with a bony reconstructive plate with a typical location.

SELF-EXPANDING FOAM VS PRE-PERITONEAL PACKING FOR EXSANGUINATING PELVIC HEMORRHAGE.

Mortality for pelvic fracture patients presenting with hemorrhagic shock ranges from 21-57%. The objective of this study was to develop a lethal and clinically-relevant pelvic hemorrhage animal model with and without bony fracture for evaluating therapeutic interventions. ResQFoam is a self-expanding foam that has previously been described to significantly decrease mortality in large-animal models of abdominal exsanguination. We hypothesized that administration of ResQFoam into the pre-peritoneal space could decrease mortality in exsanguinating pelvic hemorrhage. Two pelvic hemorrhage models were developed using non-coagulopathic swine. Pelvic hemorrhage model #1: bilateral, closed-cavity, major vascular retro-peritoneal hemorrhage without bony pelvic fracture. After injury, animals received no treatment (control, n = 10), underwent pre-peritoneal packing using laparotomy pads (n = 11), or received ResQFoam (n = 10) injected into the pre-peritoneal space. Pelvic hemorrhage model #2: unilateral, closed-cavity, retro-peritoneal hemorrhage injury (with intra-peritoneal communication) combined with complex pelvic fracture. After injury, animals received resuscitation (control, n = 12), resuscitation with pre-peritoneal packing (n = 10) or with ResQFoam injection (n = 10) into the pre-peritoneal space. For model #1, only ResQFoam provided a significant survival benefit. The median survival times were 50 and 67 minutes for pre-peritoneal packing and ResQFoam, compared to 6 minutes with controls (p = 0.002 and 0.057, respectively). Foam treatment facilitated hemodynamic stabilization and resulted in significantly less hemorrhage (21.5 ± 5.3 g/kg) relative to controls (31.6 ± 5.0 g/kg, p < 0.001) and pre-peritoneal packing (32.7 ± 5.4 g/kg, p < 0.001). For model #2, both ResQFoam and pre-peritoneal packing resulted in significant survival benefit compared to controls. The median survival times were 119 and 124 minutes for the pre-peritoneal packing and ResQFoam groups, compared to 4 minutes with controls (p = 0.004 and 0.013, respectively). Percutaneous injection of ResQFoam into the pre-peritoneal space improved survival relative to controls, and similar survival benefit was achieved compared to standard pre-peritoneal pelvic packing. The technology has potential to augment the armamentarium of tools to treat pelvic hemorrhage.Study Type: This is a Basic Science paper and, therefore, does not require level of evidence.

Two-Stage Structure-Focused Contrastive Learning for Automatic Identification and Localization of Complex Pelvic Fractures.

Pelvic fracture is a severe trauma with a high rate of morbidity and mortality. Accurate and automatic diagnosis and surgical planning of pelvic fracture require effective identification and localization of the fracture zones. This is a challenging task due to the complexity of pelvic fractures, which often exhibit multiple fragments and sites, large fragment size differences, and irregular morphology. We have developed a novel two-stage method for the automatic identification and localization of complex pelvic fractures. Our method is unique in that it allows to combine the symmetry properties of the pelvic anatomy and capture the symmetric feature differences caused by the fracture on both the left and right sides, thereby overcoming the limitations of existing methods which consider only image or geometric features. It implements supervised contrastive learning with a novel Siamese deep neural network, which consists of two weight-shared branches with a structural attention mechanism, to minimize the confusion of local complex structures of the pelvic bones with the fracture zones. A structure-focused attention (SFA) module is designed to capture the spatial structural features and enhances the recognition ability of fracture zones. Comprehensive experiments on 103 clinical CT scans from the publicly available dataset CTPelvic1K show that our method achieves a mean accuracy and sensitivity of 0.92 and 0.93, which are superior to those reported with three SOTA contrastive learning methods and five advanced classification networks, demonstrating the effectiveness of identifying and localizing various types of complex pelvic fractures from clinical CT images.

Successful Management of a Polytrauma with Open Complex Pelvic Fracture

Abstract Pelvic fractures frequently result from powerful external forces and carry a high risk of concurrent injuries. In these patients, fatalities are often caused by associated injuries. Pelvic fractures cause substantial morbidity and can lead to long-term impairment in physical functioning, as well as difficulties with daily activities and negative psychological health. Surgical intervention is necessary for treating unstable pelvic fractures, which may involve isolated posterior or combined posterior and anterior fixation utilizing screws and plates to restore anatomical alignment and promote natural healing. A 19-year-old female road traffic accident victim in hemorrhagic shock was hemodynamically stabilized and investigated for associated injuries. She was diagnosed with bilateral sacroiliac joint dislocations, bilateral superior and inferior pubic rami fractures and crescent fracture of the right iliac wing, Grade III liver injury, Grade III splenic infarction and hemoperitoneum, lung contusion, and bilateral hemothorax with multiple rib fractures, fracture of the transverse process of L4 and L5 vertebrae. A secondary survey revealed a right sciatic nerve injury, admitted to intensive care and managed by a multidisciplinary approach. Abdomen and thorax injuries were managed conservatively, and meanwhile, the pelvic fracture was stabilized by a damage control protocol, and definitive surgical intervention includes iliac crest wound debridement and pelvic ring open reduction and internal fixation by the Modified Stoppa approach. Abdomen and chest injuries were managed conservatively. Monthly regular follow-up was the first 6 months, was able to walk and sit comfortably at the end of 4 months, and was able to resume her normal routine work and job at 6 months without any pain and limitation of movements. It is essential to promptly identify and assess the injuries and implement appropriate perioperative management by a multidisciplinary team. Temporary stabilization of fracture followed by the management of associated injuries and delayed definite fixation yields the best result in polytrauma patients with pelvic fracture.

Epidemiology and socioeconomic consequences of work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance

IntroductionPelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures. Materials and methodsThis retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay. ResultsAmong a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6–12 months (2011: 24.7% vs. 9.5–16.9%; 2017: 26.1% vs. 6.1–11.0%) and >12 months (2011: 15.8% vs. 9.8–10.2%; 2017: 13.3% vs. 1.9–8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011–2020 and 2017–2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures. ConclusionsWork-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.

Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures- A case series

IntroductionThe operative fixation of pelvic ring injuries and associated acetabulum fractures presents a challenging scenario to most of the orthopaedic trauma surgeons. Current development of anatomically contoured reconstruction (ACR) plates gained popularity in fixing complex pelvic ring fractures. This study was done to assess the functional and radiological outcomes using of lateral wall stainless steel (LWSS) calcaneal plates in posterior pelvic ring injuries and displaced iliac blade fractures. Materials and methodsRetrospectively selected eight cases of pelvic ring injuries planned for fixing posterior pelvic instability and iliac blade fractures using LWSS plates. Mean follow-up was 18 months (Range 12–26 months). ResultsAverage time for radiological bony union achieved in 18 weeks (Range 13–22). Seven patients returned to their normal work. Average Majeed score was 60 (Range 50–68). Mean duration of surgery was 160 min (Range 120–200). ConclusionThis technique can be routinely used as supplementary fixation for posterior pelvic ring instability and iliac blade fractures. LWSS calcaneal plates showed no screw breakage or implant failure. Further this technique was cost effective in developing countries with limited resources.

Treatment of acetabular fracture involving quadrilateral body by external rectus abdominis incision combined with calcaneal profiled plate internal fixation

To investigate the therapeutic effect of lateral rectus abdominis incision combined with winged calcaneal plate on pelvic and acetabular fractures involving quadrilateral body. From January 2017 to April 2021, 21 cases of pelvic and acetabular fractures involving quadrilateral bodies were retrospectively analyzed, including 12 males and 9 females. The age ranged from 21 to 73 years with an average of (43.23±6.45) years. All patients were treated by lateral incision of rectus abdominis combined with open reduction and internal fixation with aerofoil plate, including 12 cases of pelvis with anterior and posterior column fractures, 7 cases of acetabular fractures with quadrilateral involvement, and 2 cases of acetabular fractures with central dislocation. All 21 patients were followed up for 12 to 36 months with an average of (18.60±6.45) months. All fractures healed. According to Matta's image reduction evaluation after operation, 11 cases of pelvic anterior and posterior column fractures were all anatomic reduction, 1 case was satisfactory reduction, 7 cases of acetabular fractures involving quadrilateral were anatomic reduction, 1 case with central dislocation was anatomic reduction, and 1 case was satisfactory reduction. The modified Merle D'Aubigne Postel hip joint score was 13 to 17 points. Lateral incision approach of rectus abdominis combined with wing-shaped steel plate can obtain good radiological and clinical results in the treatment of complex pelvic and acetabular fractures involving quadrilateral bodies, and has advantages in the treatment of complex pelvic fractures and acetabular quadrilateral fractures.

Complex pelvic injury in a morbidly obese patient – A case report

Unstable pelvic ring injuries continue to be challenging to manage. Obese patients have a higher risk of complications and such management entails additional difficulties for emergency services and the medical-surgical team. A 41-year-old male with a body mass index of 44 fell from a water slide and suffered an anteroposterior pelvic compression impact injury. He presented with a Tile C1.3 pelvic fracture, Denis III sacral fracture, and Roy-Camille Type 4 spinopelvic dissociation. We performed a posterior triangular fixation and anterior double plating, and the patient gained full recovery and was able to return to work. This case report focuses on some key tools and techniques to consider when managing complex pelvic fractures in obese patients, requiring specialized equipment or adjustments to conventional treatments to obtain a good outcome. We used accessory portals through the fat pad to adequately place the plate screws. In addition, we used polypropylene mesh for post-operative incisional hernia prophylaxis, longer instruments for iliosacral screw placement, and a multidisciplinary approach with rehabilitation and nutrition control.

MP25-17 PELVIC INSUFFICIENCY FRACTURE—AN UNDERRECOGNIZED CAUSE OF PAIN AFTER PUBECTOMY

You have accessJournal of UrologyCME1 May 2022MP25-17 PELVIC INSUFFICIENCY FRACTURE—AN UNDERRECOGNIZED CAUSE OF PAIN AFTER PUBECTOMY Molly DeWitt-Foy, Ranveer Vasdev, and Sean Elliott Molly DeWitt-FoyMolly DeWitt-Foy More articles by this author , Ranveer VasdevRanveer Vasdev More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pubectomy is traditionally used in repair of complex pelvic fracture urethral injuries (PFUI) but is now increasingly used in the management of pubic osteomyelitis that results from prostate cancer treatment. Classically, pubectomy after PFUI is thought to not disrupt the stability of the pelvic ring. However, this has not been studied in detail in patients with osteomyelitis, who often have comorbid conditions that may alter said stability and increase risk of fracture.). Our aim is to document the incidence, presentation and risk factors of sacral insufficiency fracture (SIF) in patients who have undergone pubectomy for osteomyelitis. METHODS: Retrospective chart review was performed of patients undergoing pubectomy for osteomyelitis at a single institution from 2016-2021. Descriptive statistics and univariate analysis were performed using R. Wilcoxon rank-sum test and Fisher exact test were used as appropriate. RESULTS: Sixteen patients underwent pubectomy for osteomyelitis, all after prostate radiotherapy. Mean age was 68 years and mean BMI 28.5. Six (37.5%) underwent cystectomy with urinary diversion at the time of pubectomy, 4 (23.5%) had cystectomy prior to pubectomy. Eleven (68.7%) had postoperative cross-sectional pelvic imaging, of which 3 (25%) were found to have a new SIF; one additional patient had SIF prior to pubectomy. Three SIFs were detected on MRI and one on CT scan. All patients were symptomatic of SIF, most commonly with new pelvic or perineal pain. The median BMI of patients with SIF was significantly lower than those without SIF (22.4 v 30.5, p value=0.004). Age, chronic kidney disease, bone metastasis, hyperbaric oxygen, diabetes, and androgen deprivation therapy were not significantly associated with risk of SIF. CONCLUSIONS: Sacral insufficiency fracture is a rarely described sequela of pubectomy for osteomyelitis. Lower BMI is significantly associated with SIF, perhaps indicative of overall frailty. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e435 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Molly DeWitt-Foy More articles by this author Ranveer Vasdev More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF DownloadLoading ...

Fast-Track-Protocol for Optimization of Presurgical Planning in Acute Surgical Treatment of Acetabular Quadrilateral Plate Fractures Using 3D Printing Technology and Pre-Contoured Reconstruction Plates

Background. Preoperative planning and 3D printing can be used to treat pelvic bone fractures using pre-contoured surgical plates, in particular complex, comminuted fractures involving the acetabulum and quadrilateral plate. The aim of the study was to develop a Fast-Track-Protocol (fast track methodology) for creating 3D anatomical models, that could be used to shape surgical plates, using open-source software and budget 3D printers. Such a ‘low-budget’ approach would allow a hospital-based multidisciplinary team to carry out pre-surgical planning and treat complex pelvic fractures using 3D technology. Methods. The study included 5 patients with comminuted pelvic fractures. For each patient, CT (computed tomography) data were converted into two 3D models of the pelvis-injured side and mirrored model of the contralateral, uninjured hemipelvis. These models were 3D printed and used as templates to shape surgical plates. Results. A Fast-Track-Protocol was established and used to successfully treat 5 patients with complex, comminuted fractures of the pelvis. Conclusion. Using the Fast-Track-Protocol it was possible to prepare 3D printed models and patient-specific pre-contoured plates within 2 days of hospital admittance. Such an approach resulted in better surgical technique and shorter operative times, while incurring relatively low costs.

The early definitive internal fixation of Complex Pelvic Fracture and its outcome: our experience in level 1 trauma care centre.

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Complex pelvic fractures have high mortality and morbidity hence required urgent resuscitation, haemodynamic stabilization and fracture fixation. Keeping in mind the various schools of thought regarding definitive management, there is need to study the outcomes of complex pelvic fractures after internal fixation surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twenty patients with complex pelvic fractures treated with internal fixation surgery in between 1&lt;sup&gt;st&lt;/sup&gt; June 2018-31&lt;sup&gt;st&lt;/sup&gt; December 2019 with at least 12 months follow-up were included. Clinical and functional outcome of these patients was studied and evaluated using Majeed and Hannover scoring systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of 20 patients, 19 had closed while 1 had open pelvic fracture while 11 had tile type B and 9 had tile type C fracture. After 12 months of follow up, 72% patients of tile B fractures and 55.6% in tile C had excellent Majeed score with rest having good score. Hannover score was very good in 36.4% tile B cases and 22.2% tile C cases and good in 63.6% tile B cases and 77.8% tile C cases. Type of fracture (type B or type C) had a statistically significant co-relation with chronic pain (p=0.016). It was also found that urogenital injury and sexual dysfunction (p=0.007) had a significant co-relation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Early definitive internal fixation in patients with complex pelvic fracture had very good clinical and functional outcome. Most common associated injuries in complex pelvic fractures are urogenital injuries due to close proximity. In the outcomes chronic pain and sexual dysfunction are major issues. The sexual dysfunction patients usually associated fracture of pubic rami or pubic diastasis.&lt;/p&gt;

Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers.

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

ObjectivePelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures.MethodsThe clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared.ResultsThe patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05).ConclusionsThe pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.