Dislocated Research Articles

Open sternal fracture with bilateral dislocation of the sternoclavicular joints after a high-speed bicycle accident: a case report

BackgroundOnly a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo–Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures.Case presentationThe patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury.ConclusionsImmediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments.

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty.

Elderly individuals represent a significant demographic undergoing total hip arthroplasty, with distinct risks and complications. The study aimed to determine whether predictive nursing, guided by risk assessment, could reduce these risks and improve patient outcomes. A total of 191 elderly patients undergoing total hip arthroplasty were included in the study, with 142 patients randomly assigned to either the control or observation groups. The control group received routine care, while the observation group received predictive nursing based on comprehensive risk assessment. Various assessment tools were employed to evaluate risks such as venous thrombosis, pressure injuries, falls, joint dislocation, infections, and psychological factors. The primary outcomes included functional improvement measured by the Harris Hip Score, Activities of Daily Living (ADL), anxiety levels, and patient satisfaction. Our study demonstrated that predictive nursing interventions, guided by comprehensive risk assessment, yielded significant reductions in postoperative complications, particularly deep vein thrombosis, in elderly patients undergoing total hip arthroplasty. In addition, patients who received predictive nursing care experienced notable benefits, including shorter hospital stays, heightened satisfaction levels, enhanced hip function, improved ADL scores, and reduced anxiety levels compared with those receiving standard care. The study underscores the substantial benefits of predictive nursing interventions guided by risk assessment in improving outcomes for elderly patients undergoing total hip arthroplasty, highlighting the potential of individualized nursing care to optimize postoperative recovery and enhance patient well-being.

Factors influencing clavicular tunnel widening after single bundle coracoclavicular ligament reconstruction.

The coracoclavicular ligament reconstruction (CLR) technique for the treatment of acromioclavicular joint (ACJ) dislocation has gained immense clinical popularity. However, this technique also has some limitations including complications such as distal clavicle fractures, coracoid fractures, bone tunnel widening, implant failure, and loss of reduction. A study was conducted to analyse the extent of CTW after single-bundle CLR by measuring radiographic parameters to determine its relationship with clinical variables to reduce the risk of clavicular tunnel widening (CTW), thereby providing important insights for clinical practice. This retrospective analysis was conducted at Affiliated Fuyang People's Hospital of Bengbu Medical University, and data from 96 patients who underwent single-bundle CLR for type III-VI ACJ dislocation between January 2018 and December 2023 were initially collected. Finally, 84 patients met the inclusion criteria (63 male and 21 female, mean age: 49.5 ± 12.36 years). The clavicle tunnel (CT) width and coracoclavicular distance (CCD) was measured immediately postoperatively and at 6 months follow up using radiographic imaging, and the degree of expansion at 6 months was recorded. Preoperative variables including patient sex, age, injury cause, injury side, body mass index (BMI), Rockwood classification, extent of the CCD after surgery, and the CT location were recorded to analyze their correlation with the extent of CTW at 6 months follow up. With an average follow-up duration of 10 months (range: 6-18 months). Both the extent of the CCD and CTW measured at 6 months postoperatively were differently enlarged, compared to early postoperative period (EPO) (P < 0.05). The results showed that there were no statistically significant differences in the CTW at 6 months postoperatively with respect to patients' sex, causes of injury, sides of injury, and Rockwood classification types(P > 0.05). However, the location of CT was significantly associated with the extent of CTW at 6 months postoperatively (P < 0.05). The location of CT drilling is a significant factor that affects tunnel widening. When the drilling site is situated closer to the conoid tubercle, the extent of CTW is greater than when the tunnel is located farther from the conoid tubercle.

The Operative Treatment of Sternoclavicular Joint Dislocations in Adults: A Systematic Review

The Operative Treatment of Sternoclavicular Joint Dislocations in Adults: A Systematic Review

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

BackgroundThe current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA). MethodsA retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis. The treatment groups consisted of patients prescribed non-bisphosphonate and bisphosphonate osteomodulatory agents for 1 year prior to and following surgery. The treatment groups were matched to control cohorts by age, gender, and comorbidities. Chi-square analyses were used to compare outcomes between paired cohorts. ResultsThere were no statistically significant differences (p ≤ 0.05) in risk of aseptic loosening, broken prosthesis, dislocation of prosthetic joint, periprosthetic fracture, periprosthetic osteolysis, postoperative infection, full or partial revision, or stress fracture between both the non-bisphosphonate and bisphosphonate groups following THA or TKA. Comparisons between both groups and control cohort also yielded no significant differences. ConclusionThe current study detected no significant differences in early post-operative complications following TJA between patients treated with different classes of anti-osteoporotic medications versus untreated osteopenic/osteoporotic patients. Further research is required to fully understand the impact of osteomodulatory medications on TJA outcomes. Analysis should continue to ensure a high-quality standard of care and aim to better understand outcomes for such patients requiring TJA.

A bizarre case of recurrent hemoptysis and pneumothorax in a young male

Vascular Ehlers–Danlos syndrome (vEDS) is a rare inherited disorder affecting approximately 1 in 150,000 individuals, caused by heterozygous mutations in the COL3A1 gene. Characterized by primary spontaneous pneumothorax and severe connective tissue fragility, vEDS remains poorly understood clinically, making diagnosis challenging. We present the case of a 20-year-old male with a history of mitral valve prolapse, recurrent hemoptysis, knee joint dislocations, and easy bruising. In February 2023, he was admitted to the emergency department following a seizure, syncope, and altered sensorium, which led to an extensive evaluation of his non-specific symptoms. Ultimately, he was diagnosed with vEDS.

K wire migration into spinal canal: An infrequent cause of neurological morbidity: A case report

Introduction: K wire is one of the most common implants used for fixation of acromioclavicular joint dislocation. The migration of K wire from the AC joint to the spinal canal is a rare occurrence. In this report, we present a case of a young adult who presented with weakness of left upper limb secondary to migration of K wire from the AC joint to the spinal canal. Case presentation: A 46-year-old male farmer presented with complaints of pain in the neck, tingling sensation in the left upper limb, and a tender palpable swelling on the left side of his neck with weakness of finger flexors and abductors. He had had an open reduction and fixation with K wire for Acromioclavicular dislocation three months back. CT confirmed the K wire passing through neural foramen between C5 and C6 vertebra and extending across the entire diameter of spinal canal. Under intravenous anesthesia, a transverse skin incision was made over the prominent swelling on the neck and the wire was gently removed. Minimal seepage of spinal fluid was observed which stopped on its own after few days. Discussion: Although AC joint stabilization by K wire fixation provides a safe and easy fixation with low morbidity, complications such as a loss of fixation or loosening can occur. Migration of K wire into a spinal canal is a well-known but infrequent complication. Resorption of bone, muscle action, and negative intrathoracic pressures associated with respiration and heat necrosis causes progressive loosening and dislodgement. Spinal migration is very dangerous because it can cause serious damage to the dura mater, spinal cord, and vertebral artery. Conclusion: Early identification and removal of the K wire, once it has migrated from the site of use, is mandatory to prevent its grievous complications.

Dislocation of the First Metacarpophalangeal Joint Complicated by the Interposition of the Thumb Sesamoid Bones: A Case Report

Dislocation of the First Metacarpophalangeal Joint Complicated by the Interposition of the Thumb Sesamoid Bones: A Case Report

Unraveling the therapeutic potential of Astilbe rivularis Buch.-Ham. ex D. Don in attenuation of diabetic neuropathy in laboratory rats

Ethnopharmacological relevanceAstilbe rivularis Buch.-Ham. ex D. Don is a rare medicinal plant, traditionally employed for treating several disorders. The juice, decoction or powder of the roots, rhizomes, leaves and even the entire plant, are used for managing peptic ulcer, diarrhoea, jaundice, sprains and muscular swellings, bone fracture and dislocation of joints, postpartum bleeding and other menstrual disorders. These conventional medicinal uses make Astilbe rivularis a promising candidate for further research. Aim of the studyThis study was designed to explore the neuroprotective potential of hydroethanolic extract of Astilbe rivularis (ARHE) in diabetic neuropathy (DN) in rats. Materials and methodsGC-MS analysis was used to identify the phytoconstituents present in the plant extract. DN was induced by administration of STZ (55 mg/kg, i.p.), 15 min after NAD (230 mg/kg, i.p.) injection. The rats with fasting blood glucose (FBG) level >250 mg/dl were included in the study. DN was assessed by estimating the level of FBG, lipid profile, and invitro and invivo oxidative stress parameters. Additionally, behavioural parameters like, mechanical hyperalgesia, hot and cold allodynia were estimated to assess diabetic neuropathy. Furthermore, the level of antioxidant enzymes like SOD, GSH, and TBARS in sciatic nerve and inflammatory markers like, TGF-β and IL-6 were measured. ResultsAltogether, 30 phytoconstituents were identified including heptafluorobutyric acid, hexadecanoic acid, and beta-sitosterol depicting antioxidant, antidiabetic, and anticancer properties, respectively. Administration of different doses (100, 200, and 400 mg/kg) of ARHE to diabetic rats attenuated elevated blood glucose level and restored lipid profile, body weight, food and water intake, and antioxidant level. Moreover, elevated level of inflammatory markers like, TGF-β and IL-6 was also found to be attenuated in sciatic nerve. Furthermore, ARHE attenuated the pain response assessed by mechanical hyperalgesia and hot and cold allodynia in diabetic neuropathy rats. ARHE also showed inhibitory activity on ALR enzyme and erythrocyte sorbitol accumulation, and ameliorated oxidative stress. Histopathological study indicated improvement in the architecture of sciatic nerve tissue in diabetic neuropathy rats with the treatment of ARHE. ConclusionsConclusively, hydroethanolic extract of Astilbe rivularis exhibited neuroprotective potential and ameliorated diabetic neuropathy in rats.

A rare case of lumbar facet fracture-dislocation and review of the literature.

Lumbar facet fracture-dislocation is rare, often due to hyperflexion with rotational force. Abnormal scoliosis on radiography is a key sign, prompting further imaging. Facetectomy and laminectomy ensure safe reduction, while instrumented fusion is an effective surgical treatment. Traumatic lumbar facet dislocation is an uncommon condition, particularly when unilateral lumbar facet dislocation is accompanied by a contralateral facet fracture. The patient had a locked facet joint at the left L4-L5, a fracture of the right superior articular process of L5 and a comminuted fracture at the peritrochanteric region of the right femur following a fall. Emergent operation was conducted, starting with open reduction and fixation for the right proximal femur, followed by posterior open reduction and posterolateral fusion with instrumentation, without interbody fusion, for the lumbar spine injury. The patient exhibited positive outcomes throughout the follow-up. This article highlights the trauma mechanism of lumbar facet dislocation, emphasizing hyperflexion with rotational force. Abnormal local scoliosis is a distinctive imaging sign of facet joint dislocation. Facetectomy and laminectomy are recommended for safe reduction and instrumented fusion is considered a safe and effective surgical treatment for facet joint dislocation injuries.

Treatment and management approaches in sternoclavicular joint dislocation

Sternoclavicular joint (SCJ) dislocations, while rare, pose significant risks due to the joint’s proximity to critical thoracic structures. This letter discusses the treatment and management approaches for SCJ dislocations, particularly focusing on the higher risk of complications with posterior dislocations, which may lead to neurovascular or mediastinal injuries. Surgical intervention is often required, and multidisciplinary collaboration is crucial in such cases. The importance of accurate diagnosis through imaging, such as CT scans, and the benefits of graft-based reconstructions for joint stabilization are emphasized to improve patient outcomes.

Isolated Dorsal Distal Radio-Ulnar Dislocation: About A Case and Review of the Literature

Isolated acute dislocation of the distal radioulnar joint is a rare lesion, and in 50 % of cases goes unrecognized; it may be palmar or dorsal. Its diagnosis is suspected when the wrist is traumatic, painful, with limited pronosupination and no fracture on radiological examination. Treatment is aimed at preventing the development of chronic instability and/or arthrosis, and consists of reduction followed by immobilization.

Children with Developmental Dysplasia of Hip - Our Experience of Outcome at a Tertiary Care Centre

Objective: To assess the operative outcome of children who underwent surgical management for developmental dysplasia hip at a tertiary care center. Study Design: Case series. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Oct 2021. Methodology: This case series included 25 children who underwent triple procedure encompassing open reduction, femoral shortening and Salter’s pelvic osteotomy. Post-operative analysis of the clinical outcome was done using McKay’s classification and radiological assessment done using Severin’s classification. Results: Age of enrolled participants ranged from 02 to 07 years, mean age being 4.3±1.45 years, of which 8(32%) were male and 17(68%) were female. Mean pre-operative acetabular index was 40.3±3.38 while the mean post-operative acetabular index was 25.1±3.10. On follow-up, one child had subluxation while another had complete dislocation of the hip joint. Conclusion: Triple procedure with open reduction, femoral shortening and Salter’s osteotomy gives satisfactory results in patients aged 2 to 7 with substantial reduction in post-operative acetabular index.

Knee joint dislocations-Current epidemiology and treatment in Germany.

Knee joint dislocations, though rare, present significant challenges due to potential complications like vascular and nerve damage, and are known to be often linked to sports injuries, accidents and obesity. This study aims to analyse the epidemiology, incidence and treatment approaches for knee dislocations in Germany from 2019 to 2022. This retrospective cohort study utilized data from the German Institute for the Hospital Remuneration System to examine knee dislocation cases across German medical institutions. Patient data coded under International Statistical Classification of Diseases and Related Health Problems 10 for 'knee dislocation' enabled detailed analysis by age, sex and surgical procedures categorized by operation and procedure codes. The Patient Clinical Complexity Level (PCCL) assessed complication severity. Analysis of 1643 knee dislocation cases revealed an incidence rate of 0.44-0.54 per 100,000 inhabitants annually. During the years 2020 and 2021, there were fewer cases of knee dislocations. Male patients comprised 50%-56% of cases, with an average hospital stay of 11 days. Most cases were PCCL 0 (62%-72%) and predominantly affected patients aged 18-29 years. Anterior tibial dislocations were common among classified cases. Injuries included ligament ruptures, meniscus lesions and grade I soft-tissue injuries. Patients with pre-existing knee prostheses constituted 0%-16% annually. Treatment involved closed reduction, external fixation and surgeries like capsuloligamentous reconstructions and arthroscopic procedures. Revision knee arthroplasty was required in 2%-9% of cases, with obesity rates up to 7%. This study provides valuable insights into the epidemiology, incidence and treatment of knee dislocations in Germany, with a focus on demographic risk factors, treatment complexities and the impact of obesity and knee prostheses. The findings emphasize the importance of specialized care in larger hospitals, comprehensive management of concomitant injuries and the need for improved coding accuracy. Future research should aim to refine treatment protocols. Level III.

Clinical significance for new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction

To observe the computerized tomography (CT) imaging manifestations of coracoid process fractures associated with acromioclavicular(AC) joint dislocation and make classification and summary, and explore a new classification of coracoid process fracture combined with acromioclavicular joint dislocation. The medical records of patients with the acute traumatic coracoid process fractures associated with AC joint dislocation who had undergone surgical management with clavicular hook plate fixation between May 2012 and June 2021 were retrospectively reviewed. Patients with fractures or dislocations of other parts of the ipsilateral upper limb, which affect the treatment and prognosis, or with chronic shoulder diseases on the affected side, which affect the function of the shoulder joint, were excluded. Eighteen patients were enrolled, including 10 males and 8 females, aged from 16 to 54 years old at the time of injury. The causes of injury were fall in 15 cases, traffic accident in 2 cases, and high fall in 1 case. The time from injury to operation ranged from 1 to 7 days. The morphology of coracoid process fracture and its corresponding relationship with scapula were observed on CT three-dimensional reconstruction images, and the reduction of coracoid process fracture was observed. The results were classified according to different manifestations and outcomes. A total of 18 patients with 18 shoulders were included according to the Inclusion and exclusion criteria. Three manifestations of coracoid process fracture associated with acromioclavicular joint dislocation were observed on CT three-dimensional reconstruction images. One case was typeⅠ(avulsion fracture, coracoid process shape remained general intact), and the coracoid process fracture failed to self-reduction after AC joint reduction and fixation;Fifteen patients with type Ⅱ(hinged fracture, in which one side of the coracoid process fracture remained attached to the scapula or was less displaced than the other side of the fracture) had spontaneous reduction after AC joint reduction and fixation, even 7 of them had coracoid process fracture anatomical reduction;In 2 cases of type Ⅲ (translational fracture, coracoid process fracture with approximately parallel profile), coracoid process fracture failed to self-reduce after AC joint reduction and fixation. The new type of coracoid process fractures associated with acromioclavicular dislocation on CT three-dimensional reconstruction provides an overview of the injury involvement of coracoid process fracture associated with AC joint dislocation, better understand of the nature of the disease, and a reference for clinical diagnosis, treatment and prognosis to the surgeon. Based on the fact that most coracoid fractures especially hinged fractures have spontaneous reduction after AC joint reduction and fixation, we believe that simple fixation of the AC joint is feasible and satisfactory for coracoid process fractures with acromioclavicular joint dislocation, and no surgical intervention is required for coracoid process fractures.

The Epidemiology of Pediatric Shoulder Dislocations in the United States.

Shoulder dislocations are the most common of all major joint dislocations and are a frequent cause of emergency department (ED) presentations. While the epidemiology of shoulder dislocations has been characterized in adults, it has not yet been done for children in the United States. The primary goal of this study was to calculate the incidence rate of pediatric shoulder dislocations in the United States. Secondary goals were to characterize the demographic information of children with shoulder dislocations as well as trends in management. The US Collaborative Network in TriNetX, a network of clinical data repositories containing patient data from over 100,000,000 unique individuals within the United States, was queried for patients younger than 18 years old diagnosed with shoulder dislocation from 2014 to 2024 using ICD codes. The demographic details were then extracted from the data set, and treatment approaches were determined by CPT coding. Over the past 10 years, there were 16,460 pediatric and adolescent patients diagnosed with a first-time shoulder dislocation in either an ED or ambulatory clinic. The overall incidence rate was 60.31 per 100,000 patients, while the incidence rate was 116.61 per 100,000 patients presenting in the ED and 33.95 per 100,000 patients presenting in ambulatory clinics that were under the age of 18 years. Most patients were male (73%), White (59%), and came from the southeastern region of the United States (36%). The most common treatment was a closed reduction (25%), followed by arthroscopic surgery (17%). The number of annual shoulder dislocations has increased over the past decade without an increase in the number of patients undergoing surgical treatment. There remains a high incidence rate of shoulder dislocations in the pediatric population of the United States. Despite evidence that early surgical treatment of shoulder dislocations offers improved outcomes, nonoperative treatment continues to be the most common modality without any increase in the percentage of patients undergoing surgical treatment. Level IV-descriptive epidemiological analysis.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Two-Stage surgical approach for type III odontoid fracture with C1-C2 fracture dislocation: A case report and management overview

Introduction and Importance: Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1-C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries. Case Presentation: A 43-year-old male presented with upper cervical pain and right upper limb weakness following a road traffic accident. Imaging revealed a type III odontoid fracture with posterior displacement and atlanto-axial (C1-C2) joint dislocation. The patient underwent a two-stage surgical procedure. The first stage involved transoral decompression to address the retropulsed odontoid fragment and relieve spinal cord compression. The second stage involved posterior craniocervical fixation using an autologous iliac bone graft for stabilization. The patient showed postoperative improvement and was discharged on the third day, with a stable condition at a one-month follow-up. Clinical Discussion: Managing type III odontoid fractures with C1-C2 dislocation is challenging, requiring a strategic approach to ensure spinal stability and neurological recovery. Transoral decompression provides direct access for effective decompression, while posterior fixation ensures robust stabilization. The use of an autologous iliac bone graft enhances fusion and long-term stability. This case illustrates the successful integration of traditional neurosurgical techniques with modern surgical principles. Conclusion: This case underscores the importance of traditional neurosurgical techniques in managing complex odontoid fractures. The two-stage approach of transoral decompression followed by posterior craniocervical fixation proved effective, highlighting the relevance of these techniques in achieving positive outcomes in contemporary neurosurgical practice.

Comparison of clinical efficacy between reconstruction of the superior acromioclavicular ligament with acellular dermal allografts and clavicular hook plate in acromioclavicular dislocations

Purposes: We aimed to compare the clinical efficacy of superior acromioclavicular ligament reconstruction (SALR) using acellular dermal allograft with that of clavicular hook plate fixation (HP) in patients with acromioclavicular (AC) dislocations. We hypothesized that the SALR could provide more stability than hook plate. Methods: Twenty-two cases of acute AC joint dislocation between November 2021 to December 2023 were retrospectively reviewed. All patients were divided into 2 groups based on the treatment with SALR (12 cases) or HP (10 cases). Patients were evaluated radiologically and clinically using coracoclavicular distance and ratio, pain visual analogue scale (PVAS), Single Assessment Numerical Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) at postoperative 3 months and 1 year. We evaluated whether patient achieve MCID of PVAS at the last visit, based on the minimal clinically important differences (MCIDs) of PVAS. Results: The SALR group showed a lower rate of reduction loss (8.3 % vs. 40.0 %) and similar clinical outcomes compared to the hook plate group. Initial SANE score was statistically significantly lower in SALR group (SANE: SALR, 45.8 ± 20.7; HP, 68.0 ± 15.5, p = 0.009), but there were no significant differences in final clinical outcomes, including PVAS, ASES, and SANE scores. Conclusion: SALR with acellular dermal allograft demonstrates comparable clinical outcomes to hook plate fixation and may offer a viable alternative, especially in complicated cases. Study Design: Case series; Level of evidence, 4.

Severe multiple injuries in a 15-year-old boy with pelvic fracture complete anterior dislocation of the sacroiliac joint and rupture of the internal and external iliac arteries: A case report of a rare injury.

Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases. The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries. The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture. emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management. He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise. Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded.