Pelvic Fractures Research Articles

The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures

PurposeThe purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management.MethodsTo identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient’s charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012–2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGUN = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS).ResultsIn study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3–8) (PVI) and a median score of 2 points (range 0–3) (C) (p < 0.001). The OR for peripelvic vascular injury was 24.3 for the patients who scored > 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU).ConclusionThe pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre.

Preoperative virtual reduction method for pelvic fractures based on statistical shape models and partial surface data

Virtual reduction is crucial for successful and accurate reduction of pelvic fractures. Various methods have been proposed in this regard. However, not all of them are applicable to every pelvic fracture. Among these methods, the efficiency and accuracy of the method based on statistical shape models in clinical applications require further improvement. This study proposes a virtual reduction method for pelvic fractures that uses statistical shape models and partial surface data of a broken pelvis. Simulated fracture and clinical case experiments were conducted to validate the accuracy and effectiveness of the proposed method. The simulated fracture experiments yielded an average error of 1.57 ± 0.39 mm and a maximum error of 12.82 ± 3.54 mm. The virtual reduction procedure takes approximately 40 s. Based on three clinical case experiments, the proposed method achieves an acceptable level of accuracy compared with manual reduction by a surgeon. The proposed method offers the advantages of shorter virtual reduction times and satisfactory reduction accuracy. In the future, it will be integrated into the preoperative planning system for pelvic fracture reduction, thereby improving patient outcomes.

Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma

IntroductionRecidivism is common following injury. Interventions to enhance patient engagement may reduce trauma recidivism. Education, counseling, peer mentorship, and other resources are known as Trauma Recovery Services (TRS). The authors hypothesized that TRS use would reduce trauma recidivism. MethodsOver five years at a level 1 trauma center, 954 adults treated operatively for pelvic, spine, and femoral fractures were reviewed. Recidivism was defined as return to trauma center for new injury within 30-months. All patients were offered TRS. Multivariate logistic regression statistical analysis was used to identify predictors of recidivism. ResultsThree hundred and ninety-seven of all patients (42 %) utilized TRS, including educational materials (n = 293), peer visits (n = 360), coaching (n = 284), posttraumatic stress disorder (PTSD) screening (n = 74), and other services. Within the entire sample, 136 patients (14 %) returned to the emergency department for an unrelated trauma event after mean 21 months. 13 % of TRS users became recidivists. Overall, 49 % of recidivists had history of pre-existing mental illness. High rates of TRS engagement between recidivists and non-recidivists were seen (75 %); however, non-recidivists were more likely to use multiple types of recovery services (49 % vs 34 %, p = 0.002), and were more likely to engage with trauma peer mentors (former trauma survivors) more than once (91 % vs 81 %, p = 0.03). After multivariable analysis, patients using multiple different recovery services had a lower risk of recidivism (p = 0.04, OR 0.42, 95 % CI [0.19–0.96]). ConclusionsMultifaceted engagement with recovery programming is associated with less recidivism following trauma. Future study of resultant reductions in healthcare costs are warranted. Level of EvidenceLevel II; Prognostic

Finite element analysis of five internal fixation modes in treatment of Day type Ⅱcrescent fracture dislocation of pelvis

To compare the biomechanical differences among the five internal fixation modes in treatment of Day type Ⅱ crescent fracture dislocation of pelvis (CFDP), and find an internal fixation mode which was the most consistent with mechanical principles. Based on the pelvic CT data of a healthy adult male volunteer, a Day type Ⅱ CFDP finite element model was established by using Mimics 17.0, ANSYS 12.0-ICEM, Abaqus 2020, and SolidWorks 2012 softwares. After verifying the validity of the finite element model by comparing the anatomical parameters with the three-dimensional reconstruction model and the mechanical validity verification, the fracture and dislocated joint of models were fixed with S 1 sacroiliac screw combined with 1 LC-Ⅱ screw (S 1+LC-Ⅱ group), S 1 sacroiliac screw combined with 2 LC-Ⅱ screws (S 1+2LC-Ⅱ group), S 1 sacroiliac screw combined with 2 posterior iliac screws (S 1+2PIS group), S 1 and S 2 sacroiliac screws combined with 1 LC-Ⅱ screw (S 1+S 2+LC-Ⅱ group), S 2-alar-iliac (S 2AI) screw combined with 1 LC-Ⅱ screw (S 2AI+LC-Ⅱ group), respectively. After each internal fixation model was loaded with a force of 600 N in the standing position, the maximum displacement of the crescent fracture fragments, the maximum stress of the internal fixation (the maximum stress of the screw at the ilium fracture and the maximum stress of the screw at the sacroiliac joint), sacroiliac joint displacement, and bone stress distribution around internal fixation were observed in 5 groups. The finite element model in this study has been verified to be effective. After loading 600 N stress, there was a certain displacement of the crescent fracture of pelvis in each internal fixation model, among which the S 1+LC-Ⅱ group was the largest, the S 1+2LC-Ⅱ group and the S 1+2PIS group were the smallest. The maximum stress of the internal fixation mainly concentrated at the sacroiliac joint and the fracture line of crescent fracture. The maximum stress of the screw at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum stress of the screw at the ilium fracture was the largest in the S 1+2PIS group and the smallest in the S 1+2LC-Ⅱ group. The displacement of the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 1+S 2+LC-Ⅱ group. In each internal fixation model, the maximum stress around the sacroiliac screws concentrated on the contact surface between the screw and the cortical bone, the maximum stress around the screws at the iliac bone concentrated on the cancellous bone of the fracture line, and the maximum stress around the S 2AI screw concentrated on the cancellous bone on the iliac side. The maximum bone stress around the screws at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum bone stress around the screws at the ilium was the largest in the S 1+2PIS group and the smallest in the S 1+LC-Ⅱ group. For the treatment of Day type Ⅱ CFDP, it is recommended to choose S 1 sacroiliac screw combined with 1 LC-Ⅱ screw for internal fixation, which can achieve a firm fixation effect without increasing the number of screws.

Preservación de la función eréctil tras la uretroplastia: ¿escisión y anastomosis primaria o injerto de mucosa oral?

IntroductionThe aim of this study is to evaluate and compare erection function (EF) after excision and primary anastomosis urethroplasty (EPAU) and buccal mucosal graft urethroplasty (BMGU) in bulbar urethral stricture. MethodsPatients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are: preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and 3rd, 6th and 12th months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. ResultsFifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the 6th month and returned to the baseline level by the first year. ConclusionEPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.

Effects of Iliosacral Joint Immobilization on Walking after Iliosacral Screw Fixation in Humans.

Pelvis fractures are commonly stabilized by surgical implants to facilitate their healing. However, such implants immobilize the iliosacral joint for up to a year until removal. We report how iliosacral joint immobilization affects the walking of patients. The gaits of patients with immobilized sacroiliac joints after unstable pelvic fracture (n = 8; mean age: 45.63 ± 23.19; five females and three males) and sex- and age-matched healthy control individuals (n = 8; mean age: 46.50 ± 22.91; five females and three males) were recorded and analyzed using a motion capture system. The forces between the tread and feet were also recorded. Standard gait parameters as well as dynamic patterns of joint angles and moments of the lower extremities were analyzed using the simulation software OpenSim. With the exception of hip extensor strength, the monitored joint parameters of the patients showed task-dependent deviations during walking, i.e., plantarflexor force was increased when stepping on an elevated surface, as were hip flexion and extensor moments, knee flexion and extensor moments, as well as ankle dorsiflexion and the associated negative plantarflexor force during stance on the elevated surface. Iliosacral joint fixation causes reduced forward and upward propulsion and requires an extended range of hip motion in the sagittal plane. Patients show significant mobility limitation after iliosacral screw fixation.

SAT588 Cushing’s Syndrome Due To Ectopic ACTH Secretion From Ovarian Teratomas

Abstract Disclosure: Y. Kang: None. M.S. Gildenberg: None. B.J. Quade: None. R.A. Blair: None. Background: Approximately 9-18% of Cushing’s syndrome (CS) cases are secondary to ectopic ACTH secretion, most commonly from sources in the lung or mediastinum. However, ACTH-producing tumors are rarely found in distant organs, occasionally making the localization and management challenging. Clinical Case: A 32-year-old woman with class 3 obesity, hidradenitis suppurativa, anxiety, and depression experienced atraumatic pelvic and sacral fractures. DXA scan result showed Z-scores of -3.1 in the lumbar spine, -2.6 in the femur neck, and -0.5 in the total hip. She reported a steady weight-gain of 250 lbs over 7 years despite lifestyle modifications and liraglutide. On examination, she had a round face with plethora, acne, violaceous abdominal striae, and dorsocervical fat pad. Laboratory findings revealed elevated midnight salivary cortisol levels of 453 and 424 ng/dL (n: &amp;lt;100 ng/dL), elevated 24-hour urine cortisol levels of 254 and 741 (n: 3.5-45 mcg), and an abnormal 1 mg dexamethasone suppression test (DST) result at 15.1 ug/dL. AM plasma ACTH and cortisol levels were 190 pg/mL and 18.5 ug/dL, suggesting ACTH-dependent hypercortisolism. The plasma cortisol level after an 8 mg DST was unsuppressed at 13.1 ug/dL with a dexamethasone level of 3,380 ng/dL (n: &amp;gt;800 ng/dL). Abdominal CT and MRI scans showed large bilateral adnexal masses measuring up to 13.7 cm on the left and 9.3 cm on the right, with heterogeneous solid and cystic components, consistent with mature cystic ovarian teratomas. DOTATE-PET scan did not show any areas of increased uptake. The patient underwent a laparoscopic right cystectomy and left oophorectomy, with immediate drop in cortisol (1.6 ug/dL) and signs of adrenal insufficiency post-operatively, requiring hydrocortisone replacement. After holding hydrocortisone for 24 hours prior to laboratory assessment one week post-operatively, her ACTH and cortisol were undetectable, reflecting successful source removal. Pathology report showed neuroendocrine tumor with pituitary differentiation with positive ACTH immunohistochemical staining and Ki-67 proliferative index of 22.6% on the left adnexal mass, and a mature cystic teratoma on the right. Conclusion: Although rare, pituitary differentiation of ovarian teratomas should be considered as a possible source of ectopic ACTH secretion in CS patients without obvious sources identified in commonly involved organs. Presentation: Saturday, June 17, 2023

Do we need to fix the anterior fracture component in insufficiency fractures of the pelvis? A biomechanical comparison on an FFP type IIIc fracture in an osteoporotic pelvic bone model

There is a growing understanding of the specific characteristics of insufficiency fractures of the pelvis and of general requirements for the treatment of affected patients with focus on early mobilization and effective pain reduction as the main goals of therapy. While there is consensus on the significance of achieving stability of the dorsal pelvic ring structures there is still an open discussion about the potential benefits of additional stabilization of an anterior fracture component.Within a biomechanical test setup, two established methods of dorsal fracture fixation were tested under axial loading (25–1200 N; 1000 test cycles) on an explicit osteoporotic bone model (n = 32) with a standardized FFP type IIIc fracture with and without additional fixation of the anterior fracture component. Dorsal fixation was performed with and long and a short 7.3 mm cannulated screw in S1 in one group (n = 16), and a trans sacral bar with an additional short 7.3 mm cannulated screw in S1 in the other group (n = 16). Half of the samples received a 7.3 mm cannulated retrograde transpubic screw for anterior fixation.The fixation with the trans sacral bar and the additional anterior screw fixation showed the highest rate of stability (p = 0.0014), followed by the double SI-screw fixation with stabilization of the anterior fracture (p = 0.0002). During testing, we observed the occurrence of new sacral fractures contralateral to the initial fracture in 22/32 samples.The results let us assume that stabilization of an additional anterior fracture component relevantly improves the stability of the entire ring construct and might prevent failure of the dorsal stabilization or further fracture progression.

Fat embolism syndrome after humerus and pelvis fracture complicated by acute kidney injury requiring blood purification: a case report and literature review

BackgroundFat embolism syndrome (FES) is a rare syndrome that typically occurs 12–72 h after long bone or pelvic fractures with a classic triad of respiratory distress, neurologic changes, and petechial rash. Although Gurd’s criteria for FES include anuria or oliguria, the mechanism of acute kidney injury (AKI) remain unknown. Here, we present a case of FES complicated by AKI that required blood purification.Case presentationA 79-year-old woman was admitted to our hospital because of a right humerus and pelvic fracture caused by a traffic accident. On the second day of hospitalization, she developed impaired consciousness, respiratory failure, and disseminated intravascular coagulation (DIC). Chest radiography revealed bilateral diffuse alveolar infiltration. Brain magnetic resonance imaging revealed diffuse high signal intensity on diffusion-weighted imaging and diffuse low signal intensity on susceptibility-weighted imaging in the cerebral and cerebellar regions. The diagnosis of FES was confirmed and the patient was treated with methylprednisolone (40 mg/day) and ulinastatin. On the third day of hospitalization, she was admitted to our department because of AKI with oliguria. Although echocardiography showed an elevated right ventricular artery systolic pressure suggestive of pulmonary hypertension (PH), pulmonary congestion was initially considered on chest imaging, and hemodialysis and rapid ultrafiltration were initiated. However, she developed hypovolemic shock and treatment was switched to continuous hemodiafiltration and slow ultrafiltration. Thereafter, her consciousness, hypoxemia, DIC and PH completely improved. She was weaned from blood purification therapy on the 29th day of hospitalization. She had hemolytic anemia that might have been caused by thrombotic microangiopathy (TMA), but it resolved without plasmapheresis. On the 51st day of hospitalization, the patient was transferred to another hospital for rehabilitation.ConclusionsFES can be complicated by AKI. In this case, DIC, which was difficult to differentiate from TMA, and/or renal congestion were considered to be a cause of AKI. Chest radiographs of FES may be indistinguishable from pulmonary congestion. In our case, chest radiography showed bilateral diffuse alveolar infiltrates which was not indicative of pulmonary congestion but pulmonary involvement of FES. FES is associated with PH, which may lead to right heart failure. Therefore, the patient could have developed hypovolemic shock due to hemodialysis and rapid ultrafiltration. Clinicians should pay attention to the hemodynamics when blood purification for FES is performed.

Pelvic Ring Fractures in Older Adult Patients-Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons.

Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide the decision-making process. Therefore, the aim of this survey was to provide more insight into if, when, and why patients with a fragility fracture of the pelvis (FFPs) would be considered for additional imaging and surgical fixation by treating physicians. An online clinical vignette-based survey of hypothetical scenarios was sent out to all orthopedic and trauma surgeons in the Netherlands. The questionnaire comprised multiple-choice questions and radiographic images. Differences between subgroups were calculated using the X2 test or the Fisher exact test. 169 surgeons responded to the survey, with varying levels of experience and working in different types of hospitals. In a patient with a simple pubic ramus fracture and ASA 2 or ASA 4, 32% and 18% of the respondents would always advise a CT scan for further analysis. In the same patients, 11% and 31% of the respondents would not advise a CT scan, respectively. When presented with three cases of increasing severity of co-morbidity (ASA) and/or increasing age and/or different clinical presentation of an FFP type 3c on a CT scan, an increasing number of respondents would not consider surgical fixation. There was significant variation in practice patterns between the respondents who do not work in a hospital performing pelvic and acetabular (P&A) fracture surgery and those who do work in a P&A referral hospital. Most respondents (77%) refer patients 1-5 times a year to an expert center for surgical fixation. There is currently a wide variety of clinical practices regarding the imaging and management of FFPs, which seems to be influenced by the type of hospital the patients are presented to. A regional or national evidence-based treatment protocol should be implemented to ensure a more uniform approach.

Development and validation of a nomogram for predicting deep venous thrombosis in patients with pelvic and acetabular fractures: a retrospective cohort study

PurposeTo construct a novel nomogram model that can predict DVT and avoid unnecessary examination.MethodsPatients admitted to the hospital with pelvis/acetabular fractures were included between July 2014 and July 2018. The potential predictors associated with DVT were analyzed using Univariate and multivariable logistic regression analysis. The predictive nomogram was constructed and internally validated.Results230 patients were finally enrolled. There were 149 individuals in the non-DVT group and 81 in the DVT group. Following analysis, we obtained the final nomogram model. The risk factors included age (OR, 1.037; 95% CI, 1.013–1.062; P = 0.002), body mass index (BMI) (OR, 1.253; 95% CI, 1.120–1.403; P < 0.001); instant application of anticoagulant after admission (IAA) (OR, 2.734; 95% CI, 0.847–8.829; P = 0.093), hemoglobin (HGB) (OR, 0.970; 95% CI, 0.954–0.986; P < 0.001), D-Dimer(OR, 1.154; 95% CI, 1.016–1.310; P = 0.027) and fibrinogen (FIB) (OR, 1.286; 95% CI, 1.024–1.616; P = 0.002). The apparent C-statistic was 0.811, and the adjusted C-statistic was 0.777 after internal validations, demonstrating good discrimination. Hosmer and Lemeshow’s goodness of fit (GOF) test of the predictive model showed a good calibration for the probability of prediction and observation (χ2 = 3.285, P = 0.915; P > 0.05). The decision curve analysis (DCA) and Clinical impact plot (CIC) demonstrated superior clinical use of the nomogram.ConclusionsAn easy-to-calculate nomogram model for predicting DVT in patients with pelvic-acetabular fractures were developed. It could help clinicians to reduce DVT and avoid unnecessary examinations.

Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study

BackgroundIntrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures. MethodsWe retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated. ResultsIn total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23–85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns. ConclusionsSGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.

Preoperative Virtual Reduction Planning Algorithm of Fractured Pelvis Based on Adaptive Templates.

The minimally invasive treatment of pelvic fractures is one of the most challenging trauma orthopedics surgeries, where preoperative planning is crucial for the performance and outcome of the surgery. However, planning the ideal position of fragments currently relies heavily on the experience of the surgeon. A pelvic fracture virtual reduction algorithm for target position is provided based on statistical shape models (SSM). First, according to sexual dimorphism, pelvic SSM based on point cloud curvature down-sampling are constructed as adaptive templates. Then, an optimization algorithm is designed to iteratively adjust the target pose of the fragments and the adaptive matching of the templates. Finally, the feasibility of the method is verified by simulating fractures and clinical data. The pelvis has complex shape characteristics, which can be analyzed by SSM to clearly understand the pattern of change. Experiments showed that the SSM-based pelvic fracture reduction method had translation and rotation errors of 2.20±1.09 mm and 3.16±1.26° in simulated cases, and 2.78±0.95 mm and 3.10±0.53° in clinical cases, which has higher accuracy than methods based on mean shape models, and wider applicability than methods based on pelvic symmetry. The pelvic digital model created by SSM has good generalization properties, and the SSM-based virtual reduction algorithm can effectively reconstruct the target position of the fractured pelvis in preoperative planning. The proposed reduction method has the characteristics of high precision and wide application range, which provides a powerful tool for the surgeon's virtual preoperative planning.

Emergency Endovascular Management of Gluteal Artery Pseudoaneurysm

Abstract Introduction: Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. Presentation of Case: The authors describe a case of pseudoaneurysm which was presented to the emergency department. A thorough workup revealed a history of pelvic fracture that could constitute a probable cause of the pseudoaneurysm, which was treated with selective embolization of the artery during angiography. Discussion: The most common manifestation pseudoaneurysm of inferior gluteal artery is the presence of a painful mass in the buttock. However, both diagnosis and therapy are facilitated by catheter angiography. Conclusion: Although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. In addition, the treatment performed using the endovascular technique is less invasive than the conventional technique, giving the patient better recovery.

Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture.

Ischial tuberosity (IT) avulsion fractures are an uncommon cause of injuries in athletes. In this case, a 26-year-old female suffering from posterior right hip pain for over a decade presented with debility and a decrease in athletic function. Notable history included a hamstring strain while sprinting in elementary school. Clinical examination suggested hamstring tendinopathy and ischiofemoral impingement (IFI). Magnetic resonance imaging (MRI) revealed a chronic, fragmented, IT apophyseal avulsion fracture with ischial bursitis and edema within the fragmented bone, suggesting the development of heterotopic ossification (HO). Diagnostic ultrasound revealed signs of IFI, not evident on MRI. Ultrasound-guided corticosteroid injection in her ischial bursa and ischiofemoral space provided complete relief. The patient was able to resume her activities of daily living and sports-related activities without pain. Although interventional treatments may provide temporary pain relief, a multimodal approach is required for the treatment of HO.

Cochrane Corner

This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic, and long bone fractures; interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews; and pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

The experience of a tertiary level hospital in the 2023 Turkey double earthquake zone; management of 1,092 musculoskeletal injuries in the first week.

The double earthquakes that occurred on February 6, 2023, are currently called the disaster of the century, in Turkey. This study is the first to report the experiences in the treatment of orthopedic emergency patients hospitalized in Adana City Training and Research Hospital (ACH), the largest tertiary hospital in the region. The study included the retrospective analysis of the files of the victims of the earthquakes admitted to the ACH between February 6, 2023, and February 13, 2023. The age, gender, time of admission, types and localization of injuries, treatment modalities of earthquake victims, and orthopedic surgical treatment data were recorded. In the first week of the quakes, 3,699 patients were admitted to the ER with earthquake-related injuries. A total of 1,092 patients with musculoskeletal injuries were hospitalized, and 827 (75.7%) received orthopedic surgery. Surgical procedures included wound debridement under anesthesia (n=392, 47.4%), large bone fractures and/or pelvic ring fractures (n=224, 27.1%), fasciotomies (n=327, 69.1%), and amputations (n=121, 14.6%). Although Orthopedics and Traumatology Clinic staff have the highest workload, all hospital personnel should be equipped with basic orthopedic approaches related to the disaster. We believe that taking a more active role in the follow-up of orthopedic patients will help improve the management of the chaotic processes and increase overall treatment success.

Extraperitoneal pelvic packing versus angiographic embolization for hemodynamically unstable pelvic fractures: a retrospective single-center analysis.

To retrospectively analyze the clinical data and treatment procedures of angiographic embolization (AE) and extraperitoneal pelvic packing (EPP) for traumatic pelvic fractures in our center for the purpose of providing recommendations on the selection of treatment protocols. We analyzed 110 patients with traumatic pelvic fractures treated with AE and EPP from January 2015 to May 2023. The patients were divided into the AE group (69 men, 41 women) and the EPP group (20 men, 12 women). The primary outcomes were the mortality rate and incidence of complications. The mortality rate was slightly lower in the AE than EPP group (7.3% vs. 9.4%). The overall blood transfusion volume was lower and the length of hospital stay was shorter in the AE than EPP group (7.79 ± 12.04 vs. 9.14 ± 14.21 units and 20.48 ± 11.32 vs. 22.14 ± 10.47 days). Both AE and EPP have good treatment effects. AE is preferred for patients in stable condition with severe hemorrhage. This study suggests that EPP should be the primary treatment and that AE should serve as a complementary treatment for critical patients.

Incidence of deep vein thrombosis and symptomatic pulmonary embolism in Taiwanese patients with pelvic and/or acetabular fractures: a retrospective study

Venous thromboembolism (VTE) is common in patients with trauma, and thromboprophylaxis has been advocated. However, conflicting results regarding VTE rates in the Asian population following orthopaedic procedures have been presented. We aimed to investigate the VTE incidence in Taiwanese patients with pelvic and/or acetabular fractures and identify the associated risk factors. We included 402 patients who underwent surgery for pelvic and/or acetabular fractures. All patients received mechanical thromboprophylaxis with graduated compression stockings. Duplex scanning was performed postoperatively or during follow-up when signs or symptoms of deep vein thrombosis (DVT) developed. Variables with a significance level of ≤ 0.1 in the univariate analyses were introduced into the multivariate logistic regression analysis to identify DVT risk factors. The overall DVT and symptomatic pulmonary embolism (PE) rate was 3.48% (14/402 patients). Among patients with DVT, 46.1% were asymptomatic. Patients with VTE were significantly older than those without. Multivariate logistic regression analysis revealed that age was a VTE risk factor. The incidence of DVT and symptomatic PE in our cohort was low. Advanced age was a risk factor for VTE. These findings could help clinicians develop appropriate prevention and treatment strategies for VTE in Taiwanese patients with pelvic and/or acetabular fractures.

Comparison of the two surgery methods combined with accelerated rehabilitation in the treatment of lateral compression type 1 pelvic fractures in the elderly

BackgroundTreating lateral compression type 1 (LC1) pelvic ring injuries in older patients is controversial. This study evaluated surgical treatments combined with ERAS for treating LC1 pelvic fractures in the elderly.MethodsIn this retrospective study, patients who underwent surgery with INFIX (supra-acetabular spinal pedicle screws, and a subcutaneous connecting rod; the experimental group) or superior pubic ramus cannulated screw (the control group) fixation of LC1 pelvic fracture from January 2019 to January 2022 were reviewed. Injury radiography and computed tomography were performed to determine the Young–Burgess classification. All patients performed standardized early rehabilitation exercises after surgery and were followed up for > 12 months. After surgery, the Matta score and the visual analog scale (VAS) were evaluated, and the postoperative weight-bearing time and the length of stay (LOS) were recorded. The Barthel index and the Majeed score were evaluated at 4 months after surgery and at the last follow-up.ResultsFifty-three patients were included. Thirty-two patients included in the experimental group had a mean age of 75.0 ± 6.2 (range, 66–86) years, and the other 21 patients in the control group had a mean age of 74.6 ± 4.6 (range, 68–83) years. The mean follow-up time was 13.1 ± 1.6 (range, 12–18) months in the experimental group and 13.4 ± 1.3 (range, 12–16) months in the control group. There were no significant differences in follow-up time between the groups (P > 0.05). The mean VAS score, time to weight-bearing, and LOS were 2.0 ± 0.7 (range, 1–3), 1.1 ± 0.3 (range, 1–2) d, and 5.8 ± 0.9 (range, 4–7) d in the experimental group and 2.3 ± 1.2 (range, 1–5), 2.5 ± 1.6 (range, 1–7) d, and 6.1 ± 1.6 (range, 5–11) d in the control group, respectively. Between the two groups, there was a significant difference in the postoperative time to weight-bearing (P < 0.05), while there was no significant difference in the LOS (P > 0.05). No bedrest-related complications occurred in either group. The Matta score was 90.6% in the experimental group and 90.4% in the control group (P > 0.05). At the 4-months follow-up, the experimental group had a better Barthel index and Majeed score compared with the control group, which were 86.1 ± 6.2 (range, 70–95) vs. 81.2 ± 4.1 (range, 75–90) and 86.3 ± 3.3 (range, 78–91) vs. 80.3 ± 3.9 (range, 76–86), respectively. The experimental group had better early rehabilitation effect than the control group. There was no significant difference in Barthel index and Majeed score between the two groups at the last follow-up (P > 0.05).ConclusionBoth INFIX and intramedullary superior pubic ramus cannulated screws can successfully treat LC1 pelvic fractures and reduce bed rest complications among older patients.