Operative Treatment Of Patients Research Articles

Способ оперативного лечения пациентов с экстрасфинктерными параректальными свищами

Способ оперативного лечения пациентов с экстрасфинктерными параректальными свищами

Відновлення функції стопи в пацієнтів з ішемічною контрактурою та ушкодженням периферичних нервів нижньої кінцівки

У роботі наведений аналіз оперативного лікування пацієнтів з ішемічною контрактурою стопи та ушкодженням нервів нижньої кінцівки на рівні гомілки. Для дослідження функціональних розладів використовували 100-бальну шкалу H.B. Kitaoka, тяжкість ішемічної контрактури стопи визначали за класифікацією А.П. Лябаха, С.С. Страфуна (1994). Із метою покращання функції стопи використовували операції на периферичних нервах (невроліз, шов, пластика), гомілковостопному, підтаранному суглобі (артроліз), а також подовження задньої групи м’язів гомілки й транспозиції. Віддалені функціональні результати були оцінені через 18 місяців після оперативного лікування. Використання диференційованої тактики в реконструкції стопи дозволило поліпшити функцію в середньому на 23 %.

Surgical treatment of bicuspid aortic valve disease

Background Congenital bicuspid aortic valve (BAV) – one of the most frequent cardiovascular lesions, with prevalence up to 2.4%. About a half of them need the surgical treatment throughout life. Methods 1217 patients with BAV were treated in the Institute during 2003�2012. There were 902 (74.1%) males. Patients age ranged from 3 days to 76 years, mean 50.2 ± 9,8 years. Aneurysm of ascending aorta took place in 380 (31.2%) pts, 39 (10,3%) of them admitted with dissection. We use: balloon valvuloplasty in 82 (8.1%) patients. Different operative interventions were fulfilled to the rest :1135 (93,3%) pts: open aortic valvotomy � 64 (5,3%), aortic valve replacement (AVR) – 691 (56.8%), AVR with ascending aorta banding – in 83 (6,8%), Robicsek operation – 121 (10.0%), Bentall’s operation – 162 (13.3%), Wheat’s operation – 9 (0.7%), supracoronary aortic grafting with AV resurpension – 3 (0.2%), David’s operation – 2 (0.2%); 51 (4.2%) patients with BAV treated of coarctation of the aorta earlier. Results Total 30-day mortality composed 2.3% (26 pts). Death causes: acute heart failure – in 13 (1,1%); respiratory insufficiency – in 4 (0.3%), bleeding – in 2 (0.2%), multiorgan failure – in 4 (0,3%), cerebral injury – in 3 (0.2%). Remote results were studied in 1110 (93.7%) discharged patients in term 6 months – 9 years, mean 3,6±1,2. In mostly – 84.4% and 10.9% it was good and satisfactory. Unsatisfactory in 23 (2.0%), died in remote terms 27 (2,4%) pts. Redo operation were performed in 14 (2.1%) pts after AVR in a reason of aneurysm forming. Conclusion Bicuspid aortic valve disease characterized by injury of aortic valve and ascending aorta. Aneurysm forming were observed in 380 (31.2%) patients with BAV, among them in 39 (10.3%) with dissection. Redo operations in a reason of aneurysm forming needs 2.1% in the elective AVR group. Operative treatment of patients with BAV permitted to obtain good and satisfactory remote results in 84.4% and 10.9% cases.

A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle

Both conservative and operative forms of treatment have been recommended for patients with a 'floating shoulder'. We compared the results of conservative and operative treatment in 25 patients with this injury and investigated the use of the glenopolar angle (GPA) as an indicator of the functional outcome. A total of 13 patients (ten male and three female; mean age 32.5 years (24.7 to 40.4)) were treated conservatively and 12 patients (ten male and two female; mean age 33.67 years (24.6 to 42.7)) were treated operatively by fixation of the clavicular fracture alone. Outcome was assessed using the Herscovici score, which was also related to changes in the GPA at one year post-operatively. The mean Herscovici score was significantly better three months and two years after the injury in the operative group (p < 0.001 and p = 0.003, respectively). There was a negative correlation between the change in GPA and the Herscovici score at two years follow-up in both the conservative and operative groups, but neither were statistically significant (r = -0.295 and r = -0.19, respectively). There was a significant difference between the pre- and post-operative GPA in the operative group (p = 0.017). When compared with conservative treatment, fixation of the clavicle alone gives better results in the treatment of patients with a floating shoulder. The GPA changes significantly with fixation of clavicle alone but there is no significant correlation between the pre-injury GPA and the final clinical outcome in these patients.

Psychiatric outcomes in operatively compared with non-operatively managed patients with facial trauma: Is there a difference?

Patients who sustain facial injury and who require an operation may be at greater risk for developing psychological distress and maladaptive coping. The purpose of this study was to examine psychological responses in adult victims of facial trauma after operation. A consecutive group of adult patients attending specialist outpatient clinics after facial trauma were evaluated for psychological distress. The subjects were divided into two groups based on whether their facial injuries were managed operatively or conservatively. The primary predictor variable in this study was surgical intervention. The main outcome variable was Hospital Anxiety and Depression Scale (HADS) scores. Chi-squared, Mann Whitney U-test, and multiple regression analysis were used to analyse data. The sample consisted of 102 subjects; 71 patients had been managed operatively and 31 patients treated non-operatively. Psychometric scores suggestive of anxiety were present in 21% (n = 15) of the operatively managed group compared with 13% (n = 4) of the non-operatively managed group of patients. The prevalence of depression was comparable between both groups (14% compared with 13%). The median anxiety subscale scores for the operatively managed group when compared with the conservatively managed group of patients were significantly higher (6.6 compared with 4.4, p = 0.02); however, differences in the depression subscale scores did not reach statistical significance (6.2 compared with 4.6, p = 0.06). This study shows an association between anxiety disorders and operative interventions in patients with facial trauma (HADS-A, β = 2.2, p = 0.04). Similar rates of depression were found in the surgically and conservatively managed patients.

Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial

Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Even though several prognostic factors for patellofemoral instability have been identified so far, the appropriate therapy for patients with patellar dislocation remains a controversial issue. The purpose of this study was to compare the outcome after conservative or operative treatment in patients after first-time patellar dislocation. This randomized controlled clinical trial was designed multicentric including patients from six German orthopaedic and trauma departments. Twenty patients with a mean age of 24.6 years with first-time traumatic patella dislocation were included and randomized into either a conservative arm or an operative arm. Plain X-ray images of the knee joint (a.p. and lateral view and tangential view of both patellae) were performed in all cases prior to therapy to exclude osteochondral fragments requiring refixation. An MRI was recommended, but not compulsory. Patients were consulted after 6, 12, and 24 months with a questionnaire including the criteria of the Kujala score, recurrent dislocation, and satisfaction. The mean Kujala score of the conservative vs operative treatment group was 78.6 vs 80.3 after 6 months (p = 0.842), 79.9 vs 88.9 after 12 months (p = 0.165), and 81.3 vs 87.5 after 24 months (p = 0.339). Redislocation rate after 24 months was 37.5 % in the conservative group and 16.7 % in the operative group (p = 0.347). Due to the small number of patients that could be included, no significant difference between the groups could be detected. We see a tendency towards better results after operative treatment. Our multicentric prospective randomized controlled trial revealed no significant difference between conservative and operative treatment for patients after first-time traumatic patellar dislocation. However, a tendency towards a better Kujala score and lower redislocation rates for patients with operative treatment was observed. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A meta-analysis including other study's level I data is desirable for the future.

Is thyroidectomy in patients with Hashimoto thyroiditis more risky?

BackgroundHashimoto thyroiditis (HT) is an organ-specific autoimmune disease characterized by the production of antibodies such as antithyroperoxidase, which leads to the destruction of the thyroid gland and a decrease in normal thyroid function. Thyroidectomy is performed when the patient presents with symptoms or potential neoplastic degeneration occurs; however, surgery can be difficult because of the dense inflammatory process around the thyroid gland. We hypothesized that patients with HT may have a higher rate of complications after thyroid surgery. MethodsWe identified 1791 consecutive patients who underwent thyroidectomy from May 1994 to December 2009. Patients with HT were compared with those without HT with regard to outcomes with analysis of variance and chi-square test (SPSS, Inc). ResultsPatients with HT were significantly younger and more likely to be female. There was no significant difference between the two groups in the rate of malignancy. However, patients undergoing thyroidectomy with HT had a significantly higher postoperative complication rate. Specifically, the rates of overall, transient, and permanent complications were all increased in HT patients. ConclusionPatients with HT had a higher rate of complications after thyroidectomy compared with those without HT. Therefore, careful consideration must be taken before pursuing operative treatment in patients with HT including providing adequate informed consent regarding the increased risks of surgery.

Beware of the biologicals—hospitals may die: the Rheumatism Foundation Hospital, Heinola, Finland (1951–2010)

The first patient entered the Rheumatism Foundation Hospital, Heinola, Finland in July 1951. From that point on, the hospital helped patients suffering from rheumatic disorders. Specialists in the hospital actively developed treatments and published a large number of scientific articles in international journals. The hospital was well known internationally among people working in the field. Progress in the development of disease-modifying medication (biological agents in particular) has dramatically improved the life of patients with rheumatic diseases, but all effective treatments may also have adverse effects. In this article, we briefly review the history of the Rheumatism Foundation Hospital, which was closed permanently in March 2010 due to bankruptcy. The economical difficulties were caused primarily by the progress made in disease-modifying therapy, which decreased the need of rehabilitation and operative treatment of patients with rheumatic diseases. It seems that a great success in biological agents can carry "serious adverse effects", which may kill hospitals. This is an important primary observation, which should be noticed when the future of specialised institutes is planned.

AAOS Rotator Cuff Clinical Practice Guideline Misses the Mark

AAOS Rotator Cuff Clinical Practice Guideline Misses the Mark

The Efficacy of Acromioplasty in the Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears Without Acromial Spur: Prospective Comparative Study

To assess the role of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears. A prospective randomized trial of 120 patients who had small- to medium-sized rotator cuff tears and various types of acromions without spurs were included. Sixty patients received arthroscopic rotator cuff repair with acromioplasty (group I), and another sixty received the same procedure without acromioplasty (group II). The mean age at surgery was 57.8 ± 9.3 years in group I and 55.8 ± 8.0 years in group II. The shape of the acromion was flat in 18 patients, curved in 32, and hooked in 10 in group I, and it was flat in 15 patients, curved in 36, and hooked in 9 in group II. The mean tear size was similar in the two groups (14.6 ± 5.2 mm in group I and 15.3 ± 7.0 mm in group II). Pain and satisfaction were estimated and range of motion was measured at a mean of 35 months after surgery. Functional outcomes were assessed with American Shoulder and Elbow Surgeons: Constant; and University of California, Los Angeles scores. Tendon healing was evaluated by magnetic resonance imaging postoperatively. Clinical outcome was significantly improved in both groups after arthroscopic rotator cuff repair (P < .05). There were no significant differences with respect to pain and range of motion between the groups at the final follow-up (1.1 ± 0.9 v 1.3 ± 1.4 on visual analog scale). Functional outcomes also showed no significant differences between the 2 groups (American Shoulder and Elbow Surgeons score, 90.7 ± 13.1 v 87.5 ± 12.0; Constant score, 85.0 ± 11.3 v 83.3 ± 13.0; and University of California, Los Angeles score, 33.4 ± 3.3 v 32.3 ± 3.5). Postoperative imaging showed that the retear rate was 17% in group I and 20% in group II (P = .475). Arthroscopic repair of small- to medium-sized rotator cuff tears provided pain relief and improved functional outcome with or without acromioplasty. Clinical outcomes were not significantly different, and acromioplasty may not be necessary in the operative treatment of patients with small- to medium-sized rotator cuff tears in the absence of acromial spurs. Level II, prospective comparative study.

Decrease in outpatient department visits and operative interventions due to bisphosphonates in children with osteogenesis imperfecta

IntroductionBisphosphonates are currently the medical treatment most often used in children with osteogenesis imperfecta (OI). The purpose of this retrospective pre–post study was to evaluate the efficacy of treatment with bisphosphonates. We measured the effect by evaluating the number of outpatient department consultations and operative interventions before and after treatment with bisphosphonates in children with OI.Methods and materialsOutpatient department consultation and operative intervention frequencies before and after treatment with bisphosphonates were registered. Children who had at least 2 years of medical records before treatment and at least 2 years after treatment were used in this study.ResultsOf 118 children who were treated with bisphosphonates, 51 (23 boys and 28 girls) fulfilled the inclusion criteria. Statistical analysis revealed a significant decrease in outpatient department consultations (P < 0.000) and operative intervention (P < 0.003) before and after bisphosphonate treatment.ConclusionThe pre-post design of our study shows a significant reduction of the number of outpatient department consultations and operative interventions in patients with OI after treatment with bisphosphonates.

A comparison of early versus delayed repair of traumatic rotator cuff tears

The purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) results between early and delayed operative treatment in patients with traumatic rotator cuff tears (RCT). Thirty-five patients with a traumatic RCT who have been treated surgically during a 4-year period were included in the study. The results of early versus delayed repair of traumatic rotator RCT were assessed using the Constant and UCLA scores. In addition, all patients underwent a postoperative MRI to evaluate repair integrity. Early repair (within 3weeks) was performed in 15 patients (group I) and delayed repair (after 3weeks) in the rest 20 patients (group II). The time interval between injury and operation was 12 and 131days on average for group I and II, respectively. Follow-up time was 34 and 38months for group I and II, respectively. Postoperatively, the UCLA score was 31 and 26 (P<0.05) for group I and II, respectively. The Constant score was 82 and 70 (P<0.05) for group I and II, respectively. Range of motion was significantly better in group I. According to MRI, 5 patients (33%) in the group I and 7 patients (35%) in the group II had a retear. Early repair of a traumatic RCT provides better results in terms of shoulder function in comparison with a delayed repair. A delayed diagnosis of a traumatic RCT leads to difficulties in surgery and less good results. Level III, therapeutic, retrospective, comparative study.

Ankle fractures: impact of swelling on timing of surgery, length of hospital stay and the economic burden

Introduction: Ankle fractures are among the commonest orthopaedic injuries. A delay in operating is often due to the swelling associated with such fractures. On the other hand, the delay in operative fixation beyond 24 h from injury is associated with a lengthening of hospital stay which costs approximately £225 per patient per day for an acute trauma bed. Objectives: The aim of this study was to analyse the relationship between the delay in surgical intervention of open reduction and internal fixation of ankle fractures from presentation due to ankle swelling, and the length of hospital stay and postoperative complications. Patients and Methods: A retrospective study of 145 consecutive patients treated for ankle fractures over a period of 12 months between January and December 2008. results were collated excluding talar and pilon fractures. Emergency department presentation times were noted and time of anaesthetic to determine surgical delay. Notes were reviewed for inpatient stay and postoperative complications. Results: There were 62 male and 83 female patients with a mean age of 49 years. In total, 117 (80%) patients were operated on within 24 hours of presentation (early group). 28 patients’ surgery was delayed beyond 24 hours (delayed group). Of the 117 patients the mean inpatient stay was 3.79 days (± 2.39) whereas in the delayed group the mean stay was 8.57 days (± 6.54). Of the delayed group, 57% of the cases had swelling as the cause of a postponed operation, whereas other causes included lack of theatre time and lack of fitness for surgery. In the early group, 5 patients (4.27%) had wound infections and one patient had a chest infection (0.85%). Four patients (14.28%) from the delayed group developed wound infections all of whom were from patients with ankle swelling. Conclusion: We recommend that policies be put in place to provide early operative intervention for patients with fractured ankles prior to the development of swelling as this would result in improved patient outcome and significant financial savings. If an operation is not feasible within 24 hours of admission and the ankle is swollen resulting in a high operative risk, we recommend sending the patient home for a period of 5–7 days with advice on RICE and anticoagulation which would both permit surgery and cut down costs.

Removal of Enamel Caries with an Air Abrasion Powder

This study compared the efficiency of air abrasion on enamel caries with selective enamel powder (SEP) or with alumina powder and a negative and positive control group. Ninety-three extracted molars with non-cavitated incipient enamel lesions were selected. After embedding the roots in resin, each lesion was sectioned perpendicular to the surface and photographed. Each lesion was classified microscopically as having or not having dentin involvement. The lesions were distributed into four groups with an equal number of enamel caries with or without dentin involvement. Each group was treated differently: Group 1 had SEP abrasion, Group 2 had alumina abrasion, Group 3 had sodium bicarbonate abrasion (negative control) and Group 4 had bur treatment (positive control). The surface was rephotographed after treatment. Superimposition of the photographs identified areas of "correct-excavation," "under-excavation" and "over-excavation." There were no statistical differences between lesions treated with or without dentin involvement for Groups 2 through 4. However, in the SEP group, all measured areas were significantly influenced by dentin involvement. In pairwise comparisons, no statistical differences were found between the alumina and bur groups. The SEP group, however, showed statistically significant differences for each area compared to the alumina group in enamel caries without dentin involvement. SEP performed as well as alumina and bur in lesions with dentin involvement. SEP is different in its ablative properties toward caries with dentin involvement or no dentin involvement. In terms of dental treatment, SEP seems to have a diagnostic potential for enamel lesions before operative intervention in patients with high caries risk.

A multicenter phase II study of primary systemic therapy epirubicin/cyclophosphamide followed by docetaxel plus concurrent trastuzumab for HER2-positive advanced breast cancer.

681 Background: The position of trastuzumab (T) treatment for operable patients with HER2-positive locally advanced and metastatic breast cancer has been discussed. We conducted a multicenter, prospective phase II study of primary systemic therapy including T to evaluate the efficacy and safety of epirubicin/cyclophosphamide (EC) followed by docetaxel (D) with concurrent use of T. Methods: Stage IIIB/IIIC/IV pts with HER2-positive disease (IHC 3+ or FISH +) were eligible. All patients should receive 4 cycles of EC (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2, q3w) followed by 4 cycles of D (75 mg/m2, q3w), with 12 cycles of concurrent T (loading dose 4 mg/kg followed by 2 mg/kg, qw). For the patients with stage IV disease, salvage mastectomy will be considered as a local control treatment with patients' request. The primary endpoint was pathological complete response (pCR) excluding intraductal component in the tumor by central pathological review. The secondary endpoints were clinical response rate (cRR), pCR rate in the ipsilateral axillary lymph node, disease free survival (DFS), overall survival (OS) and toxicity. Results: Between January 2006 and December 2008, 38 patients were enrolled (stage IIIB, 63.2%; IIIC, 23.7%; IV, 13.2%; ER and/or PR+, 52.6%). The intent to treat pCR rate in the primary tumor was 16.2% (6/37 pts) in total: stage IIIB, 8.3%; IIIC, 33.3%; IV, 25.0%; ER and/or PR+, 5.9%; ER and PR-, 25.0%. Among 37pts, 27 received the planned treatment. Of 27pts, 6 demonstrated pCR (22.2%). The cRR was 67.6% (25/37; cCR, 13.5%; cPR, 54.1%). The pCR rate in the ipsilateral axillary lymph node was 51.4% (19/37). No CHF was reported, however more than 10% decrease of left ventricular ejection fraction without symptom occurred in 3 patients. Conclusions: The PST including concurrent use of T combined with D is effective and safe in HER2-positive advanced breast cancer patients, even who need mastectomy for local control. The results of DFS and OS in the study will be available in the future. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Chugai Pharma

Operative treatment of patients with pertrochanteric femoral fractures outside working hours is not associated with a higher incidence of complications or higher mortality

This retrospective cohort study was conducted to investigate whether operative treatment of patients with a pertrochanteric femoral fracture outside working hours is associated with an increased risk of complications and higher mortality. During the study period 165 patients were operated on outside working hours and 123 were operated on during working hours (08.00 to 17.00). There was no difference in the rate of early complications (outside working hours 33% versus working hours 33%, p = 0.91) or total complications during follow-up (outside working hours 40% versus working hours 41%, p = 0.91). Both in-hospital mortality (outside working hours 12% versus working hours 11%, p = 0.97) and mortality after one year (outside working hours 29% versus working hours 27%, p = 0.67) were comparable. Adjustment for possible confounders by multivariate logistic regression analysis revealed no increased risk of complications when patients were operated on outside working hours. On the basis of these data, there is no medical reason to postpone operative reduction and fixation in patients with a proximal femoral fracture until working hours.

Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases

The frequency of incidental papillary carcinoma (IPC) has been reported to be between 4.6 % and 10% in operatively treated benign thyroid diseases. This study reviews the occurrence of IPC in thyroid glands removed for benign disease at our institution. Six hundred and seventy-eight patients underwent partial or total thyroidectomy for benign thyroid diseases. The incidence of IPC was compared among patients with Hashimoto's thyroiditis, multinodular goiter, follicular adenoma, and Graves' disease. Overall, 81 (12.0%) IPCs were recorded with decreasing order of frequency: Hashimoto's thyroiditis, follicular adenoma, goiter, and Graves' disease. Contralateral IPC was detected in 6/15 (40%) patients with follicular adenoma. The overall incidence of IPC in benign operatively resected thyroid disease was 12%. Hashimoto's thyroiditis had the greatest rate of IPC. IPC was encountered in the contralateral lobe in 40% of patients with follicular adenoma. The association of IPCs with Hashimoto's thyroiditis may indicate a link to thyroid cancer. Total thyroidectomy may be considered an appropriate operative treatment in patients with Hashimoto's thyroiditis and follicular adenoma requiring operation owing to the high incidence and frequent contralateral involvement of IPC, respectively.

Radical treatment for oesophageal cancer patients unfit for surgery and chemotherapy. A 10-year experience from the Norwegian Radium Hospital

Background. Over a 10-year period from 1990, 445 patients with carcinoma of the oesophagus were admitted to the Norwegian Radium Hospital and 184 of these patients received treatment with curative intent. Even though surgery is the treatment of choice for these patients, many of them suffer from medical conditions that increase the risk for postoperative mortality and morbidity. In a retrospective study, the effect of the curative treatment offered to patients was explored with a particular focus on patients unfit for surgery. Methods. Medical data of the 184 patients treated with curative intent were reviewed and additional clinical information was retrieved from local hospitals and general practitioners. Preoperative radiotherapy followed by surgery was the standard curative treatment for operable patients. Medically inoperable patients were offered radical split-course hyperfractionated radiotherapy followed by a brachytherapy boost. Results. More than 50% (103/184) received non-surgical treatment only. Patients who received radical surgery (n = 81) were younger, had better performance status, less weight loss and dysphagia compared to patients treated with radical radiotherapy (n = 102). One patient received only photodynamic therapy. The 3-year survival was 29% for patients treated with radical surgery, and 8% for patients who received radical radiotherapy. The overall median crude survival for the two groups of patients were 20 months and seven months respectively. Conclusion. The hyperfractionated radiotherapy provided symptom relief without extensive toxicity and with a possibility for cure for patients with oesophageal cancer who are unfit for surgery and chemoradiotherapy. The literature supports the curative potential of high dose accelerated hyperfractionated radiotherapy even though the optimal radiotherapy regimen still needs to be explored.

Operative treatment of unstable pelvic ring fractures

Objective To evaluate the operative treatment for patients with unstable pelvic ring fractures. Methods A retrospective study was done for the 83 patients with unstable pelvic ring fractures who had received operative treatment from January 2002 to January 2008 and complete follow-up. The duration from injury to operation averaged 12. 0 (0 to 51) days in this group. According to Tile classification, there were 35 cases of type B (B1: 17; B2: 11; B3: 7) and 48 type C (C1: 34; C2: 9; C3: 5). Sixty-six patients had associated injuries. Twenty-five cases were complicated with sacral fractures (Denis Ⅰ: 5; Denis Ⅱ: 16; Denis Ⅲ: 4), and 23 patients with acetabular fractures. Twelve hemodynamically unstable patients received resuscitation. Simple anterior ring fixation was applied in 17 patients, simple posterior ring fixation in 29 patients and combined anterior and posterior fixation in 37 patients. The functional outcome was evaluated using Majced and Harris scores. Results One patient died during the early postoperative period. The mean follow-up was 3.3 (1.0 to 7.1) years for the other 82 patients. At the time of final follow-up, the mean Majeed score was 87.5 (51 to 100). The clinical outcome was excellent in 55 patients, good in 22, fair in 4 and poor in 2. The overall good to excellent rate was 92. 7%. The mean Harris score was 91.1 (50 to 100) . The clinical outcome was excellent in 59 patients, good in 17, fair in 1 and poor in 5. The overall good to ex-cellent rate was 92.7%. Of the 17 cases with associated acetabular fractures that were operatively treated, 14 were graded as good and excellent. Of the 19 patients with associated lumbosacral plexus injury before oper-ation, 11 obtained full recovery, 5 partial recovery and 3 no recovery. Of the 10 cases with iatrogenic nerve injury, 9 obtained full recovery and 1 partial recovery with residual weakness of foot and ankle dorsiflexion.Implant failure occurred in 3 cases. Conclusions Good clinical results can be expected with operative treatment for unstable pelvic ring fractures. Severe lumbosacral plexus injury, implant failure and associated acetabular fracture are risk factors for an unsatisfactory clinical result. Key words: Pelvis; Fractures; Fracture fixation; Treatment outcome

The Utility of Ultrasound in the Evaluation of Submental Fullness in Aging Necks

To evaluate the submental region of the aging neck with high-frequency ultrasound and to assess the relative contribution of its various components to the appearance of age-related soft-tissue ptosis. Ten patients with submental soft-tissue excess were recruited from the senior author's (G.S.K.) private practice. The subcutaneous fat compartment, the subplatysmal fat compartment, and the anterior bellies of the digastric muscles were imaged with high-frequency ultrasound and measured in the cephalocaudal dimension. Pseudoherniation of subplatysmal fat, judged in relation to the inferior surface of the digastric muscles, was also assessed from acquired images. A clear delineation of submental anatomy was obtained with ultrasound in all patients (N = 10, 100%). Hypertrophied digastric muscles (n = 1, 10%) and excessive subplatysmal fat (n = 5, 50%) adversely contributed to the appearance of submental fullness in 6 patients (60%). These findings would not have been predicted with the same degree of accuracy from the physical examination alone. High-frequency ultrasound provides useful imaging of the submental region and its components. Deeply situated subplatysmal fat and anterior bellies of the digastric muscles, both of which may be difficult to assess on physical examination, can be readily evaluated with ultrasound. When sufficiently enlarged and ptotic, deep tissues of the submental space necessitate an open submentoplasty to restore a youthful neck contour. Preoperative ultrasonography can assist with anatomical imaging of the submental space and help in planning a targeted operative intervention in patients with submental soft-tissue excess.