Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.@*METHODS@#Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant.@*RESULTS@#The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.@*CONCLUSION@#The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection).

Autogenous osteochondral mosaicoplasty for the treatment of femoral condylar articular defects [a preliminary report]

Eleven patients [eight males and three females, with the age range of 26-46 years, average 34 years] have been treated for full thickness cartilage lesions as the result of chondropathy, traumatic chondral defects and osteochondritis dissecans. An average of 4.5 grafts were used for the replacements. The mean follow-up time was 9.2 months [range 6-18 months]. Evaluation was done clinically, radiologically and by control arthroscopies at three-four months for all the patients. The overall results using the modified HSS knee scoring system was 93.5 [81-100] compared to 58.5 preoperatively, beside 8 patients were grade I and 3 patients were grade II, according to the cartilage repair assessment form of the International Cartilage Repair Society [ICRS]. No donor site morbidity was experienced

Modified acromioplasty for shoulder impingement syndrome with an intact rotator cuff

The study included 20 consecutive patients [14 males and 6 females] with an average age of 6.4 years. The dominant extremity was involved in 17 patients. The follow-up period was 20 months. Before operation, all the patients had shoulder pain for at least one year despite conservative treatment. At operation, the rotator cuff tendons were explored and were intact. The modified two-step acromioplasty followed by proper rehabilitation was successful in 90% of patients. It was believed that removal of only the inferior prominence is insufficient and may lead to continuing or recurring of symptoms and that the removal of the anterior portion is advised as it continues to irritate the subacromial bursa and the rotator cuff

Gamma nailing for unstable subtrochanteric femoral fractures

Both versions of the Gamma nail were used to treat 24 unstable subtrochanteric fractures. The average age of the patients was 47 years. Closed nailing was performed in all except two cases. All except three cases had united by final follow-up, with two nonunited cases and one case of delayed union. There were no implant failures and no cutout of the lag screw from the femoral head. If a strict surgical technique is followed with attention to every detail, most of the complications with the Gamma nail can be avoided

Anterior debridement and instrumentation in the treatment of pyogentic vertebral osteomyelitis [PVO]

Primary reconstruction using bone grafts and instrumentation for pyogenic vertebral osteomyelitis [PVO] remains controversial. A prospective study of eight cases of spinal instrumentation for pyogenic vertebral osteomyelitis who were treated between 1997 and 1999 in the department of orthopaedic surgery, Ain-Shams University was carried out. They were six men and two women ranging in age from 28 to 62 years. The results revealed of the eight cases; five cervical, one thoracic and two lumbar lesions with an average follow-up period of 18 months after the operation with clinical and neurologic check-up, blood tests and serial radiographs. Antibiotic drugs were administered parenterally for an average of four weeks, followed by a two-months coarse of oral antibiotic medications. All patients were mobilized directly after instrumentation with a braceless rehabilitation except for a hard collar for cases of cervical spine. Solid bony fusion and healing of infection was achieved in all patients with no late recurrent infections neither post-infection kyphosis. Spinal instrumentation in selected cases of PVO allows early mobilization and did not seem to compromise the ability to clear infection and may even promote its resolution