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Objective:To evaluate the emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture.Methods:The 26 patients with unstable pelvic fracture were analyzed retrospectively who had undergone emergency iliosacral screw fixation at Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital from June 2018 to December 2020. They were divided into 2 groups depending on whether orthopaedic TiRobot was used to assist screw insertion. In the observation group of 14 cases subjected to TiRobot-assisted insertion of iliosacral screws, there were 10 males and 4 females with an age of (45.9 ± 10.1) years; in the control group of 12 cases subjected to conventional manual insertion of iliosacral screws, there were 9 males and 3 females with an age of (49.2 ± 11.3) years. All the surgeries were conducted within 24 hours after injury. The 2 groups were compared in terms of screw insertion time, pin insertion, intraoperative blood loss, fluoroscopy time, postoperative screw position, fracture reduction and Harris hip score at the final follow-up.Results:The 2 groups were comparable because there was no significant difference between them in their preoperative general clinical data or follow-up time ( P>0.05). The screw insertion time [(16.1 ± 3.4) min] and fluoroscopy time [(8.1 ± 3.3) s] in the observation group were significantly shorter than those in the control group [(26.4 ± 5.4) min and (25.2 ± 7.4) s], and the pin insertions [1 (1, 2) times] and intraoperative blood loss [(10.5 ± 6.4) mL] in the former were significantly less than those in the latter [6 (3, 8) times and (24.8 ± 6.7) mL] (all P<0.05). Postoperatively, the sacroiliac screw position was excellent in 18 cases and good in 2 in the observation group while excellent in 14 cases, good in 2 and poor in 2 in the control group; the fracture reduction was excellent in 12 cases, good in one and fair in one in the observation group while excellent in 10 cases, good in one and fair in one in the control group, showing insignificant differences in the above comparisons ( P>0.05). There was no significant difference either in the Harris hip score at the final follow-up between the 2 groups ( P>0.05). Conclusion:Compared with conventional manual insertion of iliosacral screws, emergency iliosacral screw fixation assisted by TiRobot can effectively decrease surgical time and reduce operative invasion due to a higher accuracy rate of screw insertion.
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Objective To evaluate the clinical outcomes of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome.Methods From January 2012 to June 2014,a total of 39 patients were treated at our department for tibial plateau fracture combined with compartment syndrome.Early operation was adopted for 18 patients in whom decompression by incisions via the medial and lateral approaches combined with internal fixation with plate and screws was performed at the primary stage and dermoplasty or wound closure conducted at the secondary stage after conditions of soft tissue allowed.Delayed operation was adopted for 21 patients in whom external fixation and decompression by incisions via the medial and lateral approaches was performed in the emergency management followed by selective open reduction and internal fixation.The 2 groups were compared in terms of indexes associated with surgery and hospitalization,Lysholm scores,EuroQol 5 dimensions (EQ-5D) indexes and visual analogue scale (VAS) at final follow-ups.Results All the patients were followed up for more than 2 years.The early operation group incurred significantly less operation time (229.1 ± 43.7 min),intraoperative blood loss (297.5 ±51.5 mL),hospital stay (11.9 ± 1.9 d) and expenditure [144,700 (103,200,179,900) Yuan RMB] than the delayed operation group [322.1 ±62.2 min,385.9 ±56.4 mL,21.5 ±3.6 d,and 197,700 (137,200,234,300) Yuan RMB,respectively] (P ＜ 0.05).There were no significant differences between the 2 groups in rate of complications [22.2％ (4/18) versus 38.1％ (8/21)],fracture union time (6.1±1.1 mversus5.8±l.4m),Lysholmscores (83.9±9.7 versus 81.1±12.3),EQ-5Dindexes (0.85±0.09versus0.84±0.12),orVAS (1.3±1.2versus 1.5±1.4) (P＞ 0.05).Conclusions In the treatment of tibial plateau fractures combined with compartment syndrome,both primary decompressive internal fixation and delayed surgery can achieve satisfactory clinical outcomes.The former is more appropriate for those without obvious limb ischemia while the latter more appropriate for those whose priority is limb salvage due to serious osteofascial compartment syndrome.Surgeons should choose reasonable procedures according to the specific conditions of the patients and strict surgical indications.
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There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.
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Objective To explore the management of postoperative infection following open reduction and internal fixation for acetabular fractures.Methods Ten patients were treated and completely followed up in Beijing Jishuitan Hospital from February 2012 to December 2016 for postoperative infection after open reduction and internal fixation for acetabular fracture.They were 9 males and one female,aged from 14 to 64 years(mean,40.6 years).According to Letournel classification,there were 2 double-column fractures,2 anterior descending transverse fractures,2 anterior column fractures,one posterior wall fracture,and one posterior wall fracture.Eight cases developed surgical regional infection within 2 weeks after internal fixation,and 2 presented with symptoms of infection more than 3 months after fracture fixation.Vacuum sealing drainage (VSD) was used to treat one case of acute superficial infection;open debridement surgery,carrier with sensitive antibiotics and intravenous antibiotics were used to treat 7 cases of acute deep infection and 2 cases of chronic deep infection.Results The infection symptoms disappeared 9 days after removal of VSD device in the one case of acute superficial infection.Normal fracture union was achieved in 6 cases after their infection was controlled;4 cases had to undergo total hip arthroplasty because their articular structure was damaged after control of infection.The 10 patients were followed up for 6 to 54 months (mean,25.7 months).Their Harris scores at the last follow-up averaged 74.8 (from 32 to 92).Conclusions Negative-pressure wound therapy is an effective management for acute superficial infection after acetabular fracture.Deep acute infection needs early repeated debridement combined with sensitive antibiotic carrier to protect joint function.For infection which is difficult to control or chronic infection associated with structural damage,repeated debridement combined with sensitive antibiotic spacer is effective for infection control at the first stage and artificial total hip arthroplasty can be carried out at the second stage when the infection is controlled.
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Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures.Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015.There were 11 male and 7 female patients,aged (45.1 ± 13.1)years.Eleven patients were injured due to road traffic accidents and 7 due to fall from height.Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients.All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment.Data were collected,such as operation time,intraoperative blood loss,hospital length of stay and perioperative complications.Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively.Excellent and good rate of operation was assessed using the Matta clinical evaluation standard.Results Three patients died and fifteen patients survived.Operation time was (120.1 ± 22.2)minutes,amount of intraoperative blood loss was (355.9 ± 56.4) ml,and hospitalization was (8.5 ± 1.6) days.Incidence of perioperative complications was 56％,including 3 patients with acute respiratory distress syndrome,1 pneumonia,2 acute lung injury,1 incisional wound infection,2 multiple organ failure and 1 diffuse intravascular coagulation.All patients were followed up for (15.1 ±2.4)months (range,12-21 months).Majeed score was decreased from preoperative (93.7 ± 6.1) points to final follow-up of (74.1 ± 9.2) points,and the EQ-5D index was decreased from preoperative 0.96 ± 0.04 to final follow-up of 0.74 ± 0.19 (both P ＜ 0.05).Excellent and good rate of operation was 80％.Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures,but the incidence of complications is high.Doctors should choose reasonable treatment plan according to the surgical indications.
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Objective:To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.Methods:In the study, 6 cases of pelvic injury associated with complete an-terior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed.We described the history and severity of injury, emergency treatment, and fracture radio-logy.In all the cases, the surgical treatment and postoperative functional exercise were performed.We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery.Their X-rays showed good reduction of sacroiliac joints.All the cases were followed up on an average of 1.6 years.Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1.The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick.The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.
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<p><b>OBJECTIVE</b>To establish a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures by statistical analysis.</p><p><b>METHODS</b>From January 2011 to December 2012, 1 705 patients with fresh lower extremity fractures were admitted to department of orthopaedic trauma, Beijing Jishuitan Hospital. They were randomly divided into two groups, the group 1 (n = 879) was used to screen risk factors and derived a predictive models based on logistic regression, the group 2 (n = 826) validated the models.</p><p><b>RESULTS</b>Among the patients, there were 1 106 male and 599 female patients, with an average age of (50 ± 18) years.Variables related to preoperative deep venous thrombosis were age, length of time before surgery, cause of injury, low/high-energy injury, location of injury, history of cardiovascular and cerebrovascular diseases, and D-Dimer. The scores based on OR were: age ≤ 35 years: 1 point, > 35- < 65 years: 4 points, ≥ 65 years: 6 points; length of time before surgery, < 8 days:1 point, ≥ 8 days:2 points;low-energy injury:1 point, high energy injury:3 points;location of injury, foot and ankle:1 point, calf:3 points, around the knee: 5 points, femoral diaphysis and proximal femur:7 points, pelvis and acetabulum:4 points, ≥ 2 sites:6 point;history of cardiovascular and cerebrovascular diseases, yes:2 points, no:1 point. D-Dimer < 600 µg/L:1 point, ≥ 600 µg/L:3 points. Area under receiver operating characteristic curve was 0.79, critical point 15.5 points, sensitivity was 77.00%, specificity was 68.17%.</p><p><b>CONCLUSION</b>The score can predict the preoperative deep venous thrombosis for patients with fresh lower extremity fractures, but limited.</p>