Management of delayed vertically unstable pelvic fractures

Current treatment protocols for surgical intervention in unstable pelvic fractures recommend early fixation. For some reasons, patients are referred late after trauma, and surgery imposes difficulties to the patient and the surgeon. This study represents a case series of 16 patients with vertically unstable pelvic fractures who presented 3 weeks or more after the initial trauma to Assiut University Hospital during a period of five years. Time since injury averaged 7 weeks [range 3-32 weeks]. There were 14 males and 2 females. Age of the patients averaged 28 years. There were twelve unilateral and four bilateral type-C pelvic fractures. The posterior injury was iliac bone fracture in 5 patients, sacroiliac joint disruption in 5 and sacral fracture in 10. The anterior injury was symphyseal disruption in 9 patients, pubic rami fracture in 6, and combined pubic rami fracture and symphyseal disruption in one patient. Seven patients had neurologic injuries. Combined posterior and anterior pelvic ring fracture fixation was done in 9 patients. Posterior pelvic fixation alone was done in 7 patients. Radiographic assessment of reduction was done according to Matta and Tornetta, and functional assessment was done using Majeed score. The mean postoperative follow up was 31 months. All fractures healed. Complications included transient L5 palsy [n=1], ilio-femoral DVT [n=l], early metal failure [n=2]. Postoperative fracture displacement averaged 5 mm [range 1-19 mm]. Fracture reduction was considered excellent in 11 patients [69%], good in four patients [25%], and fair in one patient [6%]. Limb length discrepancy ranged from 0-17 mm [average 4 mm]. Functional result was excellent in 12 patients [75%], good in three patients [18.75%] and fair in one patient [6.25%]. This study supports planned surgical intervention for delayed vertically unstable pelvic fractures. Rules of inter-hospital referral should impose early transfer of patients to avoid the additional difficulties of late fixation

Simultaneous bilateral femoral neck fractures. Etiology and outcome in a consecutive case series

A case series of seven patients with simultaneous bilateral femorae neck fractures is presented. Six patients were females and one patient was male with an age range from 18-68 years. The mechanism of injury was high-energy trauma in one patient. In the remaining six patients, the trauma was a minor trauma with the presence of a predisposing disease. These included epilepsy in two patients [fractures followed convulsions in one patient], and osteomalacia, primary hyperparathyroidism, chronic renal failure, bone metastasis [one patient each]. The surgical procedures included internal fixation by cancellous lag screws in one patient, intertrochanteric valgus repositioning osteotomy and plating in one patient, and hemiarthroplasty [unipolar or bipolar] in five patients. At the final follow-up, five patients were available for evaluation of the index operation [one patient died and another was lost to follow-up]. Follow-up averaged 50 months [range 18-77 months]. For the fixation group patients [n=2], all fractures healed and the functional score was excellent in one patient and good in one patient. For the replacement group [n=3], two patients had a good result and the third patient was considered a failure of the index surgery. Despite being rare, exploring reported cases with bilateral femoral neck fractures can help in establishing a high index of suspicion for identifying patients who are at risk aiming at early diagnosis and better management

Modified Scott's operation for management of lumbar spondylolysis and minimal degree spondylolithesis

Thirty-two patients complaining of low back pain and diagnosed as spondylolysis were included in this study. All of them had spondylolysis of the lumbar spine at different levels. The affected level was L5 [n = 16], L4 [n = 10] and multiple-levels lysis [n = 6]. Twenty-two patients had associated grade I spondylolithesis in association with the lysis. The other 11 patients had spondylolysis only. These patients were managed surgically in this study by the modified Scotts technique using pedicular screws and washers as anchorage point instead of wiring around the transverse process. The defect was filled by iliac grafts either paste or tricortical one. Minimal decompression through limited fenestration was done in three patients. The patients were followed up for one year at least. The follow up duration ranged between 12 and 30 months with an average 18 months. The study concluded that this modified technique is a safe and easy technique, avoiding the complications of wire breakage and transverse process fracture of the traditional Scotts technique. It can be applied to multiple level lysis with the preservation of a good back motion