Early usage of extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta for treatment of pelvic fractures with hemodynamic instability / 中华创伤杂志

Objective To investigate the clinical outcomes of extraperitoneal pelvic packing combined with temporary occlusion of abdominal aorta in treatment of pelvic fractures with hemodynamic instability.Methods A retrospective case series study was made on 14 patients with pelvic fractures with hemodynamic instability managed by extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta between December 2006 and December 2013.There were ten males and four females,with mean age of 38.2 years old (range,18-63 years).The fractures were classified according to the Tile classification,including two patients with type B1,two with type B2.2,one with type C1.1,two with type C1.2,two with type C1.3,three with type C2,and two with type C3.In addition,10 patients were with closed pelvic fractures and four with open pelvic fractures.All patients were diagnosed as hypovolemic shock once they were admitted.Every patient was given anti-shock treatment,temporary occlusion of abdominal aorta,and extraperitoneal pelvic packing instantly,in order to control hemorrhage of pelvic fracture after they were admitted.The operation time,red blood cell transfusion volume,preoperative and postoperative blood pressures,heart rates as well as other relevant parameters concerning death and survival were recorded and compared.Postoperative infection and wound healing status were recorded as well.Results The operation time was 50-70 minutes (mean,61 minutes).After surgery,the length of ICU stay was (10.9 ± 9.8) days and hospital stay was (23.1 ± 14.9) days.Red blood cell transfusion volume before and after surgery was (17.7 ± 2.2)U and (8.4± 1.7)U,respectively (P ＜ 0.05).The parameters of systolic pressures varied from preoperative (63.6 ± 2.1) mmHg to postoperative (90.9 ± 1.1) mmHg,and the parameters of heart rates declined from preoperative (106.2 ± 5.9) beats/min to postoperative (94.0 ± 6.2) beats/min,(P ＜ 0.05).Ten patients were available for follow-up of 8-24 months (mean,11.5 months).There were four deaths (29％) postoperatively,among which three were died from multisystem and organ failure,and one from severe brain injury.There were statistically significant differences between the survivors and the deaths in terms of time from injury to operation,average systolic pressures,and average heart rates (P ＜ 0.05).None had complications and wound was well healed.Conclusion For pelvic fractures with hemodynamic instability,extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta has advantages of short manipulation time and effective outcomes,which can control the hemorrhage of pelvic fracture and ameliorate the hemodynamic status.

Treatment of open tibial plateau fractures with Hybrid external fixation / 中华创伤骨科杂志

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation.Methods From January 2011 through January 2015,9 complicated open tibial plateau fractures were treated with Hybrid external fixation.They were 6 males and 3 females,with an average age of 33.8 years (range,from 18 to 53 years).According to the Schatzker classification,there were 5 cases of type Ⅴ and 4 ones of type Ⅵ.According to the Gustilo classification,there were 5 cases of type Ⅱ,3 ones of type Ⅲ A and one of type Ⅲ B.All the patients were treated with Hybrid external fixation with or without minimally open reduction.Results The average operation time was 185.6 minutes (from 140 to 240 minutes).The average time for hospital stay was 18.4 days (from 10 to 45 days).The patients were followed up for an average of 15.6 months (from 6 to 36 months).All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months).The external fixation was removed after confirmation of fracture union.According to Merchant scores,the clinical results were evaluated as excellent in 4 cases,as good in 3,as fair in one and as poor in one.The knee joint was stable in each case.Pin tract infection was observed in one and wire loosening in one.Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures.

Open reduction and internal fixation for floating symphysis pubis / 中华骨科杂志

Objective To explore the clinical characteristics of the floating injury of symphysis pubis and clinical outcome of open reduction and internal fixation.Methods A retrospective study was conducted to analyze the 48 patients who had been treated in our department with open reduction and internal fixation for the floating injury of Symphysis pubis from January 2008 to January 2013.There were 31 males and 17 females,with an average age of 36.5 years (range,20 to 61 years).Thirty-five patients were injured in traffic accidents and 8 were injured by falling injuries,and the other 5 were crushed by maehine.Fortyfive cases were complicated with fractures of the posterior pelvis ring; 14 cases were complicated with acetabular fractures; 17 cases were complicated with extremity fractures; 1 1 cases were complicated with thoracic and abdominal injuries and 6 cases were associated with urogenital system injury.The average period from trauma to operation was 7 days (range,3 to 25 days).Operation was performed under general anesthesia.The bilateral pubic ramus fractures were fixed with reconstruction plate in 41 cases,and 7 cases were fixed with cannulated screw through minimally invasive method.Forty-one cases with posterior ring fractures were fixed simulaneously.Results There were 44 patients being followed up with an average period of 16 months (range,12 to 30 months).All the fractures of the pelvis were clinically healed with an average period of 12.6 weeks (range,10 to 16 weeks).According 图o the Majeed score system,the functional results were exc ellent in 30 cases,good in 10 cases,and fair in 4 cases; The average score was 81.5 (range,60 to 100).Two patients who had wound fat liquefaction at 3 days after operation were healed by dressing changing; 8 patients got deep vein thrombosis at 10 days (range,5 to 15 days) after operation were cured by conservative treatment; 3 patients got supra pubic pain at 6 days (range,5 to 7 days) after operation were healed by oral non steroidal anti-inflammatory analgesic drugs and physical therapy in one year.Conclusion Floating injury of symphysis pubis is a kind of severe pelvic fracture which affects the stability of pelvic ring.Open reduction and internal fixation is a good method to stabilize the pelvis ring and to get early rehabilitation.This may contribute to good clinical resuls and good function.

Internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach / 中华骨科杂志

ObjectiveTo explore the clinical effect of internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach.MethodsFrom June 2008 to June 2011,26 patients were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach.Sixteen cases were diagnosed as fractures of the acetabular anterior column,and ten as fractures of the pubic rami.The patient was positioned supine or lateral floating.The incision included two parts.The lateral part along the anterior one-third of the iliac crest about 3-5 cm.The insertion of the abdominal muscles and the origin of the iliacus were sharply incised from the crest.By subperiosteal dissection,the iliacus was elevated from the internal iliac fossa as far medially as to expose the anterior inferior iliac spine,iliopubic eminence and acetabular anterior column.The medial part of the incision was from the pubic tubercle transverse lateral extend 2-3 cm.Subperiosteal dissection to expose the superior pubic ramus.Two windows were dissected subperiosteal to connect through a tunnel along the anterior column of the acetabulum and pubic ramus.Fractures were reduced,and reconstruction plates were contoured and placed through the tunnel.Two or three screws were used at each window to fix the fractures.ResultsAccording to Matta evaluation system,anatomic reductions of the hip were in 13 cases,good in 11 and fair in 2 cases.Twenty-three patients were followed up from 6 to 30 months(mean,15.6 months).Hip functions were excellent in 13 patients,good in 6,and fair in 4 patients according to the D'Aubigne scores system.Pelvic functional results showed 12 were excellent,9 were good and 2 were fair according to Majeed scores system.No complications such as infection or deep venous thrombosis occurred.ConclusionThis modified ilioinguinal approach,with less operation time and low rate of complications,is simple and minimally invasive.It is easy for surgeons to perform plate moulding and could provide firm fixation.