Anterior and posterior stabilization for rotationally and vertically unstable pelvic fractures

Rotationally and vertically unstable fractures of the pelvis, represent a challenge to most treating teams and surgeons. Their outcome, when treated conservatively, is far from satisfactory. For that reason, treating surgeons have been pushed to consider surgical management for these difficult cases. During the period from October 1999 until January 2005, we reviewed our results in the management of 37 of these difficult cases, that necessitated anterior and posterior stabilizations to obtain satisfactory stability. We dealt with 28 males and 9 females. The age distribution of these patients ranged from 6 to 63 years with a mean of 30 years. Patients were followed for an average of 27.8 months [12-60 months]. All patients were surgically treated by one surgeon. At the last follow-up patients were assessed both clinically and radiologically. There were different combinations of anterior and posterior pelvic lesions. The anterior lesions consisted of 13 superior and inferior rami fractures, 14 symphyseal disruptions and 10 symphyseal disruptions associated with superior and inferior pubic rami fractures. Posterior lesions consisted of 4 iliac wing fractures lateral to the sacroiliac joint, 14 sacroiliac dislocations and 9 sacral fractures. There were 10 cases of sacroiliac facture dislocations with 7 cases involving an iliac fracture and 3 involving the sacral alum. Different combinations of fixation modalities were used according to the pathoanatomy of the lesions whether anterior or posterior. Patients were followed up both radiologically and clinically. All cases united fully with a variable amount of residual displacement at the posterior lesions. Based on our used criteria of radiological assessment we had 11 [29.7%] excellent, 21 [56.7%] good, 3 [8.1%] fair and 2 [5.45] poor results. Functional assessment was done based on the following criteria of pain, standing, sitting and performance at work. Assessment of these results graded our results as 16 [43.2%] excellent, 18 [48.6%] good results and 3 [8.2%] fair results

new four in one stabilizing operation for anterior recurrent dislocation of the shoulder joint

A preliminary study of a new surgical technique included eight male patients with recurrent anterior dislocation of the shoulder, all managed operatively after failure of the rehabilitation program. The new surgical technique included four main steps done in one operation, namely imbrication of the redundant capsule, anterior bone block by using the coracoid process, muscular dynamic buttress for anterior and inferior capsule and finally imbrication of the upper half and lower half of the subscapularis muscle. Our average age 27.88 years ranged from 22 - 40 years. All achieved satisfactory results [excellent to good]. Bony union of the transferred coracoid process has occurred in all patients. No recurrence of dislocation has happened after an average follow up period of 3.15years ranged from 8 months to 6 years