Minimally invasive treatment of unstable pelvic fractures with blunt head technique of Kirschner wire and 3D-printed external template technigue / 中华创伤骨科杂志

Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.

Clinical Analysis of Gun Shot and Explosive Injuried Patients of the Brain

A series of 24 cases of gun shot and explosive injuried patients of the brain is analyzed according to causes, types, operability, the relation between Glasgow coma scale(GCS) and operative mortality, associated injuries, complications and sequelae. The authors notice that gun shot and explosive injury of the brain are more worse than blunt head trauma because of injury mechanism by itself.

Massive Epistaxis from Carotid Artery Injuries Associated with Blunt Head Trauma: Report of 2 Cases

Two cases of massive epistaxis following nonpenetrating head injury are reported. A 23-year-old man was referred to us because of massive epistaxis and binocular blindness which developed about two months after a head injury. Carotid angiography demonstrated a intracavernous carotid aneurysm protruding into the ethmoid and sphenoid sinuses, and occlusion of the supraclinoid part of contralateral carotid artery. CT scan demonstrated a large hyperdense mass extending into the parasellar area, the ethmoid and sphenoid sinuses, and both orbits with destruction of bony structures. Treatment was delayed because the patient developed typhoid fever and sepsis, he died about six months after a head injury from a severe cerebral infarction due to internal carotid artery occlusion. A 34-year-old man, involved in a car accident, was admitted in semicomatose state. Over the next 72 hr he become more alert but he had massive epistaxis 11 day later which required blood transfusions. Carotid angiography revealed a false aneurysm of the distal part of the internal maxillary artery. About 30 days later, the false aneurysm occluded by embolization with Gelfoam. The patient recovered uneventfully from these procedures.