Ipsilateral above-knee amputation in patient with recurrent dislocation after total hip arthroplasty: A case report.

Amputation secondary to vascular complications of recurrent dislocations after total hip arthroplasty (THA) is an extremely rare. We describe an unusual case of above-knee amputation resulting from vascular complications after recurrent dislocations of a THA. A 63-year-old male patient with walking pain and limp has a history of acetabular fracture and central dislocation of the femoral head. He was diagnosed as post-traumatic arthritis and subluxation of the femoral head and suffered from four similar dislocations in 210 days after the THA. The patient received conservative treatment after every hip dislocation. However, four months after the fourth reduction, the emergent femoral artery and popliteal artery exploration and catheter thrombectomy were performed at another hospital. An ipsilateral above-knee amputation was done after sepsis and failure of the revascularization procedure. Clinicians should be cognizant that above-knee amputation resulting from vascular complications after recurrent dislocations of a THA may occur. The lack of adherence to critical treatment may have led to the severe outcome of amputation. In conclusion, patient education and compliance are essential for both the treatment of hip dislocations and arterial occlusion. More active and effective measures should be used to prevent such catastrophic events.

Clinical and epidemiological characteristics of 369 patients with pelvic fractures in Eastern Zhejiang Province of China: a retrospective study.

BACKGROUND: Data on the epidemiological characteristics and prognostic factors of patients with pelvic fractures are lacking, particularly in China. This study aimed to summarise the clinical and epidemiological characteristics of patients with pelvic fractures in eastern Zhejiang Province, China, and to identify risk factors for poor prognosis. METHODS: The clinical data of 369 patients with pelvic fractures admitted to the Ningbo No. 6 Hospital between September 2020 and September 2021 were retrospectively analysed. Data on the demographic characteristics; fracture classification; injury time, cause, and site; treatment plan; and prognosis were collected using the Picture Archiving and Communication System and the Hospital Information System. Differences in constituent proportions were analysed using the chi-square test. Logistic regression analysis was used to identify factors affecting patient prognosis. Statistical significance was set at p ≤ 0.05. RESULTS: Among the 369 patients, there were 206 men and 163 women, at a ratio of 1.26:1, and the average age was 53.64 ± 0.78 years. More than 50% of patients were aged 41-65 years. The average length of hospital stay was 18.88 ± 1.78 days. The three most common causes of pelvic fractures were traffic accidents (51.2%), falls from height (31.44%), and flat-ground falls (14.09%). There were significant differences in the distribution of the three causes of injury depending on age (p < 0.001), sex (p < 0.001), and occupation (p < 0.0001). Most patients were manual workers (48.8%). Furthermore, most patients (n = 262, 71.0%) underwent surgical treatment for pelvic fractures. Postoperative complications occurred in 26 patients (7.05%), and infection was the main complication (73.08%). Age (p = 0.013), occupation (p = 0.034), cause of injury (p = 0.022), treatment options (p = 0.001), and complications (p < 0.0001) were independent factors affecting the prognosis of patients with pelvic fractures. One death (0.027%) occurred, which was due to severe blood loss. CONCLUSIONS: Age, occupation, cause of injury, treatment options and complications were factors affecting patient prognosis. In addition, changes in blood flow and prevention of infection warrant attention.

Clinical application of C2 laminar screw technique.

C2 laminar screws have become an increasingly used alternative method to C2 pedicle screw fixation. However, the outcome of this technique has not been thoroughly investigated. A total of 35 cases with upper cervical spinal instability undergoing C2 laminar screw fixation were reviewed. All cases had symptoms of atlantoaxial instability, such as craniocervical junction pain, and were fixed with the Vertex cervical internal fixation system. A total of 68 screws were placed and hybrid constructs (a C2 translaminar screw combined with a C2 pars screw) were incorporated in two patients. In this series, there were no intraoperative complications and no cases of neurological worsening or vascular injury from hardware placement. Computed tomographic scans demonstrated a partial dorsal laminar breach in ten patients. None of these resulted in neurological symptoms. None of the patients was found to have a breach of the ventral laminar cortex. All the C2 laminar screws fixations were performed successfully. There was no instability seen on the films with no evidence of hardware failure or screw loosening during the follow-up period in all patients. In conclusion, C2 laminar screw technique is straightforward and easily adopted; it can efficiently and reliably restore upper cervical stability. It is an alternative method to C2 pedicle screw fixation, especially in patients with unilateral occlusion of vertebral artery and pedicle deformity of C2.