Management of acetabular fractures in elderly patients.

Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.

Successful treatment of sternal non-union by ultrasound.

We report a case of sternal non-union after open aortic valve replacement surgery in a 48-year-old man. The sternotomy was repaired using stainless steel wires and later, 'flexigrip' cables. He presented to us six months later complaining of persistent pain in the sternotomy site. CT-scan confirmed a sternal non-union. After consultation with the ultrasound device, and aortic valve manufacturers, we established that there was no previous similar reported case, but there were no contraindications to use of ultrasound. We started treatment using non-invasive pulsed ultrasound therapy. The non-union healed clinically and radiologically within four months. This is the first report of treatment of sternal non-union using low intensity ultrasound. This therapy appears safe and can be used as a first line of treatment for adequately stabilized sternal non-unions.