Does minimally invasive percutaneous transilial internal fixator became an effective option for sacral fractures? A prospective study with novel implantation technique.

AIM: To assess radiological and functional outcomes of transilial internal fixator (TIFI) for treatment of sacral complete transforaminal fractures with a novel implantation technique that decrease wound irritation problems in addition to facilitating easy application of reduction methods beside showing the best entry points, screw trajectories and angles. METHODS: A Prospective case series from 2019 to 2021 was conducted at university hospital including 72 patients with Denis type 2 sacral fractures. The operative and fluoroscopy time, reduction, implantation techniques, postoperative radiological and functional data were collected and evaluated with minimum follow-up of 12 months. RESULTS: The mean initial fracture displacement was 4.42 mm while mean postoperative maximum residual fracture displacement was 2.8 mm, Radiological outcome assessed using Matta's grading at the final follow-up visit with 63 cases scored as Excellent,7 cases as Good, 2 cases as fair. Functional outcome using Majeed scoring shows 64 cases of Excellent grading and 8 cases were Good. Short operative and fluoroscopy time, easy reduction techniques, few skin problems were recorded. CONCLUSION: TIFI through a minimally invasive technique represents a valid method for dealing with transforaminal sacral fractures. TIFI provides a rigid fixation for posterior ring injuries with few risks regarding iatrogenic nerve injury, avoiding different variations of upper sacral osseous anatomy or sacral dysmorphism. In addition, there is no necessity for high quality fluoroscopy for visualization of sacral foramina intraoperatively, decreasing risk of radiation exposure, unlike other methods of fixation as iliosacral screws. Our novel modification for implantation technique provides few risks for postoperative and wound complications.

Role of arthroscopy for the diagnosis and management of post-traumatic hip pain: a prospective study.

The current published literature regarding the role of hip arthroscopy in the diagnosis and management of post-traumatic hip pain is still limited. Therefore, we conducted the present prospective study to determine the value of hip arthroscopy in the diagnosis and management of various causes of hip pain after traumatic conditions. The present study included a prospective cohort of 17 patients with symptomatic post-traumatic hip pain. It was conducted between July 2013 and May 2018. The mean age was 22 (19-29) years and the mean follow-up was 24 (r: 7-36) months. Prior to surgery, every eligible patient underwent assessment of functional status using the Modified Harris Hip Score, Oxford hip score (OHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. All patients underwent arthroscopic management for their diagnosed pathologies. The most commonly encountered diagnosis was labral tear (58.8%), followed by ligamentum teres tear (35.3%) and loose intra-articular fragments (29.4%). In addition, 52.9% of the patients had associated CAM lesion and 11.8% had associated Pincer lesion. The mHSS, OHS and WOMAC score showed significant improvement in the post-operative period (P < 0.001), all the 17 patients had 100% Patient Acceptable Symptomatic State; only one patient did not achieve minimal clinical importance difference. One case underwent labral debridement for failed labral repair (5.8%), another patient developed maralgia paraesthetica (5.8%). In conclusion, hip arthroscopy is a useful and effective minimally invasive procedure for the diagnosis and management of selected patients with post-traumatic hip pain. Moreover, hip arthroscopy was safe technique with no reported serious adverse events.

Fixation of quadrilateral plate fractures of the acetabulum using the buttress screw: A novel technique.

INTRODUCTION: Quadrilateral plate fractures constitute one of the most challenging components of acetabular fractures. The objective of this study is to describe and evaluate the novel technique of buttress screw fixation of the quadrilateral plate component of the acetabular fractures. PATIENTS & METHODS: Forty cases of acetabular fracture with associated quadrilateral plate component were included in the study. Mean age was 35 years (range, 16-68years), with a mean follow-up 16.4 months (range, 9-36months). Fixation of the quadrilateral plate was achieved by one or more buttress screws. The screws were inserted through the reconstruction plate, and placed close to the edge of the pelvic brim. To effectively achieve the 3-point fixation principle, the screw was inserted through the plate hole then outside the bone rubbing on the pelvic surface of the quadrilateral plate. RESULTS: Anatomical reduction of the quadrilateral plate component of the fractures was achieved in all but one patient. The modified Merle D'Aubigné and Postel score was excellent in 13 cases, good in 23 cases, fair in three cases, and poor in one case. No screw displacement or failures were observed during follow-up evaluation. No major complications related to this technique were observed in this series. CONCLUSION: Buttress screw fixation of the quadrilateral plate fracture component in associated acetabular fractures is a safe and effective technique for reduction and fixation of these challenging fractures with no major complications related to this novel technique.

Anterior cruciate ligament reconstruction; is a tourniquet necessary? A randomized controlled trial.

PURPOSE: This work aimed at studying the effect of tourniquet use on surgical performance and peri-operative outcomes of anatomic single-bundle ACL reconstruction. METHODS: Eighty-four patients undergoing ACL surgery were randomized into two groups: the tourniquet (A) group and the non-tourniquet (B) group. Post-operative pain, need for analgesics, the volume of blood obtained in the drain, girth diameter changes in the thigh and calf, muscle strength and amount of haemarthrosis were used as outcome measures to compare the two groups. RESULTS: Fifty-eight patients were available for analysis. In the A group, the degree of pain and need to analgesics was significantly higher at 4 and 10 h. The volume measured in the surgical drain, at 24 h post-operative, was higher in the A group (p = 0.001). The calf and thigh girth diameters at 2 weeks showed a highly significant girth difference between the two groups (p = 0.001). CONCLUSION: This study showed that tourniquet use in ACL reconstruction increases immediate post-operative symptoms of pain and haemarthrosis and that the effects on muscle strength are only temporary. The tourniquet can be replaced by using of a mixture of morphine and adrenaline with no interference with the quality of visibility, nor operative time. LEVEL OF EVIDENCE: I.