ABSTRACT
We present an unusual case of an unstable pelvic fracture during pregnancy period, who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation. Successful treatment of these rare cases is possible with careful pre-, peri-, and post-operative evaluation of the mother and fetus by a multidisciplinary team.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Fetal Death , Fractures, Bone , Hemorrhage , Pelvic Bones , Wounds and InjuriesABSTRACT
BACKGROUND: Screw penetration of the hip joint is a serious complication during plate-screw internal fixation of acetabular anterior column or anterior wall fractures through an anterior approach. The purpose of the cadaveric study is to determine safe paths for screw placement on the anterior column of the acetabulum. METHODS: A total of 46 hemipelvises (24 male, 22 female) were utilized in this study. These hemipelvises were sectioned, and formed cross-sections anterior endpoint (AEP), anterior quarter point (AQP), midpoint (MP), posterior quarter point (PQP) and posterior endpoint (PEP), respectively. Positions at distances of 0.5-, 1.0-, and 1.5-cm lateral to the pelvic brim on cross-section AQP, MP and PQP were marked, respectively. The nearest distance from entry points of the anterior column to the hip joint, the average medial angulation of cortical screws at 0.5-, 1.0-, and 1.5-cm entry points on cross-section AQP, MP and PQP were measured. RESULTS: The nearest distance from 0.5-, 1.0-, and 1.5-cm entry points to the hip joint is 15.6 +/- 1.5, 13.1 +/- 1.2, and 11.2 +/- 1.4 mm, respectively. The maximum medial angulation to provide safe cortical screw placement at 0.5-, 1.0-, and 1.5-cm entry points is 8.2 +/- 2.2 degrees, 14.9 +/- 3.4 degrees, and 26.1 +/- 4.5 degrees, respectively. CONCLUSIONS: During the operation of plate-screw fixation of the anterior column on the acetabulum, there are three ways to avoid screw penetration of the hip joint. The first one is to use the long screw. Its entry point is placed as close to pelvic brim as possible, and the entry direction is parallel to the quadrilateral surface. The second one is to use the short screws whose lengths are 14, 12 and 10 mm and locate them in the region between the pelvis brim and 0.5-cm entry point, between 0.5- and 1.0-cm entry point, between 1.0- and 1.5-cm entry point, respectively, regardless of the direction of the screw placement. The third one is to take quadrilateral surface as a reference plane, and adjust the medial angulation of the screw placement according to different target locations, i.e., in the coronal plane ranges from 0 degrees to 10 degrees in the region between pelvis brim and 0.5-cm entry point, 10 degrees-20 degrees in the region between 0.5- and 1.0-cm entry point, and 20 degrees-30 degrees in the region between 1.0- and 1.5-cm entry point.
Subject(s)
Acetabulum/anatomy & histology , Acetabulum/surgery , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Hip Injuries/prevention & control , Acetabulum/injuries , Aged , Bone Plates , Bone Screws/adverse effects , Cadaver , Female , Hip Injuries/etiology , Humans , Male , Middle AgedABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of operative treatment of scapular fractures through modified Judet approach.</p><p><b>METHODS</b>From January 1997 to October 2005, 21 patients (15 females, 6 males; mean age 34 years) of scapular fractures were treated by open reduction and internal fixation through the modified Judet approach. According to Hardegger classification system, there were 11 patients of scapular body fractures, 10 patients of scapular neck fractures, 8 patients of glenoid rim fractures, 7 patients of glenoid fossa fractures, 9 patients of scapular spine fractures, and 6 patients of scapular acromion fractures.</p><p><b>RESULTS</b>Eighteen patients were followed up with an average of 21 months (range 6 months-4 years). According to Rowe scores system, 12 patients showed excellent, 3 showed good, 2 showed fair, and 1 showed poor.</p><p><b>CONCLUSIONS</b>The modified Judet approaches have the advantages of wide exploration, safety, and easy fixation. It is a good choice to the operation for most types of scapular fractures through the modified Judet approach.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Follow-Up Studies , Fracture Fixation, Internal , Methods , Fractures, Bone , General Surgery , Scapula , Wounds and Injuries , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of severe cerebral fat embolism (SCFE).</p><p><b>METHODS</b>The data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy.</p><p><b>RESULTS</b>Two of the nine patients died of severe complications, the other seven recovered without severe sequela.</p><p><b>CONCLUSIONS</b>Gurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.</p>
