Incidence, risk factors, and prognosis of sciatic nerve injury in acetabular fractures: a retrospective cross-sectional study.

PURPOSE: This study aimed to investigate the incidence, risk factors of the sciatic nerve injury in patients with acetabulum fractures and assess its prognosis. METHODS: A retrospective cross-sectional review was conducted on 273 patients with acetabulum fractures who were treated between January 1st, 2017, and December 30th, 2019. The medical records and radiographs of these patients were analyzed. RESULTS: The overall nerve injury rate was 7.7% (21 of 273 cases), with 3.1% (8 of 273 cases) occurring because of the initial injury and 12.8% (13 of 101 cases) as post-operative complications. Among those with nerve injuries, 95.2% (20 of 21 cases) were males and the average age of the patients was 31.5 (SD 9.5) years. The most common mechanism of injury was motor vehicle collisions with 55.7% (152 of 273 cases), and the most common fracture pattern associated with nerve injury was posterior column and posterior wall fracture with 31.6% (6 of 21 cases). Hip dislocation was found in 16.5% (14 of 21 cases) of patients with nerve injury. The Kocher Langenbeck approach was the most common approach used for patients with post-operative nerve injury, and the prone position was significantly associated with sciatic nerve injury during the operation. Of all patients with nerve injury, 52% (11 of 21 cases) had fully recovered, 29% (6 of 21 cases) had partially recovered, and 19% (4 of 21 cases) had no improvement. The average follow-up was 15 months. CONCLUSION: This study emphasizes the incidence of sciatic nerve injuries in individuals with acetabulum fractures and highlights key risk factors, including hip dislocation, posterior column, and posterior wall fractures. It is noteworthy that the Kocher Langenbeck approach and the prone position may contribute to iatrogenic nerve injuries. Encouragingly, over half of the patients who suffered nerve injuries achieved full recovery, while nearly one-third experienced partial recovery. These findings underscore the vital significance of recognizing and addressing these risk factors in clinical practice.

Impact of Screw Type on Kyphotic Deformity Correction after Spine Fracture Fixation: Cannulated versus Solid Pedicle Screw.

STUDY DESIGN: Retrospective review. PURPOSE: To detect the effect of cannulated (poly-axial head) and solid (mono-axial head) screws on the local kyphotic angle, vertebral body height, and superior and inferior angles between the screw and the rod in the surgical management of thoracolumbar fractures. OVERVIEW OF LITERATURE: Biomechanics studies showed that the ultimate load, yield strength, and cycles to failure were significantly lower with cannulated (poly-axial head) pedicle comparing to solid core (mono-axial head). METHODS: The medical charts of patients with thoracolumbar fractures who underwent pedicle screw fixation with cannulated or solid pedicle screws were retrospectively reviewed; the subjects were followed up from January 2011 to December 2015. RESULTS: Total 178 patients (average age, 36.1±12.4 years; men, 142 [84.3%]; women, 28 [15.7%]) with thoracolumbar fractures who underwent surgery and were followed up at Hamad Medical Corporation were classified, based on the screw type as those with cannulated screws and those with solid screws. The most commonly affected level was L1, followed by L2 and D12. Surgical correction of the local kyphotic angle was significantly different in the groups; however, there was no significant difference in the loss of correction of the local kyphotic angle of the groups. Surgical correction of the reduction in the vertebral body height showed statistical significance, while the average loss of correction in the reduction of the vertebral body height was not significantly different. The measurement of the angles made by the screws on the rods was not significantly different between the cannulated (poly-axial head) and solid (mono-axial head) screw groups. CONCLUSIONS: Solid screws were superior in terms of providing increased correction of the kyphotic angle and height of the fractured vertebra than the cannulated screws; however, no difference was noted between the screws in the maintenance of the superior and inferior angles of the screw with the rod.

Clinical series of three hundred and twenty two cases of Achilles tendon section with laceration.

PURPOSE: We aim to report the epidemiology of open Achilles tendon lacerations to determine the incidence of associated complications and identify the factors contributing to the development of the infection after repair and to propose a treatment protocol for this rare injury. METHODS: Retrospective review of the medical charts of patients with open Achilles tendon injury operated and followed up at the orthopedic department at Hamad Medical Corporation, Doha, Qatar, from 2010 to 2015. RESULTS: There were (322) cases of open Achilles tendon lacerations, average age (32.1 years), (97.5 %) male. The most common cause was found to be slipping in the bathroom (81.7 %), followed by injury from sharp objects (15.5 %), and injury while using a grinder (2.8 %). Partial cuts were more common than complete cuts (63.5 %) and (35.9 %). The infection rate was 8.7 %. The patient-related factors that affected the infection rate was age (p = 0.02), diabetes, smoking status, the cause of injury and type of cut did not affect the infection rate. Management-related factors that affected the infection rate were time to surgery (p <0.001) and the length of hospital stay (p <0.001). With regard to surgery-related factors, there was no difference in infection rate by suture type (p = 0.373), immobilization type (p = 0.493), and surgeon experience (p = 0.481). The reoperation rate was a higher in the infected group as compared to the non-infected group (p = <0.001). DISCUSSION: Open Achilles tendon lacerations is common in Qatar, despite the dirty environment of the common cause (bathroom injury) the incidence of infection is low if proper protocol is followed including early irrigation in emergency, early antibiotics such as cefazolin for 72 hours, and primary repair under sterile environment in operating theater, followed by immobilization with or without slab. CONCLUSION: The incidence of a major complication in primary open Achilles tendon lacerations repairs is relatively low. Primary Achilles tendon laceration repair is safe.

Posterior Hip Dislocation with Ipsilateral Femoral Head and Shaft Fracture - Using a Temporary External Fixator as a Method for Closed Reduction.

INTRODUCTION: Complex fractures are increasing because of various traumatic mechanisms. They drift from standard classifications, and their treatment is controversial. Of such cases are hip dislocations with associated fractures of the ipsilateral femur. CASE REPORT: This case report describes the condition of a 30-year-old man involved in a motor vehicle collision. Clinical examination, X-rays, and computed tomography scan revealed a posterior hip dislocation with an ipsilateral femoral head and mid-shaft fractures. The patient was treated by closed reduction of hip dislocation using a temporarily applied external fixator followed by intramedullary nailing of the femoral shaft. Achieving a closed reduction is a challenge with ipsilateral fractures but it should be favored over open reduction due to a lower risk of complications. The type of femoral head fracture, in this case, may have aided in an easier reduction. CONCLUSION: Hip dislocation is an orthopedic emergency and its treatment is challenging if associated with ipsilateral fractures. The decision of a closed versus an open approach should be made after considering the management plans of other injuries.