Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study.

BACKGROUND: Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. METHODS: We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. RESULTS: Eighteen patients (bilateral in one case) met the diagnostic criteria. All these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P = 0.046). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P = 0.009). The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs. 6.70 months; P = 0.001). CONCLUSIONS: All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

Incidence of Traumatic Sciatic Nerve Injury in Association with Acetabular Fracture: A Retrospective Observational Single-Center Study.

Purpose: Traumatic sciatic nerve injury is one of the most serious consequences of acetabular fracture. However, reports on this type of injury are rare. In this study, we investigated the demographics of acetabular fracture with traumatic sciatic nerve injury, the clinical characteristics of patients with these injuries, and potential risk factors. Patients and Methods: We retrospectively reviewed patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of the acetabular fracture, whether or not sciatic nerve injury occurred, types of sciatic nerve injury, and risk factors were analyzed. Results: A total of 195 patients met the diagnostic criteria for acetabular fractures. The average Injury Severity Score was 25.9 and the average Abbreviated Injury Scale score was 12.4. Road traffic accidents and falls from height were the main causes. Chest injuries and lower extremity fractures were the most common associated injuries. Posterior wall fractures were the most common fracture type. After exclusion of spinal cord and iatrogenic sciatic nerve injuries, 18 patients with acetabular fractures had traumatic sciatic nerve injury. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Logistic regression analysis identified a higher AIS score, posterior column fracture, and posterior hip dislocation to be predictors of traumatic sciatic nerve injury. Conclusion: Acetabular fractures were mostly high-energy injuries. Posterior wall fractures were the most common acetabular fracture types. Most patients sustained injury to the sciatic nerve as well as injury to the common peroneal and tibial nerve divisions. A higher AIS score, posterior column fracture, and posterior hip dislocation were predictors of acetabular fracture combined with traumatic sciatic nerve injury.

Bilateral posterior fracture-dislocation of the shoulders: Two rare case reports and literature review.

RATIONALE: Bilateral posterior fracture-dislocation of the shoulders occurs rarely and the diagnosis is often challenging. This injury is often missed or delayed on initial presentation, leading to continuous pain, disability, and rising medical costs. Timely diagnosis and proper treatment are very important to restore shoulder function. PATIENT CONCERNS: Here we report 2 rare cases. Case 1 was a 53-year-old physical worker with severe pain and limited shoulder movement after an unexpected fall. Case 2 was a 55-year-old man with pain in upper limbs and shoulders after an electric shock. DIAGNOSIS: Both of them were diagnosed as bilateral posterior fracture-dislocation of the shoulders by computed tomography (CT) scan. INTERVENTION: After systematic preoperative evaluation, both of them were treated with open reduction and internal fixation. OUTCOMES: After 16 months follow-up, case 1 was pain-free in both shoulders. He had returned to full activity and was satisfied with his level of function. At 24 months follow-up, both shoulders of case 2 were painless and stable with acceptable range of motion and he was able to carry out daily activities. LESSONS: Our case reports highlight that bilateral posterior fracture-dislocation of the shoulders is easy to be missed; one way to prevent missing diagnosis is to suspect cases with pain and limited external rotation, especially those with a history of seizures, electric shock, or severe trauma; appropriate history inquiry, physical examination, proper shoulder images are the key to correct diagnosis.

An insertion/deletion polymorphism within the 3'­untranslated region of COL1A2 confers susceptibility to osteoporosis.

Polymorphisms located in microRNA (miRNA) binding sites may interfere with the interaction between miRNAs and mRNAs, and thereby alter the expression of genes. The current study aimed to investigate the association between an insertion/deletion (INS/DEL) polymorphism in the 3'­untranslated region (3'­UTR) of COL1A2 and the risk of developing osteoporosis. In the present study, COL1A2 was identified as a target gene of let­7g in osteoblast cells obtained from patients, using a luciferase reporter system. This was further confirmed by the observation that exogenous overexpression of let­7g in the osteoblast cells downregulated the expression of COL1A2 in the cells in the INS/INS group, however not in the DEL/DEL group. In addition, a total of 487 subjects were enrolled in the present study and their bone mineral density (BMD) was measured. The BMD at the four tested sites, the femoral neck, total left hip, L1­L4 and intertrochanteric areas, were significantly reduced in the INS/DEL or DEL/DEL group compared with the INS/INS group. Furthermore, the levels of COL1A2 and let­7g were measured in the primary osteoblasts obtained from 48 patients with osteoporosis. While the let­7g levels were comparable between each genotype group, the expression level of COL1A2 in the DEL/DEL and INS/DEL group was significantly greater compared with the INS/INS group. In conclusion, the present study demonstrated that the INS/DEL polymorphism in the 3'­UTR of COL1A2 is able to interfere with the interaction between miRNA and mRNA. In addition, it is the first study, to the best of our knowledge, to indicate that the minor allele (Del) is associated with a reduced risk of developing osteoporosis.

Temporary Balloon Occlusion of the Abdominal Aorta in Treatment of Complex Acetabular Fracture.

BACKGROUND The aim of this study was to explore the efficacy of temporary balloon occlusion of the abdominal aorta assisting open reduction and internal fixation (ORIF) in the treatment of complex acetabular fracture. MATERIAL AND METHODS From August 2000 to October 2011, a total of 48 patients with complex acetabular fracture were enrolled in this study. Average operative time, intraoperative blood loss volume, blood transfusion volume, satisfactory reduction, and postoperative functional recovery rate were recorded and compared between the 2 groups. RESULTS A significant difference was observed between the 2 groups in operative time (P=0.003). For intraoperative blood loss and blood transfusion, ORIF combined with temporary balloon occlusion of abdominal aorta techniques appeared to be superior to normal ORIF (blood loss: P=0.007; and blood transfusion: P=0.019, respectively). However, no differences were observed in postoperative blood loss or transfusion (P>0.05). Patients in group A showed better hip function than those in group B (group A: a good-to-excellent rate of 77.8%; group B: a good-to-excellent rate of 78.3%; P>0.05). With regard to the incidence of postoperative complications, there were no significant differences between the 2 groups (group A: 9/18; group B: 11/23; P=0.890). CONCLUSIONS In the treatment of complex acetabular fracture, temporary balloon occlusion of the abdominal aorta is a reliable technique to assist ORIF surgery to staunch the flow of blood.

Modified Ilioinguinal Approach to Treat Pelvic or Acetabular Fractures: A Retrospective Study.

The aim of this study was to evaluate the potential advantages and clinical results of a modified minimally invasive ilioinguinal approach for the treatment of acetabular or pelvic fractures to the results obtained using a standard ilioinguinal approach. Forty-six patients who were diagnosed as having anterior column acetabular fractures or anterior pelvic ring fractures underwent open reduction and internal fixation through 2 different surgical approaches between June 2008 to June 2012 in our trauma center was studied. The modified ilioinguinal group included 20 patients and the other 26 patients were in the standard ilioinguinal approach group. The clinical and radiographic results were recorded and compared between the 2 groups. There were no significant differences between 2 groups in the mean age, sex, fractures type, and causes of acetabular or pelvic fractures. The mean blood loss in the modified group was 560.0 ±â€Š57.3 mL versus 850.0 ±â€Š59.0 mL in the standard ilioinguinal group. The operative time was significantly reduced with modified ilioinguinal approach (86.0 ±â€Š4.56 min vs. 101.9 ±â€Š5.38 min). The mean hospital stay was 16.8 ±â€Š0.58 days and 18.7 ±â€Š0.52 days in the modified and standard ilioinguinal groups, respectively. According to the Matta score, the quality of reduction between the 2 groups was not significantly different. The complication rate was low in the modified group but not significantly different between the 2 groups. Forty-two patients were followed up with clinical examination and radiographs at a mean of 15.2 months. Solid union was observed in 42 cases at a mean time of 14.8 weeks. The mean Harris Hip Score and the Majeed scores at the time of evaluation were not significantly different between the 2 groups. On comparing the 2 surgical ilioinguinal approaches, it was found that using modified ilioinguinal approach decreased operative time and blood loss, and did not affect the quality of fracture reduction and fracture healing. This study demonstrates that the modified ilioinguinal approach is a simple and minimally invasive approach for anterior column acetabular fractures and pubic rami fractures comparing with the standard ilioinguinal approach.

Carvacrol protects against spinal cord injury in rats via suppressing oxidative stress and the endothelial nitric oxide synthase pathway.

Carvacrol (CAR) is a naturally occurring phenolic monoterpene and has been demonstrated to possess a spectrum of pharmacological actions. The present study was designed to assess the neuroprotection of CAR against spinal cord injury (SCI) in rats and to identify the underlying mechanisms. SCI was induced using the modified weight­drop method in Wistar rats. CAR or saline was administered at doses of 25, 50 and 100 mg/kg for 46 days. Neuronal function following SCI was evaluated using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale. Spinal cord edema was assessed by measuring the water content in spinal cord tissues. The oxidative indicators, including malondialdehyde, catalase, superoxide dismutase glutathione peroxidase and 8­isoprotane as well as endothelial nitric oxide synthase (eNOS) activity and caspase­3 were measured using corresponding commercial kits. The protein expression of eNOS and B cell lymphoma­2 (Bcl­2) as well as Bcl­2­associated X protein (Bax) was analyzed by western blot analysis. The SCI­induced rats demonstrated marked reductions in BBB scores. CAR treatment recovered neurological function with decreasing BBB scores. CAR was found to have inhibitory effects on the water content in the spinal cord, oxidative stress, eNOS, nitric oxide production and apoptosis­associated molecules, including Bax and caspase­3 as well as promoting Bcl-2 expression in SCI-induced rats. These results suggested that CAR protects against SCI via mediating oxidative stress and the eNOS signaling pathway.

Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery.

PURPOSE: This study aims to compare the efficacy and accuracy of percutaneous screw fixation using three-dimensional [Formula: see text] navigation and conventional C-arm fluoroscopy in pelvic fracture surgery. METHODS: This was a retrospective study of 81 patients with pelvic fractures treated using percutaneous screw fixation between June 2005 and January 2011. All pelvic fractures were treated with closed reduction, small open reduction, or medium open reduction. Intraoperative radiation exposure, fixation, surgical outcome, and functional recovery were compared based on the fluoroscopy navigation method used during screw fixation. Radiographic follow-up was assessed at 1, 3, 6, and 9 months postoperatively, and a CT scan was completed at 9 months postoperatively. RESULTS: A total of 130 cannulated screws were placed. Average screw fixation time and fluoroscopy exposure time in [Formula: see text] group were lower than the C-arm fluoroscopy group ([Formula: see text] vs [Formula: see text]) [Formula: see text]. Seventy-four of the 81 patients made a full recovery. Successful outcome was confirmed with radiological imaging and postoperative follow-up at 6-24 months. No delayed union or nonunion was detected. No significant difference in functional recovery at 6 months postoperative was found due to the fluoroscopy imaging technique. CONCLUSIONS: Percutaneous screw fixation using the [Formula: see text] navigational system minimizes the fluoroscope exposure and screw insertion time, while improving screw insertion accuracy. Moreover, the [Formula: see text] navigational system provided a reliable method for fluoroscopy imaging in pelvic fractures.