Minimally invasive stabilization of posterior pelvic ring injuries through transiliac internal fixator versus Iliosacral screw: A prospective comparative cohort study.

INTRODUCTION: Longitudinal sacral fractures are usually a matter of controversy regarding decision-making for reduction, fixation, and approach. Percutaneous and minimally invasive techniques present perioperative difficulties, but with fewer postoperative complications compared to open techniques. The objective of this study was to compare the functional as well as radiological outcomes of the Transiliac Internal fixator (TIFI) versus Iliosacral screw (ISS) fixation of sacral fractures applied percutaneously in a minimally invasive technique. METHODS: A Prospective comparative cohort study was conducted in a level 1 trauma center in a university hospital. The study included 42 patients with complete sacral fractures, 21 patients have been allocated to each group (TIFI group & ISS group). The clinical, functional, as well as radiological data, were collected and analyzed for the 2 groups. RESULTS: The mean age was 32 (18 -54 years), and the mean follow-up was 14 (12 -20 months). There was a statistically significant difference in favor of the TIFI group regarding a shorter operative time (P = 0.04) as well as less fluoroscopy time (P = 0.01) whereas there was less blood loss in the ISS group (P = 0.01). Both the mean Matta's radiological score, the mean Majeed score as well as the pelvic outcome score were comparable between the 2 groups with no statistically significant difference. CONCLUSION: This study suggests that both TIFI and ISS through a minimally invasive technique represent valid methods for sacral fracture fixation with a shorter operative time, less radiation exposure in TIFI and less blood loss in the ISS. However, the functional, as well as radiological outcomes, were comparable between the 2 groups.

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.

Functional and radiological outcomes of dynamic hip screw with trochanteric stabilizing plate versus short proximal femoral nail in management of unstable trochanteric fractures: A randomized-controlled trial.

OBJECTIVES: This study aims to compare dynamic hip screw (DHS) with trochanteric stabilizing plate (TSP) versus short proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the functional and radiological outcomes. PATIENTS AND METHODS: Between June 2019 and March 2020, a total of 68 patients (32 males, 36 females; mean age: 69.7±8.2 years; range, 60 to 88 years) with unstable trochanteric fractures were included in this randomized-controlled trial. Eligible patients were randomized to undergo DHS with TSP (n=34) or short PFN (n=34) and followed for 12 months. The outcome measures including Harris Hip Score (HHS), operating room time, the amount of blood loss and need for intraoperative transfusion, return to activity, time to union, postoperative complications, failure rate, and mortality rate were analyzed. RESULTS: The mean operative time in the DHS+TSP group was 105±10 min, while in the PFN group it was 94±8 min (p=0.001). The mean time until union in the DHS+TSP group was 10.1±1.9 weeks, while in the PFN group, it was 8.8±1.8 weeks (p=0.008). The mean time to return to the pre-fracture activity level in the DHS+TSP group was 12.6±2.6 weeks, while in the PFN group, it was 10.8±2.1 weeks (p=0.005). The mean HHS for the DHS+TPS group was 77.9±8.4, while for the PFN group, it was 80.4±8.7 (p=0.26). There was no significant difference in the walking capability between the two groups. One-year mortality rate was 29.4% in the PFN group and 17.6% in the DHS+TSP group (p=0.284), indicating no significant difference. Mechanical failure was recorded in three cases (8.8%) in the DHS+TSP group compared to two cases (5.8%) in the PFN group with no statistically significant difference. These five cases needed later revisions with total hip replacement. CONCLUSION: The use of PFN in unstable trochanteric fractures was associated with a shorter time until union and a faster return to the pre-fracture level of activity than the DHS+TSP group. Postoperative hip function, walking independence, as well as complication and one-year mortality rates were comparable.

Fragment-specific fixation of posterior wall acetabular fractures.

PURPOSE: Fractures of the posterior wall (PW) of the acetabulum have a wide variety of patterns; treating them as a single entity using the standard ilio-ischial plate would be inappropriate. We are presenting our experience with a fragment-specific fixation technique in which each PW fragment is reduced and fixed with separate buttress/anti-glide plate(s) in a tailored fashion, abandoning the use of the ilio-ischial plate. PATIENTS AND METHODS: Fragment-specific fixation was applied to 46 patients with PW fractures (33 simple and 13 associated fracture types) with a mean follow-up of 34.9 ± 20.5 months (range: 12-72). Kocher-Langenbeck approach was utilized for all patients with dissection limited to the fracture site (a limited form of the approach was used in three patients). RESULTS: Anatomical reduction of the fracture was achieved in 41 (89.1%) patients, imperfect reduction in four (8.7%), and poor reduction in one (2.2%) patient. Excellent to good radiological and functional results were achieved in 91.3% of cases. A single case had recurrent subluxation which was related to avascular necrosis of the highly comminuted wall fragments. Four patients developed post-traumatic arthritis and required total hip arthroplasty. None of our cases developed clinically significant heterotopic bone formation. CONCLUSION: With a versatile yet a strong-enough construct and limited soft tissue dissection, fragment-specific fixation yielded very good results with few complications.