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.

Minimally invasive sacroiliac fusion, a case series, and a literature review.

INTRODUCTION: Non-autoimmune sacroiliac joint pain contributes to nearly a quarter of low back pain patients. Non-surgical management fails to satisfy patients. A new minimally invasive technique for sacroiliac stabilization has been introduced, defying the traditional rules of fusion. The results outside explanatory trials and in day-to-day practice have not been reported. MATERIALS AND METHODS: This case series includes 20 patients diagnosed with chronic sacroiliac pain resistant to conservative management for at least 6 months. The diagnosis was confirmed with a positive sacroiliac injection. Patients underwent stabilization using the iFuse® implant. Patients were followed up for a minimum of one year. The primary outcome was the functional outcomes, assessed using VAS, ODI, and SF36. Secondary procedure rates, complication rates, and radiological assessments of fusion were collected as secondary outcomes. RESULTS: At one year, the mean VAS score improved from 81.25 ± 10.7 SD preoperatively to 52.5 ± 26.8, p-value 0.0013. The mean ODI improved from 54.8 ± 11.21 SD preoperatively to 41.315 ± 15.34, P value = 0.0079. The mean PCS and MCS of SF36 improved by 17 and 20 points, respectively. Only 55% of patients achieved the MCID for the VAS score. 35% of the cohort had secondary procedures. DISCUSSION: Minimally invasive sacroiliac fusion resulted in an improvement in mean functional scores with a wide dispersion. Patients not achieving MCID are patients with either a malpositioned implant, an associated lumbar pathology, or an inaccurate diagnosis. Our results are underwhelming compared to similar work but are still better than conservative cohorts in comparative studies. CONCLUSION: Minimally invasive sacroiliac fusion can be used successfully in select patients. Attention to diagnosis and surgical technique can improve the reproducibility of results.

Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial.

INTRODUCTION: Biomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures. METHODS: Thirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta's radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset. RESULTS: Fifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12-24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups. CONCLUSION: Single poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.

Quadrilateral plate fractures of the acetabulum: Proposition for a novel classification system.

BACKGROUND: Currently, there is no definition or classification system for quadrilateral plate (QLP) fractures; the aim was to anatomically and radiologically characterise the QLP, propose a definition and classify QLP fractures. METHODS: This study included an anatomical component and a radiological component. The anatomical study aimed at defining the characteristics of the QLP; the QLP was identified using four articulating bony pelvis specimens. A titanium mesh was placed on the specimens' quadrilateral surface; standard anteroposterior and oblique views were obtained, and axial CT images, to determine the radiological landmarks. The radiological study included the review of images of patients with QLP fractures; fractures involving the QLP were identified in a series of 609 consecutive patients with acetabular fractures. RESULTS: We considered QLP fractures where the QLP is separated from both columns of the acetabulum; this was found in 16% (98 cases). They were mostly encountered with associated both columns fractures (60 cases; 61%), Separation of the QLP could be complete or incomplete, or simple or comminuted, so QLP fractures were divided into three types: QLP1, simple with incomplete separation; QLP2, comminuted with incomplete separation; QLP3, comminuted with complete separation (QLP4), simple with complete separation. CONCLUSION: The QLP was characterised, and a definition and classification system; Cairo University Hospitals (CUH) Classification was proposed for these fractures. We believe that this classification may prove useful in the future for the identification and management of these fractures.

Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees.

OBJECTIVES: The objective of this study was to evaluate and compare the outcome of the crossed and the lateral pin configurations in the management of supracondylar humeral fractures in children in the hands of junior trainees. DESIGN: Prospective randomized controlled trial. SETTING: Level I Trauma Center. PATIENTS: Sixty children with supracondylar humeral fractures. The mean age was 5.1 years (1.5-9 years). The minimum follow-up period was 6 months, with no patients lost to follow up. INTERVENTION: Thirty patients were managed by crossed and 30 by the lateral method. All surgeries were performed by junior trainees in their first 3 years of training. MAIN OUTCOME MEASUREMENTS: Postoperative stability, ulnar nerve injury, range of motions, and pin tract infection. RESULTS: The crossed configuration was stable in all the patients, whereas the lateral method was less stable in 20% of the cases because the distal fragment rotated in 5 patients and posteriorly displaced in 1 patient. The difference was statistically significant with a P value of 0.031. Ulnar nerve neurapraxia occurred in 1 patient from the lateral group and it recovered in the fourth month, whereas no ulnar nerve injury occurred in the crossed configuration group. Two patients in the lateral group lost approximately 100 of elbow flexion. CONCLUSIONS: This prospective randomized controlled trial showed that the crossed pin configuration method provided more stability than the lateral pin configuration, especially, in the hands of junior trainees in their first 3 years of training, and the difference was statistically significant. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy.

UNLABELLED: The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. LEVEL OF EVIDENCE: 4.