Transiliac Cerclage in Unstable Pelvic Ring Fractures.

BACKGROUND: To evaluate the outcomes of transiliac cerclage with Dall-Miles cable in the internal fixation of the posterior complex in unstable pelvic ring fractures between January 1995 and December 2014. MATERIAL AND METHODS: A study of 42 men injured at work with an average age of 35.2 years (range, 23 to 61) was conducted. The mechanisms of injury were traffic accidents in 25 cases (59.5%), crushing accidents in 12 cases (28.6%), and fall from height in 5 cases (11.9%). Thirty-six cases were polytraumatized patients (85.7%). The patients were evaluated using Majeeds functional score and Mattas radiological criteria. RESULTS: The average follow-up time was 135.8 45.6 months. The clinical outcomes were excellent in 17 cases (40.5%), good in 19 cases (45.2%), fair in 5 cases (11.9%), and poor in 1 case (2.4%). The radiological outcomes were satisfactory in 32 cases (76.2%) and unsatisfactory in 10 cases (23.8%). All fractures were healed. The sequelae were 3 cases (7.2%) of lower limb dysmetria and 3 cases (7.2%) of chronic neuropathic pain. CONCLUSION: The internal fixation of the sacroiliac complex by Dall-Miles cable cerclage reinforced with small fragment plates should be considered as an alternative method for minimally invasive osteosynthesis in selected cases of unstable pelvic ring fractures.

Osteogénesis por distracción en seudoartrosis infectada de fémur: Caso clínico / Distraction osteogenesis in femoral infected nonunion. Case report

Comunicamos un caso de seudoartrosis infectada de fémur secundaria a una fractura expuesta de tipo IIIC, tratada con osteogénesis por distracción. Hombre de 32 años con una fractura expuesta de fémur derecho con lesión arterial por disparo de escopeta. Es operado de urgencia y se le efectúa limpieza quirúrgica, fijación externa y reparación arterial. Evoluciona con una seudoartrosis infectada femoral distal, por lo que, a los 24 meses de evolución, es sometido a una resección amplia y queda un defecto óseo de 12 cm, que se resuelve mediante distracción osteogénica. La osteogénesis por distracción es útil para obtener la reparación y la consolidación de variados defectos óseos. Requiere de un paciente comprometido con un proceso terapéutico demandante. Nivel de Evidencia: IV

We report a case of infected nonunion secondary to a type IIIC open femoral fracture, treated by distraction osteogenesis. A 32-year-old man with a gunshot open fracture of the distal right femur with arterial injury. Surgical debridement, external fixation and arterial repair are performed as emergency procedure. The patient develops a femoral infected nonunion, so 24 months later a wide resection is performed leaving a 12 cm bone defect that is regenerated by distraction osteogenesis. Distraction osteogenesis is a useful procedure for the repair and consolidation of several bone defects. It requires patient´s commitment to a demanding therapeutic process. Level of Evidence: IV