An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement.

BACKGROUND: Percutaneous stabilization using three-dimensional (3D) navigation system is a promising treatment for pelvic and acetabular fractures. However, there are still some controversies regarding the use of 3D navigation to treat pelvic and acetabular fractures. The purpose of this study was to compare the Iso-C(3D) fluoroscopic navigation, standard fluoroscopy, and two-dimensional (2D) fluoroscopic navigation in placing percutaneous lag screws in pelvic specimens to better understand the merits of 3D navigation techniques. METHODS: Fifty-four instrumentation procedures were performed in this study using six cadaveric pelvic specimens. Three groups were designated for different procedures and tests: group I, standard fluoroscopy; group II, 2D fluoroscopic navigation; and group III, Iso-C(3D) fluoroscopic navigation. Nine screws were placed in each pelvis, including four screws placed bilaterally through the ilium into S1 and S2 vertebrae, four screws placed bilaterally through anterior and posterior columns of acetabulum, and one screw placed through the pubic symphysis. 3D fluoroscopic techniques were evaluated to determine the accuracy of screw position, instrumentation time, and fluoroscopic time. The data were statistically analyzed using SPSS 13.0. RESULTS: The malposition rate was 38.89%, 22.22%, and 0% in standard fluoroscopy, 2D fluoroscopic navigation, and Iso-C(3D) fluoroscopic navigation groups, respectively. There was no significant difference between standard fluoroscopy and 2D fluoroscopic navigation. Compared with Iso-C(3D) fluoroscopic navigation, there were significant differences (analysis of variance [ANOVA], P < 0.05). The mean instrumentation operating time using Iso-C(3D) fluoroscopic navigation technique was 15.4 ± 4.5 min. There were significant differences compared with standard fluoroscopy (31.5 ± 6.2 min) and 2D fluoroscopic navigation (26.3 ± 7.5 min; ANOVA, post hoc Scheffe, P < 0.01). The mean fluoroscopic time of Iso-C(3D) fluoroscopic navigation was 66 ± 4.8 min. Compared with standard fluoroscopy (132.8 ± 7.3 min) and 2D fluoroscopic navigation (47.7 ± 5.6 min), there were significant differences (ANOVA, post hoc least significant difference, P < 0.01). CONCLUSIONS: In the present study, we compared Iso-C(3D) fluoroscopic navigation, 2D fluoroscopic navigation, and standard fluoroscopy. Iso-C(3D) fluoroscopic navigation showed a higher accuracy rate in positioning and a shorter instrumentation operating time. The fluoroscopic time was longer in Iso-C(3D) fluoroscopic navigation than that in standard fluoroscopy, indicating that radiation exposure can be moderately reduced in Iso-C(3D) fluoroscopic navigation operation, although the fluoroscopic time was the shortest in 2D fluoroscopic navigation.

[Operative treatment of the scapular fractures through modified Judet approach].

OBJECTIVE: To investigate the effect of operative treatment of scapular fractures through modified Judet approach. METHODS: From January 1997 to October 2005, 21 patients (15 females, 6 males; mean age 34 years) of scapular fractures were treated by open reduction and internal fixation through the modified Judet approach. According to Hardegger classification system, there were 11 patients of scapular body fractures, 10 patients of scapular neck fractures, 8 patients of glenoid rim fractures, 7 patients of glenoid fossa fractures, 9 patients of scapular spine fractures, and 6 patients of scapular acromion fractures. RESULTS: Eighteen patients were followed up with an average of 21 months (range 6 months-4 years). According to Rowe scores system, 12 patients showed excellent, 3 showed good, 2 showed fair, and 1 showed poor. CONCLUSIONS: The modified Judet approaches have the advantages of wide exploration, safety, and easy fixation. It is a good choice to the operation for most types of scapular fractures through the modified Judet approach.

The diagnosis and treatment of severe cerebral fat embolism.

OBJECTIVE: To improve the diagnosis and treatment of severe cerebral fat embolism (SCFE). METHODS: The data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy. RESULTS: Two of the nine patients died of severe complications, the other seven recovered without severe sequela. CONCLUSIONS: Gurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.