Does operative treatment of geriatric pelvic ring injuries lead to a high risk of one-year mortality?

Introduction: Non-operative management of pelvic ring injuries in the elderly is associated with a high risk of one-year mortality. The majority of these injuries are the result of a low-energy mechanism, however, due to the multiple medical comorbidities in this patient population the injuries are associated with a high degree of morbidity. The purpose of this study was to determine the one-year mortality risk after operative treatment of pelvic ring injuries in a geriatric patient population and the effect of patient and injury characteristics on the risk of mortality.

Posterior pelvic ring bone density with implications for percutaneous screw fixation.

Background: Although the second (S2) and third (S3) sacral segments have been established as potential osseous fixation pathways for screw fixation, the S2 body has been demonstrated to have inferior bone density when compared to the body of the first (S1) sacral segment. Caution regarding the use of iliosacral screws at this level has been advised as a result. As transiliac-transsacral screws traverse the lateral cortices of the posterior pelvis, they may be relying on bone with superior density for purchase, which could obviate this concern.

Improved Intraoperative Fluoroscopy for Pelvic and Acetabular Surgery.

Over the past 3 decades, the evolution of pelvic and acetabular surgery has been supported by the advances in intraoperative pelvic fluoroscopic imaging technology. The new Ziehm RFD 3D C-arm unit provides routine fluoroscopic pelvic imaging but also offers rapid and high-quality real-time axial, sagittal, and coronal intraoperative imaging. This technology allows the surgeon to accurately assess fracture reduction, loose body removal, and implant locations while the patient is still under anesthesia.

Safe Zone Quantification of the Third Sacral Segment in Normal and Dysmorphic Sacra.

Objective: To quantify the osseous anatomy of the dysmorphic third sacral segment and assess its ability to accommodate internal fixation.

Design: Retrospective chart review of a trauma database.

Setting: University Level 1 Trauma Center.

Management and radiographic outcomes of femoral head fractures.

Background: Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable.

A Useful Preoperative Planning Technique for Transiliac-Transsacral Screws.

Stabilization of posterior pelvic ring injuries is increasingly performed using percutaneously placed iliosacral and transiliac-transsacral screws. Understanding the unique and specific anatomical variations present in each patient is paramount. Multiple methods of evaluating potential osseous fixation pathways for screw placement exist, but many require specific imaging protocols, specialized software, or modification of data.

Use of the initial trauma CT scan to aid in diagnosis of open pelvic fractures.

Open pelvic disruptions represent high-energy injuries. The prompt identification and management of these injuries decreases their associated morbidity and mortality. Computed tomography (CT) scans are routinely obtained in the initial evaluation of patients with pelvic injuries.

Percutaneous fixation of hypertrophic nonunion of the inferior pubic ramus: a report of two cases and surgical technique.

Symptomatic hypertrophic nonunions of the inferior pubic ramus are amenable to percutaneous screw fixation in patients with suitable osseous anatomy. Preoperative planning, knowledge of bony and surrounding soft-tissue anatomy, and understanding of intraoperative pelvic fluoroscopy are required for proper screw fixation in the medullary canal of the inferior pubic ramus. In this article, we report 2 cases of adults with symptomatic hypertrophic nonunions of the superior and inferior pubic ramus, treated successfully with percutaneous medullary screw fixation.

What I expect from an orthopaedic traumatology fellow.

After 2.5 decades working with a variety of orthopaedic traumatology fellows, I have learned that several qualities and behaviors are important to a successful experience. Most fellows possess them, but some do not.

The pubic midline exposure for symphyseal open reduction and plate fixation.

Background: Open reduction and plate fixation of the disrupted symphysis pubis is commonly performed through a horizontal Pfannenstiel incision. Certain clinical situations that complicate the soft tissue conditions of the lower abdomen may make the Pfannenstiel incision a less appealing option. We report on the use of a vertical pubic area midline skin incision in a series of patients undergoing open reduction and plate fixation of their traumatically disrupted symphysis pubis.

Intraosseous correction of misdirected cannulated screws and fracture malalignment using a bent tip 2.0 mm guidewire: technique and indications.

Percutaneous pelvic screw placement is a technically demanding procedure. A precise intraosseous pathway must be prepared before screw placement into any osseous fixation pathway of the pelvis. Adjustments to a drill or guidewire become increasingly difficult as the instrument is advanced within the pelvis.

Posterior iliac crescent fracture-dislocation: what morphological variations are amenable to iliosacral screw fixation?

Objectives: Posterior iliac crescent fracture with associated sacroiliac joint disruption (PICFSID) is a type of traumatic posterior pelvic injury associated with instability. Posterior iliac fracture location and obliquity along with other details determine the treatment. Open reduction and internal fixation has been previously recommended for the majority of crescent fractures.