Chronic pelvic insufficiency fractures and their treatment.

Fragility and insufficiency fractures of the pelvis (FFP) and sacrum (SIF) are increasingly prevalent, particularly among the elderly, due to weakened bone structure and low-energy trauma. Chronic instability from these fractures causes persistent pain, limited mobility, and significant reductions in quality of life. Hospitalization is often required, with substantial risks of loss of independence (64-89%) and high mortality rates (13-27%).

Role of vascularised fibula graft in the surgical management of radiation-induced midshaft femoral fractures. Case report and literature review.

Background: Post-radiation fractures (PRF) are a recognised complication of radiation treatment for soft tissue sarcomas. They have a low incidence and typically occur up to 5 years following treatment, more commonly affecting the pelvis, ribs and femur. Due to radiation-induced changes in bone, PRFs typically require more complicated intervention compared to post-trauma fractures, however, limited literature exists, particularly in regards to mid-shaft femoral PRFs.

Ipsilateral femoral head and intertrochanteric fractures with posterior subluxation of the hip: A rare case report.

Introduction: Hip fractures are common in elderly patients, often accompanied by comorbidities. These fractures can be combined with other injuries, such as a femoral head, neck, or shaft dislocation. The cause of this complex injury is not well-established, but factors like high-energy trauma or falls from a certain height may contribute.

The Use of Perpendicular Reconstruction Plates for the Buttressing of the Quadrilateral Surface Fractures of the Acetabulum: An Easy and Low-Cost Choice.

The quadrilateral surface fractures of the acetabulum are becoming more frequent due to the aging population. The optimal fixation of the quadrilateral surface through an appropriate surgical approach and a reliable and effective technique presents a challenge for orthopedic trauma surgeons. In this study, we present the results of 12 patients treated in our department who underwent internal fixation of the quadrilateral surface with two reconstruction plates in a vertical orientation for adequate fracture buttressing.

Clinical outcomes of open reduction and internal fixation combined with sartorius muscle iliac bone graft transplantation for displaced femoral neck fractures in middle-aged and young adults: a retrospective analysis of 24 cases.

Objective: This study aimed to evaluate the clinical outcomes and complications of open reduction and internal fixation (ORIF) combined with sartorius muscle iliac bone graft transplantation (SIBFT) in the treatment of displaced femoral neck fractures in middle-aged and young adults.

Methods: A retrospective analysis was performed on 26 patients under the age of 60 with displaced femoral neck fractures (Pauwels III or Garden III-IV) treated at our institution between April 2019 to July 2022. All patients underwent open reduction and internal fixation (ORIF) through the Smith-Petersen (S-P) approach, augmented with a sartorius muscle iliac bone graft transplantation.

The intrapelvic approach to the acetabulum.

The today well accepted intrapelvic approach for acetabular and pelvic ring injury fixation was first described by Hirvensalo and Lindahl in 1993 followed by a more detailed description by Cole and Bolhofner in 1994. Compared to the well-known ilioinguinal approach, described by Letournel, this approach allows an intrapelvic view to the medial acetabulum, while using the ilioinguinal approach a more superior, extrapelvic view, is dissected to the area of the acetabulum. Several names have been used to describe the new intrapelvic approach with increasing usage, mainly ilio-anterior approach, extended Pfannenstiel approach, Stoppa-approach, Rives-Stoppa approach, modified Stoppa approach and recently anterior intrapelvic approach.

Efficacy and safety of osteoporosis treatment in older adults. Approach for the secondary prevention of fractures in older populations. A proposal by SEFRAOS.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of the microarchitecture, resulting in bone fragility and risk of fractures. As the life expectancy of the population increases, fragility fractures are expected to become more common. Indeed, the incidence rate for major fracture (hip, vertebra, pelvis, etc.

[Treatment of acetabular fractures with the two-incision minimally invasive (TIMI) approach].

Objective: We present the two-incision minimally invasive (TIMI) approach for the treatment of anterior acetabular fractures.

Indications: Displaced fractures of the anterior column of the acetabulum; complex fractures of the acetabulum in combination with the posterior approach (Kocher-Langenbeck); periprosthetic fractures of the acetabulum with or without additional revision of the cup.

Contraindications: Possibly previous extended surgery in the anatomical region of the approach.

Fractures of the quadrilateral plate treated with a reconstruction plate and trans-plate quadrilateral screws: An experimental study on cadaveric specimens and finite element analysis.

Quadrilateral plate fracture is one of the most complex and challenging pelvic lesions. Operative reduction and internal fixation are the gold standard management for displaced quadrilateral plate fractures. Traditional methods include various kinds of operative reduction and internal fixation through either anterior or posterior approaches using various combinations of plates and lag screws or acute total hip arthroplasty.

Hemorrhage in Pelvic Ring Fractures After Low-Energy Trauma: A Systematic Review.

: The aim was to investigate diagnostic, treatment and preventive options to establish an overview of the existing evidence on hemorrhage in pelvic fractures in older adults. : A systematic review was conducted. Due to the rarity of this complication, only case reports and series with individuals older than 55 years with a pelvic ring fracture that is caused by a low-energy trauma or no apparent trauma, along with hemorrhage, were eligible.

Fractures of the Pelvis and Acetabulum: Novel Insights into Diagnostics and Treatment.

Over the past decade, the number of fractures of the pelvis and acetabulum has increased dramatically, by up to 58% [...

Outcome of pelvic ring injuries.

Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score.

Comparison of two surgical treatment strategies for fragility fractures of the pelvis based on early postoperative mobility outcomes using insole force sensors.

Introduction: Increasing incidences for fragility fractures of the pelvis (FFP) have been reported and surgical treatment remains demanding. While conventional screw osteosynthesis is a common method, complications may arise due to altered bone morphology in the osteoporotic pelvic bone. The iFuse implant system is a novel implant, first introduced for treatment of degenerative sacroiliac joint dysfunction, which offers promising biomechanical characteristics with potential benefits for treatment of FFP.

Preoperative 3D printing planning technology combined with orthopedic surgical robot-assisted minimally invasive screw fixation for the treatment of pelvic fractures: a retrospective study.

Objective: To explore the advantages and effectiveness of preoperative 3D printing planning technology combined with orthopedic surgical robot-assisted screw placement in the minimally invasive treatment of pelvic fractures compared to orthopedic surgical robot-assisted screw placement alone.

Methods: A retrospective analysis of the clinical data of 29 patients with unstable pelvic fractures treated with orthopedic surgical robot-assisted percutaneous screw fixation from July 2021 to August 2023 was conducted. Among them, 13 patients who underwent preoperative 3D printing technology for screw planning were assigned to the experimental group, and the remaining 16 patients were assigned to the control group.

Aggressive Mesenchymal Chondrosarcoma of the Rib With Early Skeletal Metastases: A Diagnostic Challenge.

Mesenchymal chondrosarcoma (MCS) is a rare, aggressive subtype of chondrosarcoma characterized by biphasic histology, often misdiagnosed due to its rarity and histological resemblance to other small round cell tumors. It predominantly affects adolescents and young adults. We report a 27-year-old male presenting with a progressively enlarging, painless mass in the right inframammary region, initially attributed to muscular strain.

Single-modality endocrine therapy versus radiotherapy after breast-conserving surgery in women aged 70 years and older with luminal A-like early breast cancer (EUROPA): a preplanned interim analysis of a phase 3, non-inferiority, randomised trial.

Background: Optimal therapy following breast-conserving surgery in older adults with low-risk, early-stage breast cancer remains uncertain. The EUROPA trial aims to compare the effects of radiotherapy and endocrine therapy as single-modality treatments on health-related quality of life (HRQOL) and ipsilateral breast tumour recurrence (IBTR) outcomes in this population.

Methods: This non-inferiority, phase 3, randomised study was conducted at 18 academic hospitals across Italy (17 centres) and Slovenia (one centre).

Trends of trauma team physicians toward patients with bleeding in Saudi Arabia: a cross-sectional study.

Objectives: Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients.

Methods: A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding.

Traumatic Anterior Hip Dislocation With an Open Book Pelvic Fracture and Femoral Artery Compression: An Atypical Case Report.

Case: A 34-year-old patient was involved in a motorcycle accident, resulting in an anterior hip dislocation associated with an open book pelvic fracture and compression to the femoral artery. He required an emergent closed reduction of the hip dislocation and open reduction and internal fixation of the pelvic fracture.

Conclusion: This case underscores the importance of maintaining a high level of suspicion for anterior hip dislocation, particularly in patients involved in motorcycle accidents, where a flexed, abducted, and externally rotated hip is common.

Safe corridors for sacroiliac fixation in pediatric patients.

Introduction: Pelvic ring fractures are rare in the pediatric population and can be treated using sacroiliac screws when needed. The aim of this study was to identify safe anatomical corridors for sacroiliac fixation in different pediatric age groups and also to determine the prevalence of sacral dysmorphism in the study sample.

Method: We measured the dimensions of the horizontal and oblique S1 corridors and the horizontal S2 corridor in pelvic computed tomography scans of 138 children aged 1 to 16 years.

Traumatic lumbosacral instability: part 1 - proposing a definition and identifying underlying injury patterns.

Traumatic lumbosacral instability (TLSI) generally refers to a traumatic disruption of the lumbopelvic junction. The ambiguous use of this term has contributed to confusion and limited understanding of injuries that can impact lumbosacral stability. As of now, TLSI lacks a clear definition, and the underlying injury patterns remain inadequately characterized.

Endoscopic-assisted anterior pelvic ring osteosynthesis for pelvic ring injuries: a technical report.

Introduction: In the surgical treatment of pelvic ring injuries (PRIs), there is an increasing adoption of minimally invasive techniques to improve surgical outcomes. Since the introduction of endoscopic-assisted osteosynthesis for PRIs in 2019, various surgical challenges have been identified. To improve surgical and clinical outcomes, we modified the existing procedures and aimed to present the surgical outcomes of patients with pelvic fractures who underwent endoscopic-assisted surgery.

An Analysis of Junctional Tourniquet Use Within the Department of Defense Trauma Registry.

Background: Junctional hemorrhage is a leading cause of battlefield death. Multiple FDA-approved junctional tourniquet (JTQ) models demonstrate effective hemorrhage control in laboratory settings. However, there are few real-world use cases within the literature.

Variation in lumbar regional kyphosis between supine and standing positions. Implications for spinal fracture management.

Purpose: The variation of lumbar lordosis between standing and supine position is poorly explored in literature. This study sought to analyze variation of lumbar regional angulations (RA) in healthy volunteers between standing and supine positions, according to pelvic incidence (PI).

Methods: This study included 171 patients who had an abdominal CT-scan in supine position and 879 healthy volunteers with full-body stereoradiographs.

Osteoporotic Fragility Fracture Is Associated With an Increased Rate of New Mental Disorder Diagnosis.

Introduction: Fragility fractures can be substantially life-altering with notable effects on patient well-being and mental health. The purpose of this study was to evaluate the risk of developing a new mental disorder diagnosis within 2 years following osteoporotic fragility fracture.

Methods: A retrospective cohort study was conducted using a large national insurance claims database.

Causal association between cholecystectomy and fracture: A Mendelian randomization study.

Previous observational studies have reported that cholecystectomy is associated with an increased risk of fracture. However, the causality of this association remains unclear. This study aimed to explore the causal relationship between cholecystectomy and fracture using a Mendelian randomization (MR) approach.