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Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures; however, the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel. This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS: Computer searches of CNKI, WanFang, VIP, CBM, PubMed, Embase, Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022. The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China. The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria, respectively. The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria. The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software for inclusion metrics. Outcome metrics included operative time, intraoperative bleeding, fluoroscopy time, fluoroscopy frequency, number of holes drilled, Majeed postoperative function score, the excellent and good rates of Matta fracture reduction, the excellent and good rates of Gras screw position, fracture healing time and complications. RESULTS: (1) A total of 13 publications were included, 2 were randomized controlled trials both referring to randomized methods, 11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale, 1 scored 8, 9 scored 7; and 1 scored 6; the quality of literature was good. A total of 748 patients were included, including 430 in the robot-assisted group and 318 in the freehand group. (2) The results of the metaanalysis showed that the operative time (MD=-28.30, 95%CI:-40.20 to -16.40), intraoperative bleeding (MD=-6.36, 95%CI:-10.06 to -2.66), intraoperative fluoroscopy time (MD=-12.13, 95%CI:-19.54 to -4.72), intraoperative fluoroscopy frequency (MD=-17.39, 95%CI:-29.00 to -5.78), number of intraoperative needle drillings (SMD=-9.50, 95%CI:-14.27 to -4.73) and the excellent and good rates of Gras screw position (OR=8.65, 95% Cl:3.26-22.92) in the robot-assisted group were significantly better than those in the freehand group (P<0.05). (3) In the robot-assisted group, the overall postoperative complication rate was significantly reduced (OR=0.10, 95% Cl: 0.02-0.48, P < 0.05). (4) No significant difference was detected in fracture healing time (MD=-0.08, 95%CI:-0.21,0.06), the excellent and good rates of Matta fracture repositioning rate (OR=2.06, 95%Cl: 0.97-4.39), and Majeed functional score (MD=0.91, 95%CI: -0.31-2.13) between both groups (P>0.05). CONCLUSION: Compared with freehand sacroiliac joint nailing, robotic assistance shortens the operative time, reduces intraoperative bleeding, decreases radiation damage to patients and medical staff, improves the excellent and good rate of screw position, and reduces the overall incidence of postoperative complications in patients, but there was no significant improvement in fracture reduction quality, fracture healing time, and postoperative function. In the future, more large-sample, multicenter, and high-quality randomized controlled trials are still needed to verify. [ABSTRACT FROM AUTHOR]

Background: The percutaneous iliosacral screw technique represents a global standard fixation method for unstable fractures of the posterior pelvic ring. However, the inaccurate positioning of iliosacral screws is associated with a significant risk of severe intra-operative complications. Therefore, this study aimed to investigate the relationship between the skin entry point of the transverse iliosacral screw of the first sacral vertebral body and the anterior superior iliac spine and the greater trochanter of the femur using computed-tomography-guided validation. Methods: Overall, 91 consecutive patients admitted to a tertiary referral center in China for posterior pelvic ring fixation via the "triangulation method" using computed-tomography-guided validation between January 1, 2020, and December 31, 2020, were included in this retrospective observational cohort study. Modeling and simulated iliosacral screw placement were performed using the Mimics software. The distance between the three points of interest was measured, and their relationship in a rectangular coordinate system was determined. Patients were categorized according to gender, body mass index, and femoral rotation angle to investigate the factors affecting the positional relationship between the three points. Results: An equilateral triangular relationship was observed between the positioning points of the transverse iliosacral screw, anterior iliac spine, and greater trochanter. Additionally, 95% of the entry points were within a circle radius centered 12 mm at the apex of an equilateral triangle comprising the anterior superior iliac spine and the greater trochanter as the base. The entry point in the femoral external rotation was more dorsal than that in the internal femoral rotation. Furthermore, the entry point in females was more rostral than that in males, and the entry point in overweight patients was more dorsal than that in normal-weight patients. Conclusions: The skin entry point of the percutaneous iliosacral screw can be located by drawing an equilateral triangle from the anterior superior iliac spine and the greater trochanter as the base to the dorsum end of the patient's head. In summary, this retrospective cohort study validated the safety and efficacy of the "triangulation methods" for percutaneous fixation of unstable posterior pelvic ring injuries. [ABSTRACT FROM AUTHOR]

Background: Fragility fractures of the pelvis (FFPs) are osteoporotic pelvic fractures or insufficiency pelvic fractures caused by the low energy injury or stress fracture in daily livings in the elderly more than 60 years, which the incidence is increasing with the aging population in our country. FFPs result in considerable morbidity and mortality and as well as massive financial burden on the already strained health systems throughout the world. Methods: This clinical guideline was initiated by the Trauma Orthopedic Branch of Chinese Orthopedic Association; the External Fixation and Limb Reconstruction Branch of Chinese Orthopedic Association; the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation; Senior Department of Orthopedics of Chinese PLA general hospital; the Third Hospital of Hebei Medical University. The grading of recommendations assessment, development and evaluation (GRADE) approach and the reporting items for practice guidelines in healthcare (RIGHT) checklist were adopted. Results: 22 evidence based recommendations were formulated based on 22 most concerned clinical problems among orthopedic surgeons in China. Conclusion: Understanding these trends through this guideline will facilitate better clinical care of FFP patients by medical providers and better allocation of resources by policy makers. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• TirobotTM is a Chinese independent development of universal orthopaedic surgery robot, can be used in spine, limbs, joints and other orthopaedic surgery. It is a representative work in the development of surgical robots in China. In this study, TirobotTM was used to assist S2 screws placement in treating unstable posterior pelvic fractures. • The clinical value of S2 screws in the treatment of pelvic posterior ring unstable fractures was systematically summarized, including S1 dysmorphia and biomechanical advantages, so as to provide a reference for the clinical treatment of such fractures. • We confirmed that robot-assisted S2 screw placement improved the safety and accuracy of surgery, reduced the radiation exposure, and improved the efficiency compared with traditional surgical methods. Percutaneous sacroiliac screw is one of the main methods to treat unstable posterior pelvic ring injury. However, complexity of pelvic anatomical structure increases the difficulty and risk with freehand operation. Besides, S2 screw fixation began to receive attention. The purpose of the current study was to evaluate the safety, accuracy, efficiency and clinical outcome of robot-assisted S2 screw fixation for posterior pelvic ring injury. We reviewed 128 cases of unstable posterior pelvic ring injury treated by percutaneous sacroiliac screw fixation in our hospital from January 2016 to January 2020. All cases were divided into robot-assisted S1 group (RAS1), robot-assisted S2 group (RAS2), freehand group S1 group (FHS1) and freehand group S2 group (FHS2). The mean times of fluoroscopy per screw and adjustment per guide wire were used to evaluate radiation exposure and the efficiency of screw placement, respectively. The final position of the screw was evaluated with postoperative CT to illustrate security and accuracy. 108 patients (84.38%) were followed up for 5~24 months and the Majeed scores were compared among groups. A total of 180 screws were inserted. In comparison of the mean times of fluoroscopy per screw and adjustment per guide wire, RA group was significant less than FH group, further comparison revealed that freehand S2 placement need more fluoroscopy and adjustment times compared with freehand S1 placement, but for robot-assisted procedure, there was no difference between placing S1 and S2. Screw penetration was found in the FHS1(3/48) and FHS2(2/14) and none in RAS1 or RAS2, which means robot-assisted groups were more safety and accurate (P <0.001). The mean Majeed score in RAS1 (83.33±13.47) and RAS2 (82.32±11.42) was higher than in FHS1 (80.43±12.25) and FHS2 (75.08±18.47), but this difference failed to reach significant. Compared with the freehand operation, TiRobot increased the safety and accuracy, reduced radiation exposure, and improved the efficiency. TiRobot could reduce the risk of S2 placement and provide a safe and feasible way for clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. Methods: The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. Results: The patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). Conclusions: The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures. [ABSTRACT FROM AUTHOR]

Purpose: The use of a robotic arm has been well-described in the literature for the placement of pedicle screws in spine surgery as well as implants for sacroiliac joint fusion. There are no reports describing the use of a robotic arm to place screws in osseous fixation pathways (OFPs) employed in the treatment of pelvic ring and acetabular fractures outside of a single center in China. Using a Sawbones model, the authors describe a technique for using a robotic arm widely available in Europe and the Americas for placement of 6.5 mm cannulated screws into two OFPs commonly used in the treatment of pelvic and acetabular fractures. Methods: Using the Mazor X Stealth Edition (MSXE) robot from Medtronic, the authors were able to place a pin into the pelvis onto which the robot was docked. The authors were then able to designate the area of interest using navigated instruments, and in combination with the MSXE "scan and plan" marker, obtain cross-sectional imaging using the O-Arm and successfully register the MSXE robot. We then used the provided software to plan trajectories for the lateral compression type 2 (LC-II) screw pathway as well as a pathway for a trans-ilio-trans-sacral screw. We describe in detail the steps for setup, planning and placement of 6.5 mm cannulated screws using the MSXE robotic arm into these two OFPs. Results: Visual inspection and plain x-rays demonstrated successful placement of the screws into the two planned OFPs. No breach of cortical bone was seen on either visual inspection of the model or demonstrated on post-procedure x-rays. Conclusion: It is possible to use the Mazor X Stealth Edition robot to place screws into the LC-II and trans-ilio-transsacral screw pathways in a Sawbones model. This is only a feasibility study, and should in no way be taken to suggest that clinical application of this technique should be attempted. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of robot-assisted treatment of unstable pelvic fractures through a percutaneous iliac lumbar double rod fixation combined with a percutaneous pelvic anterior ring INFIX (internal fixator) fixation.Methods: This was a retrospective analysis of 17 cases of unstable anterior and posterior pelvic ring fractures treated between April 2016 and October 2018 by the third Ti-robot system produced in China. The posterior ring was supported with an iliac lumbar double rod fixation and the anterior ring with an INFIX fixation. Operation time and peri-operative bleeding were recorded. The reduction of pelvic fracture displacement was evaluated by Matta score, the post-operative results were evaluated according to Majeed score, and the complications were recorded.Results: Twelve males and five females, aged 21-71 years (mean 40.1 ± 3.8 years) were followed up for three to 12 months, (median 6.7 months). Tile typing showed seven B1 type, two B2 type, and eight C1 type cases. Operation time was 90-160 minutes (mean 112.9 ± 16.8 minutes), bleeding was 80-150 mL (mean 105.9 ± 20.6 mL). X-ray three to five  days after operation was evaluated by Matta score as excellent in 15 and good in two cases. Majeed score at last follow-up was 85-98 points, excellent in 17 cases. Two cases of lower extremity deep vein thrombosis received an inferior vena cava filter. The filters were removed after two  weeks. One case showed incision fat liquefaction healing and the wound healed three  weeks after surgery.Conclusion: Orthopedic robot-assisted treatment of unstable pelvic fractures by a percutaneous iliac lumbar double rod fixation and a percutaneous pelvic anterior ring INFIX fixator was minimally invasive and feasible. A prospective study is needed. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to evaluate the effectiveness and advantages of percutaneous fixation of anterior column acetabular fracture with “hammering technique.” Materials and Methods. We retrospectively reviewed 16 patients with percutaneous fixation of anterior column acetabular fracture with “hammering technique.” There were 11 males and 5 females with an average age of 38.88 years (range: 24–54 years) in our study. Our study included 7 nondisplaced fractures, 6 mild displaced fractures (<2 mm), and 5 displaced fractures (>2 mm). The mean time from injury to surgery was 4.5 days (range: 2–7 days). Results. The average of operation time was 27.56 minutes (range: 15–45 minutes), and the mean blood loss was 55.28 mL (range: 15–100 mL). The mean fluoroscopic time was 54.78 seconds (range: 40–77 seconds). The first pass of the guide wire was acceptable without cortical perforation or intra-articular perforation in 88.89% (16/18) of the procedures, and the second attempt was in 11.11% (2/18). Conclusion. Our study suggested that percutaneous fixation of anterior column acetabular fracture with “hammering technique” acquired satisfying surgical and clinical outcomes. It may be an alternative satisfying treatment for percutaneous fixation of anterior column acetabular fracture by 2D fluoroscopy using a C-arm with less fluoroscopic time. [ABSTRACT FROM AUTHOR]

Background: Better understanding of three-dimensional (3D) morphology of the pelvis at the area of inferior border of the arcuate line is very important, which could guide the surgeons to treat pelvic and acetabular fractures more efficiently. The objective of this study is to provide references for screw placement and design of anatomical internal fixators for the fixation route along the pelvic inferior border of the arcuate line.Methods: Seventy five cases of computed tomography (CT) scan data were collected using Medical Image Database in Shanghai General Hospital between December 2009 and November 2010. 44 males and 31 females, aging from 21 to 91 years (average: 57.8 years) were enrolled. Using MIMICS 13.0, these data were used for three dimensional (3D) reconstructions of pelvic model. A curve from the pubic tubercle, along the inferior border of the arcuate line, to the sacroiliac joint was depicted and then divided into 11 equal parts. The measurements of whole length of the curve, the radius of the curvature and the thickness of bone at each decile point were performed, respectively.Results: The thinnest bone thickness at acetabular area was 17.24 ± 2.90 mm and 9.94 ± 2.69 mm for male and female, respectively. The radius of curvature at the decile points 1, 8 and 10 were smaller compared with the surrounding points.Conclusions: Using a screw shorter than 10 mm perpendicular to the bone surface along the inferior border of the arcuate line can avoid intra-articular screw penetration. There should be more recontouring of the plate at the areas of pubic tubercle and posterior edge of the acetabulum when placing a fixator along this fixation route. This study provides solid guidance for pelvic and acetabular surgeries as well as designing of anatomical fixators along inferior border fixation route at this area. [ABSTRACT FROM AUTHOR]

Focuses on hip fractures and preventive measures in Hong Kong, China. Comparison of physical activity with calcium intake; Importance of maintaining daily physical activity and calcium intake in urbanized Chinese population; Age and sex distribution of patients with hip fracture.