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BACKGROUND: Pelvic fractures encompass a range of types, and the utilization of a pelvic reduction frame for restoration often lacks a systematic repositioning method. Instead, it relies on the operator's experience in conjunction with fluoroscopic findings, which can lead to uncertainty and non-reproducibility. OBJECTIVE: To investigate the clinical efficacy of combining computer-simulated repositioning techniques with a pelvic reduction frame for the treatment of anteroposterior compression-III pelvic fractures. METHODS: A retrospective analysis was conducted on 19 patients with anteroposterior compression-III pelvic fractures who underwent preoperative repositioning via computer simulation and intraoperative repositioning with the assistance of a pelvic reduction frame between January 2018 and December 2021. Among them, 7 cases were fixed with double plate in anterior ring and 12 cases were fixed with single plate combined with anterior subcutaneous internal fixation (INFIX). All patients received posterior ring fixation with two sacroiliac screws. Operative duration, intraoperative reduction time, the frequency of intraoperative fluoroscopy use, blood loss, and follow-up duration were documented. These data were utilized to monitor fracture healing time and postoperative complications. Fracture reduction quality was evaluated according to the Matta scale, and the Majeed Pelvic Function Score was employed to assess patient function during the final follow-up. RESULTS AND CONCLUSION: (1) Surgery was successfully completed in all 19 patients. The anterior ring was secured with double plates in 7 cases, while a single plate combined with INFIX was utilized in 12 cases. The posterior ring was stabilized with two sacroiliac screws, specifically targeting the S1 and S2 cones. (2) The operation duration ranged from 74 to 147 minutes, with a mean of (101.63±19.55) minutes. Intraoperative repositioning took place over a period of 26 to 41 minutes, with a mean of (38.11±3.31) minutes. The number of intraoperative fluoroscopies conducted ranged from 35 to 81, with a mean of (62.68±13.11) times. Intraoperative bleeding volumes varied from 60 to 130 mL, with a mean of (85.37±20.57) mL. (3) All the patients were diligently monitored for a duration of 12 to 26 months. Fracture healing was observed within a time frame of 12 to 20 weeks, with a mean of (16.37±2.50) weeks. (4) The evaluation according to Matta's criteria one day post-surgery revealed excellent outcomes in 14 cases and good outcomes in 5 cases. At the final follow-up, the Majeed function score indicated excellent results in 16 cases and good results in 3 cases. (5) Two patients experienced localized fat liquefaction phenomena, characterized by redness, swelling, and oozing at the incision site, which gradually resolved with proactive dressing changes. None of the patients encountered complications such as internal fixation loosening, loss of fracture reduction, or nerve injuries post-surgery. It is concluded that the combined approach of using computer-simulated repositioning techniques in conjunction with pelvic reduction frames for the treatment of anteroposterior compression-III pelvic fractures has advantages in enhancing repositioning efficiency and improving pelvic function. [ABSTRACT FROM AUTHOR]

Background: Bisphosphonate use is associated with atypical non-traumatic fractures, which are most commonly seen in the femur. Case presentation: We report a 63-year-old postmenopausal woman who presented acutely with progressively worsening lumbar pain radiating to her left hip for 10 days. There was no antecedent trauma. On examination, the patient could not bear weight on her left leg due to the severity of the pain. Radiography and computed tomography of the pelvis demonstrated an iliac wing fracture which was treated conservatively. The patient had a significant past medical history of breast cancer and intense bisphosphonate use for several years which was discontinued 3 years previously. No discrete bone lesion was seen at the fracture site on computed tomography, and there was no evidence of metastatic disease elsewhere. A dual-energy X-ray absorptiometry scan showed the lowest bone mineral density T-score of − 1.2. A diagnosis of an atypical fracture related to long-term bisphosphonate therapy was made. Conclusion: To the best of our knowledge, this is the first reported case of an isolated iliac wing fracture associated with long-term bisphosphonate therapy in the literature. Whilst the incidence of such fractures is exceedingly rare, it is an important differential in patients with atypical fractures on long-term bisphosphonates. [ABSTRACT FROM AUTHOR]

The German Pelvic Group as part of the former German section of the AO-International (now AO Trauma Germany) and the German Trauma Society (DGU) represents a 34-year success story of data documentation for the optimization of pelvic and acetabulum surgery. The historical development and the corresponding course are presented. With increasing work, the initial data were integrated into the DGU Pelvic Register. It is used to record data on fractures of the pelvic ring and acetabulum with the aim to derive optimized treatment options and to gain new scientific knowledge. The register started in 2004 as an initiative of the DGU GPG. In June 2024, the DGU Board approved the upgrade of the status of the working group to a formal section Pelvic and Acetabulum Fractures as standing division of the German Trauma Society. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionPatients with traumatic brain injury are at high risk for venous thromboembolism. Therefore, pharmacological prophylaxis for venous thromboembolism has become critical in managing trauma patients. Unfortunately, the decision to initiate prophylaxis in patients with radiographic progression must be carefully weighed against the risk of further progression of intracranial haemorrhage, with little evidence to support decision-making.A retrospective review was performed at a Canadian Level 1 Trauma Centre from 2011-2017. Included adult patients had evidence of radiographic intracranial haemorrhage progression on repeat CT, and patients receiving prophylaxis were compared with those not having received prophylaxis. Regression analyses were performed to determine the decision-making process for providers when caring for these patients.242 patients were included in the study, with 33.1% of these patients not receiving pharmacological prophylaxis during admission. Of those without prophylaxis, 1.2% developed deep vein thromboses, no patients with pulmonary emboli, compared with five patients in the prophylaxis group with pulmonary emboli. The probability of not receiving prophylaxis was higher if abbreviated injury score is greater or equal to 4, decreased in cases of pelvic fracture or solid organ injury, or if the patient required an operative procedure.Patients with isolated, non-operative severe traumatic brain injury may be at risk of not receiving pharmacologic prophylaxis for venous thromboembolism during hospital admission. This decision may place patients at greater risk of venous thromboembolism, and thereby increased morbidity and mortality. As such, further investigation and initiatives to improve pharmacologic prophylaxis in this patient population is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Severe pelvic hemorrhage significantly contributes to mortality in trauma patients, yet the most effective treatment for severe pelvic injuries remains unclear. This systematic review evaluates the mortality and morbidity associated with bilateral internal iliac artery ligation (BIIAL) in patients experiencing severe hemorrhage from traumatic pelvic fractures. Methods: Comprehensive searches were conducted in MEDLINE PubMed, EMBASE, and Cochrane databases until February 7, 2024, to identify relevant articles. The risk of bias in observational studies was assessed using the ROBINS-I tool, which evaluates bias risk in nonrandomized intervention studies. The primary outcome was mortality following BIIAL, with the secondary outcome being complications related to the procedure. Results: The review included eight studies, all observational. The overall mortality rate after BIIAL ranged from 45.0% to 76.9%. Ischemic complications from BIIAL were infrequent. A high and unclear risk of bias due to confounding and participant selection was noted across the studies. Four studies highlighted distinct indications for BIIAL compared to angioembolization. BIIAL was employed for patients with severe hemodynamic instability or when angiography was not available. Conclusion: Due to geographical limitations and significant heterogeneity among the studies reviewed, the true effect size of BIIAL remains indeterminate. Nevertheless, further prospective studies with robust designs are necessary. BIIAL holds potential as a viable option when angioembolization is not accessible or in cases of critical patient instability. [ABSTRACT FROM AUTHOR]

Purpose: The optimal timing for definitive surgical treatment of pelvic fractures in polytrauma patients remains a topic of ongoing discussion due to the complexity of these injuries. This analysis therefore aims to systematically compare early versus late definitive operative stabilization of pelvic fractures on outcome in polytrauma patients. Methods: PubMed, CENTRAL and Web of Science were systematically searched to identify relevant completed and ongoing studies from the inception of each database to March 13, 2023. Systematic reviews, randomized control trials (RCTs) and observational studies comparing early (< 24 h) versus late (> 24 h) definitive operative stabilization in adult polytrauma patients admitted to the ICU were included. Results: Since no systematic reviews and RCTs were available on this subject, one observational study was identified, including a total of 418 polytrauma patients (nearly = 165, nlate = 253), median age: 40.3 years (early 40.1 years, late 40.4 years). Early definitive stabilization was associated with a decreased risk of acute respiratory distress syndrome (ARDS) compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.38, 95% CI 0.18–0.81; RD 78 fewer per 1000, 95% CI 104 fewer to 24 fewer; 1 study, 418 participants; very low certainty of evidence). Furthermore, early definitive stabilization may decrease the risk of pneumonia compared to late stabilization of unstable pelvis and acetabulum fractures (RR 0.50, 95% CI 0.28–0.88; RD 85 fewer per 1000, 95% CI 122 fewer to 20 fewer); 1 study, 418 participants; very low certainty of evidence). Conclusion: There is limited evidence regarding early definitive fracture repair (≤ 24 h) compared to late repair of pelvic fractures in polytrauma patients. One observational study showed a reduced incidence of septic respiratory complications, ARDS, and multi-organ failure (MOF) in polytrauma patients who received early definitive fracture repair. [ABSTRACT FROM AUTHOR]

Background: Earthquakes frequently cause injuries to the musculoskeletal system. Studies conducted after earthquakes often report on injured limbs, fractures, and surgeries. This study aimed to enhance preparedness for future earthquakes by acquiring knowledge about the prevalence of fractures and the relationship between fracture types and injury mechanisms. Methods: A retrospective analysis was conducted on medical records of patients with fractures admitted to our hospital following the 2023 Kahramanmaraş Earthquake. Patients with fractures resulting from traffic accidents or other causes unrelated to earthquakes were excluded. The recorded data included age, gender, fracture site, fracture type, mechanism of injury, date, duration of surgery, and peak creatine kinase (CK) level. The injury mechanisms were classified into four main categories: injured by falling objects, falling while running, falling from height, and being trapped under rubble. The study investigated the relationship between fractures and other factors. Results: The study included 185 patients with a mean age of 39.62 ± 20.83 years. The most frequent mechanism of injury was being trapped under rubble. In total, there were 214 fractures, with pelvic fractures being the most common (21.50% of all fractures). Tibia fractures were the most common fractures in the lower extremities (15.89%). Women had a significantly higher occurrence of pelvic fractures (33.3%) compared to men (14.5%) (p = 0.003). The frequency of pelvic fractures significantly increased as age decreased (p = 0.007). Patients with pelvic fractures had a significantly greater peak CK concentration (p = 0.006). Open fractures were more common in the first few days, and Kirschner wires were the first treatment applied at a mean of 74 h and external fixators at a mean of 94.3 h. Conclusion: Injuries from falling objects from roofs and jumping from heights are important in earthquakes. In addition to lower extremity fractures, pelvic fractures are common in earthquake disasters. Most pelvic fractures are simple lateral compression fractures and it is important to follow the patients for crush syndrome in the first days instead of focusing on definitive fracture treatment. Open fractures should be prioritized for fracture surgery within the first few days. External fixators and Kirschner wires are recommended. Closed fractures should be treated conservatively and definitive surgical procedures should be postponed to the following weeks. [ABSTRACT FROM AUTHOR]

Hip fracture prevention approaches like prophylactic augmentation devices have been proposed to strengthen the femur and prevent hip fracture in a fall scenario. The aim of this study was to validate the finite element model (FEM) of specimens augmented by prophylactic intramedullary nailing in a simulated sideways fall impact against ex vivo experimental data. A dynamic inertia‐driven sideways fall simulator was used to test six cadaveric specimens (3 females, 3 males, age 63–83 years) prophylactically implanted with an intramedullary nailing system used to augment the femur. Impact force measurements, pelvic deformation, effective pelvic stiffness, and fracture outcomes were compared between the ex vivo experiments and the FEMs. The FEMs over‐predicted the effective pelvic stiffness for most specimens and showed variability in terms of under‐ and over‐predicting peak impact force and pelvis compression depending on the specimen. A significant correlation was found for time to peak impact force when comparing ex vivo and FEM data. No femoral fractures were found in the ex vivo experiments, but two specimens sustained pelvic fractures. These two pelvis fractures were correctly identified by the FEMs, but the FEMs made three additional false‐positive fracture identifications. These validation results highlight current limitations of these sideways fall impact models specific to the inclusion of an orthopaedic implant. These FEMs present a conservative strategy for fracture prediction in future applications. Further evaluation of the modelling approaches used for the bone‐implant interface is recommended for modelling augmented specimens, alongside the importance of maintaining well‐controlled experimental conditions. [ABSTRACT FROM AUTHOR]

Purpose: To determine if difference in Hounsfield Units (HU) of the medullary bone between the injured and non-injured femurs in patients with greater trochanteric fractures is associated with occult intertrochanteric (IT) extension. Methods: Retrospective review was performed of 81 patients (age range 54–102, 54 females and 27 males) who underwent CT and subsequent MRI after identification of a greater trochanteric fracture without evidence of IT extension on radiography and/or CT. Hounsfield units of the injured and non-injured femurs on CT were recorded at the level of the base of the greater trochanter centrally (ROI1) and the level of the upper border of the lesser trochanter posteromedially (ROI2). The difference between the injured and non-injured femur for each ROI1 and ROI2 were calculated. Absence or presence, and if present, extent of IT extension was assessed on MRI. Analysis was performed to determine if there is correlation of difference in density with presence, and extent of occult IT fractures. Results: 81 cases met inclusion criteria, 14 (17%) had no IT extension, 11 (14%) had less than 50% IT extension and 56 (69%) had 50% or greater IT extension. There was statistical significance between presence and absence of IT extension between the injured and non-injured femur for ROI1 (HU) no IT extension median (IQR): 18.8(4–40), ROI1 (HU) present IT extension median (IQR): 65.5(46–90) p <.0001, and for ROI2 no IT extension median (IQR): 3(-8-25.5) and ROI2 present IT extension 51(40.5–76), p <.0001. There was statistical significance of the extent of IT extension: ROI1 less than 50% IT extension median (IQR): 37.5(27.5–57), ROI1 50% or greater IT extension median (IQR): 72.3(53.5–91.3), p <.0001, and for ROI2 less than 50% IT extension median (IQR): 17.5(8–49), and ROI2 50% or greater IT extension median (IQR): 55.8(45.3–81.5), p <.0001. A threshold ROI2 difference of 50 HU resulted in specificity of 92% and sensitivity 60.7% of for IT extension 50% or greater. Conclusion: Patients presenting with greater trochanteric fractures, an asymmetric increased density measured by ROI differences within the medullary space of the IT region between the injured and non-injured femur is associated with occult IT extension. [ABSTRACT FROM AUTHOR]

To discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe, and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future. The bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and performs the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries. One hundred twenty-seven patients, median age 58 years (interquartile range [IQR] 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n = 48), pelvic fracture urethral injury (PFUI) (n = 61), prostate cancer treatment (n = 14) and instrumentation (n = 4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High-grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. Fourteen patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow-up of 36 months. Sparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future. [ABSTRACT FROM AUTHOR]

Objective: To analyze the risk factors associated with the occurrence of death during the treatment of patients with hemodynamically unstable pelvic fractures. Methods: The present study is a retrospective research design, which selected 136 patients with hemodynamically unstable pelvic fractures admitted to China Resource & WISCO General Hospital from March 2020 to March 2022 as the subjects of the study. They were divided into a survival group (113 cases) and a death group (23 cases) according to whether the patients died during treatment. The general clinical data and laboratory test indexes of the two groups were compared to analyze the risk factors affecting the death of pelvic fracture patients. Receiver operator characteristic (ROC) curves were plotted, and the area under the curve was calculated. Results: The two groups were significantly different in aspects of age, systolic blood pressure, rapid emergency medicine score, injury severity score (ISS), sequential organ failure assessment (SOFA) score, prothrombin time, activated partial thromboplastin time, and percentages of patients with bleeding volume > 2,000 mL, shock index > 2, and minimum oxygenation index < 200 (P<0.05). Logistic regression analysis suggested that shock index > 2, ISS, SOFA score, and bleeding volume > 2,000 mL were independent risk factors for patient death. ROC analysis showed that the area under the curve for shock index > 2, ISS, SOFA score, and bleeding volume > 2,000 mL was 0.656, 0.732, 0.907, and 0.798, respectively. Conclusions: Severe shock, increased ISS and SOFA score, and bleeding are independent risk factors for death in patients with hemodynamically unstable pelvic fractures. Implementation of rapid and efficient targeted management during treatment of high-risk patients with these factors is key to reducing their risk of death. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature 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.)

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature 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.)

Introduction: Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury. Methods: Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21–25 points), mild ED (16–21 points), moderate ED (9–15 points), and severe ED (5–7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking. Results: A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05). Conclusion: Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED. [ABSTRACT FROM AUTHOR]

Background: This study investigated the clinical efficacy of Double INFIX for the treatment of unstable pelvic fractures. Methods: We performed a retrospective analysis of 23 patients with unstable pelvic fractures treated using the Double INFIX minimally invasive technique. The cohort included five cases of Tile B1 type, eight cases of B2 type, six cases of B3 type, three cases of C1 type and one case of type C2. Pre- and postoperative evaluations included standardised pelvic serial films and three-dimensional CT scans. Key observational indicators were fracture reduction quality (assessed using Matta's criteria), fracture healing, functional recovery (evaluated with the Majeed function assessment criteria), and incidence of complications. Results: The mean follow-up duration was 24.48 ± 1.78 months. The average fracture healing time was 4.00 ± 1.41 months, and the average time for removal of fixation was 7.43 ± 1.75 months. Repeat imaging at 12 months postoperatively using Matta's criteria showed eight cases with excellent results (52.17%), 13 cases with good results (34.78%), three cases with fair results (13.04%), and no cases with poor results. The combined excellent and good rate was 86.96%, whereas the fair rate was 13.04%. The average Majeed hip joint function score at the final follow-up was 95.04 ± 1.72. Postoperative complications included meralgia paresthetica in two cases (8.7%) and sacrococcygeal discomfort in three patients when lying flat. Conclusion: Double INFIX is a minimally invasive treatment technique with adequate clinical efficacy for managing unstable pelvic fractures. [ABSTRACT FROM AUTHOR]

In a prospective study, we examined the recovery trajectory of patients with lower extremity fractures to better understand the healing process in the absence of complications. Using a chest-mounted inertial measurement unit (IMU) device for gait analysis and collecting patient-reported outcome measures, we focused on 12 key gait variables, including Mean Leg Lift Acceleration, Stance Time, and Body Orientation. We employed a linear mixed model (LMM) to analyze these variables over time, incorporating both fixed and random effects to account for individual differences and the time since injury. This model also adjusted for varying intervals between assessments. Our study provided insights into gait recovery across different fracture types using data from 318 patients who experienced no complications or readmissions during their recovery. Through LMM analysis, we found that Tibia-Distal fractures demonstrated the fastest recovery, particularly in terms of mobility and strength. Tibia-Proximal fractures showed balanced improvements in both mobility and stability, suggesting that rehabilitation should target both strength and balance. Femur fractures exhibited varied recovery, with Diaphyseal fractures showing clear improvements in stability, while Distal fractures reflected gains in limb strength but with some variability in stability. To examine patients with readmissions, we conducted a Chi-squared test of independence to determine whether there was a relationship between fracture type and readmission rates, revealing a significant association (p < 0.001). Pelvis fractures had the highest readmission rates, while Tibia-Diaphyseal and Tibia-Distal fractures were more prone to infections, highlighting the need for enhanced infection control strategies. Femur fractures showed moderate readmission and infection rates, indicating a mixed risk profile. In conclusion, our findings emphasize the importance of fracture-specific rehabilitation strategies, focusing on infection prevention and individualized treatment plans to optimize recovery outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: The incidence of fragility fractures of the pelvis (FFP) has increased significantly over the past decades. Unilateral non-displaced fractures, defined as FFP II, are the most common type of fracture. When conservative treatment fails, surgical treatment is indicated. We hypothesize that the use of bilateral SI screws (BSIs) or a transsacral screw (TSI) is superior compared to a unilateral screw (USI) because of a significant reduction in the risk of adjacent fractures and a reduction in fracture progression. (2) Methods: A finite element model of a female pelvic ring was constructed. The ligaments were simulated as tension springs. The load was applied through the sacrum with the pelvis fixed to both acetabula. An FFP IIc was simulated and fixed with either a USI or BSI or TSI. The models were analyzed for a quantitative statement of stress and fracture dislocation. (3) Results: The BSI and TSI resulted in less dislocation compared to the USI. The stress distribution on both sides of the sacrum was favorable in the BSI and TSI groups. The BSI resulted in a higher rotational stability compared to the TSI. (4) Conclusions: The use of either a BSI or TSI for fixation of unilateral FFP is biomechanically favorable compared to the use of a USI. In addition, the use of a BSI or TSI reduces the stress on the contralateral uninjured side of the sacrum. This may reduce the risk of an adjacent fracture or fracture progression. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acetabular fractures are rare fractures of the pelvis which usually result from trauma. Whilst data are reported on sexual and genitourinary function in those with pelvic fractures, less is known about those with isolated acetabulum fractures. This systematic review aimed to determine, first, the frequency of sexual and genitourinary dysfunction following isolated acetabulum fractures and, second, the nature of these complications. Methods: A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Results: Seven studies based on 648 individuals were identified with a mean follow-up time of 33.6 ± 22.4 months. Five papers described sexual functional outcomes, and two reported genitourinary function. Acetabulum fractures were noted to have an impact on sexual function ranging from 20.0% to 39.8% within the groups analysed. With respect to genitourinary outcomes, incidence of lower urinary tract injury and spontaneous voiding failure was quite low, but due to the existence of little data, firm conclusions cannot be made. Conclusions: This review has highlighted a paucity of data related to outcomes of sexual and genitourinary function in patients who are post-acetabulum fracture. The limited available data suggests that acetabular fractures have an impact on sexual function, but the impact on genitourinary function is less clear. Further prospective work is required to better understand the relationship between baseline demographics, injury characteristics, injury mechanism and concurrent injuries, and surgical fixation and acetabular-fracture outcomes. [ABSTRACT FROM AUTHOR]

Introduction Complex, high-energy extremity trauma secondary to explosive mechanisms has been increasingly common in modern warfare, accounting for a majority of combat wounds throughout the conflicts in Iraq and Afghanistan. Fellowship-trained orthopaedic trauma surgeons treated many of these complex injuries; however, as the number of casualties continue to decrease during a period of relative peace, a growing concern over maintaining military trauma readiness exists. Methods The Military Health System Data Repository was queried for all Common Procedural Terminology (CPT) codes associated with 18 fellowship-trained orthopaedic trauma surgeons from 2013 to 2019. The codes were further analyzed and categorized based on common trauma subspecialty procedures such as fracture fixation of the pelvic ring, acetabulum, upper and lower extremity, peri-articular, and nonunion/malunion surgery. We used descriptive statistics to quantify both the average number of cases per surgeon per year in each of the subcategories and case volume among Military Treatment Facilities (MTFs) during the study period. Results We identified 7,769 CPT codes for surgical procedures throughout the study period. The most common surgical procedures performed were: removal of implant (n  = 836, 11%), knee arthroscopy (n  = 507, 7%), and debridement of devitalized tissue (n  = 345, 4%). The total trauma subspecialty procedural codes and average cases per surgeon per year were as follows: pelvic ring (n  = 54, <1 case/year), acetabulum (n  = 90, 1 case/year), upper extremity (n  = 1,314, 15 cases/year), lower extremity (n  = 2,286, 25 cases/year), peri-articular (n  = 675, 8 cases/year), and nonunion/malunion (n  = 288, 3 cases/year). San Antonio Military Medical Center (SAMMC) accounted for the most fracture-related CPT codes overall (35%), while all other MTFs contributed approximately 10% or less of all fracture-related codes. Conclusions These results highlight the lack of orthopaedic trauma volume at other MTFs outside of SAMMC, raising concern for maintaining military readiness during an inter-war period of relative peace. The DoD continues to make concerted efforts to maintain readiness through civilian partnerships and subsequently increase surgical case volume for military trauma surgeons. Future efforts should include an in-depth analysis of caseloads of military trauma surgeons providing care at both MTFs and civilian institutions to optimize preparedness in future conflicts. [ABSTRACT FROM AUTHOR]

To validate the value of the LSE classification and scoring system in predicting surgical outcomes for male anterior urethral stricture cases. A retrospective review was conducted on 566 patients who underwent urethroplasty between August 2004 and March 2022. After excluding pelvic fracture urethral injury and non-stricture diseases and incomplete data, 358 patients were classified according to the LSE classification system, and both U score and LSE score were calculated. We investigated the relationship between LSE score and U score in predicting recurrence. Recurrence was defined as any instance requiring re-intervention. To identify factors contributing to recurrence, logistic regression analysis was performed on the LSE score and variables not included in the scoring system. The breakdown of S, and E components showed external trauma as the most common cause of strictures, with proximal bulbar urethra being the most common segment. Significant associations were observed between stricture etiology and segment, as well as between surgical technique and segment. A strong correlation (r = 0.73) was found between U score and LSE score, with no significant difference in predicting recurrence between the 2 scores. Surgical complexity differed significantly between LSE score groups, but surgical duration did not. Patients with LSE <7 showed a better recurrence rate in Kaplan-Meier analysis. Multivariate logistic analysis identified LSE ≥7 as an independent risk factor for recurrence. The LSE classification system and scoring system demonstrate validity in characterizing anterior urethral strictures and predicting surgical outcomes. [ABSTRACT FROM AUTHOR]

To test the efficacy and feasibility of pelvic bone marrow sparing intensity modulated radiation therapy (PBMS-IMRT) in reducing bone density loss for patients with cervical cancer undergoing pelvic radiation therapy (RT). Patients with nonsurgical cervical cancer with stage Ib2-IIIc cancer were randomly allocated into the PBMS group or the control group. The PBMS group additionally received pelvic bone marrow dose constraint. Computed tomography (CT) imaging sets were acquired at baseline and at 1, 3, 6, 9, and 12 months after treatment. Radiation dose and Hounsfield unit were registered. Bone density loss rates and fracture events at different follow-up time points were recorded. Data from 90 patients in the PBMS group and 86 patients in the control group were used for statistical analysis, which included 30 and 26 patients with extended-field radiation therapy (EFR), respectively. The median follow-up for all patients was 12 months. Compared with baseline, the bone density of all bones at the last follow-up decreased by 43% and 53% in the PBMS and control groups, respectively, with the most significant decline at 1 month after treatment. Although patients without EFR received minimal irradiation in the upper lumbar spine, a 22.33% decrease in bone density was detected. In the group of patients with EFR, the decrease was 51.18% (P <.01). Lumbar or pelvic fracture incidence rates of patients in the PBMS and control groups were 7.8% and 12.79%, respectively. Among the dosimetric parameters, mean dose had the strongest correlation with bone density loss. In patients undergoing pelvic RT, the loss of bone density can begin to appear early after RT, and it can occur either inside or outside of the irradiation field. Results of this study showed that PBMS-IMRT reduced bone mineral density loss compared with IMRT alone. [ABSTRACT FROM AUTHOR]

Case histories: The medical records of cats and dogs admitted to the Department of Small Animal Surgery of the Centre Hospitalier Vétérinaire Pommery (Reims, France) with a history of vehicular trauma or falls from the first floor or higher were screened for occurrences of a lower urinary tract (LUT) rupture. Signalment, reported injuries, diagnostic imaging findings, and blood test results were extracted from the medical records. Clinical findings: A total of 585 animals were included in the study: 339 cats and 246 dogs. The overall prevalence of LUT rupture was 1.36% (8/585) and was 1.2% (3/246) in dogs and 1.4% (5/339) in cats. The most common site of rupture was the bladder (5/8 cases). All orthopaedic injuries were pelvic fractures and animals with pelvic fractures were 6.4 (95% CI: 1.67–24.41; p = 0.012) times more likely to incur urinary tract rupture than those without pelvic fractures. However, three cases had LUT rupture without associated orthopaedic injury. All affected patients had free abdominal fluid identified by abdominal focused assessment with sonography for trauma. Serum urea and creatinine concentrations were elevated in 5/8 cases of LUT rupture, and 4/8 cases were able to urinate. Clinical relevance: Although LUT injury and pelvic fracture were significantly associated in this study, 3/8 cases of LUT rupture in this study had no orthopaedic injury and half retained the ability to urinate. Thus, lack of associated fractures and ability to urinate should not be used to rule out a LUT rupture. The possibility of bladder or urethral rupture should be considered in all patients with a history of severe blunt trauma. [ABSTRACT FROM AUTHOR]

Purpose of the study Pelvic avulsion fractures in children are rare and usually associated with sports. The study aimed to evaluate the epidemiology, complications, and displacement cutoff value for surgical treatment. Material and methods In a retrospective study (2007–2022), we used a group of 201 boys and 20 girls (p < 0.0001). The mean age of boys was 14.9 ± 1.7, and 14.0 ± 1.9 years for girls (p = 0.0129). Injuries included 86 anterior superior iliac spine (ASIS), 83 anterior inferior iliac spine (AIIS), 28 ischial tuberosity (ITU), 13 iliac crest, nine reflected head of the rectus femoris avulsions, and two ipsilateral ASIS + AIIS avulsions. The displacement cutoff value was determined using logistic regression. Complications were assessed using Cox regression and Kaplan-Meier plots. Results The mean incidence of avulsions was 21 per 1,000,000 children per year. The highest prevalence of osteosynthesis was in ITU (10 out of 28, 35.71%); iliac crest and reflexed head avulsions were treated conservatively. Running was related to the highest risk of ASIS, football for AIIS, and gymnastics for ITU. Most avulsions occurred in September, the fewest in July. Displacement cutoff values were calculated as 10.5mm for ASIS, 9.5mm for AIIS, and 14.5mm for ITU. The most common healing complication was distraction 31 (14.0%), refracture in 2 ITU and non-union in 1 ITU; ITU complications were treated with osteosynthesis. According to the Cox regression, the following items significantly affected outcomes: fracture type (p < 0.0001), early verticalization (p = 0.0062), and initial displacement (p < 0.0001). Discussion Our study had several limitations, such as it was retrospective, there was a loss of patients from follow-up, and a lack of functional evaluations, for example, using Majeed’s score modified for pediatric patients. The positives of the study included a relatively large group of patients from multiple hospitals, the use of logistic regression to determine displacement values to help differentiate between OS and conservative treatment, the inclusion of fracture incidence data, and the inclusion of patients with both surgical and conservative treatment. Conclusions In the case of ASIS and AIIS avulsions, osteosynthesis can be considered for displacements ≥ 1cm and ≥ 1.5cm for ITU avulsions. Early verticalization was associated with a lower risk of healing complications in distraction injuries. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine 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.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing 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.)

The unusual fusion of splenic tissue with gonadal or mesonephric tissue remains is the hallmark of a rare congenital condition known as splenogonadal fusion (SGF). It arises during embryological development due to the proximity between the splenic anlage and gonadal mesoderm, typically between the 5th and 8th weeks of gestation. Even though SGF is typically asymptomatic, it is most commonly discovered by accident during imaging, surgery, or autopsy. Here, we present the case of a 17-year-old male who sustained pelvic fractures after a fall from height. Hemoperitoneum, right sacral ala and left iliac fractures, bilateral pubic rami fractures, and an incidental finding of continuous SGF were also discovered during imaging. Multidisciplinary review and imaging confirmed the congenital abnormality.Conservative treatment of pelvic fractures and follow-up assessment of SGF, including genetic counseling, were the main goals of management.

Purpose: To explore the clinical characteristics of pediatric pelvic fracturs caused by traffic accidents and to analyze the accompanying injuries and complications. Methods: A total of 222 cases involved traffic accidents was enrolled in this case-control study. The data of children with pelvic fractures caused by traffic accidents who were admitted to our hospital from January 2006 to December 2021 were analyzed retrospectively. Sex, age, Tile classification, abbreviated injury scale score, injury severity score, mortality, and accompanying injuries were studied. The ANOVA was used for measurement data, and the non-parametric rank sum test was used for non-normally distributed data. The Fisher's exact probability method was used for the count data. Results: Of all enrolled cases, 140 are boys and 82 are girls, including 144 cases aged < 6 years, 65 aged between 6 and 12 years, and 13 aged > 12 years. Depending on the injury mechanism, there are 15 cases involving pedestrians vs. motorcycles (PVM), 91 cases involving pedestrians vs. passenger cars (PVC), 78 cases involving pedestrians vs. commercial vehicles (PVV), and 38 cases involving motor vehicles vs. motor vehicles (MVM). Associated injuries are reported in 198 cases (89.2%), primarily involving the abdomen injury in 144 cases (64.9%), and lower limb injury in 99 cases (44.6%). PVV injury involves longer hospital stay (p = 0.004). Intensive care unit admission rate is significantly higher in the MVM group than in other groups (p = 0.004). Head injury (p = 0.001) and face injury (p = 0.037) are more common in the MVM group, whereas abdominal injury (p = 0.048) and lower limb injury (p = 0.037) are more common in the PVV group. In the MVM group, the brain injury (p = 0.004) and femoral neck injury (p = 0.044) are more common. In the PVM group, the mediastinum (p = 0.004), ear (p = 0.009), lumbar vertebrae (p = 0.008), and spinal cord (p = 0.011) are the most vulnerable regions, while in the PVV group, the perineum (p 12 years have higher pelvic abbreviated injury scale scores (p = 0.019). There are significant differences in the classification of pelvic fractures among children < 6, 6 – 12, and > 12 years of age, with Tile C being more likely to occur in children > 12 years of age (p = 0.033). Children aged > 12 years are more likely to sustain injuries to the spleen (p = 0.022), kidneys (p = 0.019), pancreas (p

Abstract Background Acetabular fractures typically require open surgery to restore hip joint function. Openness may lead to serious tissue damage, increased bleeding, and the risk of nerve and vascular damage. Minimally invasive closed reduction or percutaneous fixation aims to minimize additional harm to patients and provide reliable fixation to promote fracture recovery and functional rehabilitation. This study aimed to assess the radiographic and clinical effectiveness of pedicle screw external fixation as a definitive treatment approach for selective acetabular fractures. Methods The present study enrolled 43 patients with acetabular fractures who were categorized into three groups based on their definitive treatment plans: pedicle screw external fixation group, traditional external fixation stent fixation group, and open reduction internal fixation group, comparing the operative duration and the time required for fracture healing. Fracture reduction was evaluated using the Tornetta and Matta grading system, and postoperative clinical outcomes were analyzed using the Majeed score. Analyze three surgical methods by comparing clinical indicators and prognostic references. Results Among the 43 patients, there were 12 cases in the pedicle screw external fixation group, 14 cases in the traditional external fixation stent fixation group, and 17 cases in the open reduction internal fixation group. There were no significant differences in age, gender, injury mechanism, Injury Severity Score (ISS), or other demographic factors among the three groups. The reduction of fractures with internal fixation was significantly better than that with external fixation(p = 0.032). Operative duration and quality of reduction did not significantly differ between the pedicle screw external fixation group and the traditional external fixation stent fixation group. However, the pedicle screw external fixation group exhibited distinct advantages in postoperative quality of life (p = 0.041) and a lower incidence of loose fixing screws compared to the traditional external fixation stent fixation group. Conclusion Compared to traditional external fixation stent fixation, pedicle screw external fixation represents a superior definitive treatment option for acetabular fractures due to its stability and improved patient quality of life.

Abstract Introduction To compare the biomechanical outcomes of C1.1 posterior pelvic ring fractures treated with different numbers of LC-II screws and plate internal fixation. Materials and methods Nine adult preserved pelvic specimens were used. After being measured by bone densitometry, the specimens were randomly divided into 3 groups of 3 pelvic specimens each. The C1.1 pelvic fractures were generated by iliac osteotomies and anterior pelvic ring osteotomies. The fractures were fixed and randomly divided into three groups: (1) one LC-II screw, (2) two LC-II screws, and (3) two reconstruction plates. The anterior pelvic rings were all fixed with pubic branch screws. A biomechanical testing machine loaded all specimens vertically, recording the displacement and ultimate load of the specimens to quantify the stiffness. Results When loads up to 1000 N were applied, the displacement of the iliac bone was close between the one LC-II screw and the two LC-II screw group specimens; (P > 0.05); when loads such as 1000 N, 1200 N and 1400 N were applied, there was no significant difference in displacement between the plate fixation group and the two LC-II screw fixation group (P > 0.05), both of which were superior to the one LC-II screw fixation group (P 0.05), and both were superior to the one LC-II screw fixation group (P

Abstract Background In recent years, the incidence of pelvic fractures has been on the rise, predominantly affecting the elderly population. Deep vein thrombosis may lead to poor prognosis in patients. monocyte-to-lymphocyte ratio is novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model. Method This study used binary logistic regression analysis to predict the predictive effect of MLR on the occurrence of DVT in pelvic fractures patients. And use R studio to construct nomogram model. Result The results showed that Age (1.04 [1.01, 1.07], p = 0.006), WBC (1.44 [1.28, 1.61], p

Background: Hemodynamically unstable pelvic ring fractures from high-energy trauma are critical injuries in trauma care, requiring urgent intervention and precise diagnostics. With ongoing advancements in trauma management, treatment strategies have evolved, with some techniques becoming obsolete as new ones emerge. This study aimed to evaluate changes and trends in treatment algorithms for these injuries over approximately 40 years. Methods: A systematic review of PubMed and EMBASE was conducted to include articles published over roughly four decades that presented visual treatment algorithms or workflows for managing unstable pelvic ring fractures. Identified algorithms were categorized by publication period and analyzed by initial assessment, diagnostic methods, pelvic stabilization, and hemorrhage control interventions. Results: The search identified 5,434 publications, of which 32 met the inclusion criteria. 75% of these studies were published between 2011 and 2022, reflecting a growing focus on standardization, particularly in Europe, North America, and Asia. Physiological assessment remains essential in the initial management of hemodynamically unstable pelvic ring fractures, guiding resuscitation and influencing the selection of intervention and imaging. The use of pelvic binders or sheets has risen steadily, highlighting their role in hemorrhage control and temporary stabilization. CT scans and angiography have largely replaced pelvic X-rays in diagnostic protocols, becoming preferred radiological methods alongside focused assessment with sonography for trauma (FAST). Pelvic stabilization remains critical, with external fixation being the most commonly used technique, showing an upward trend in recent years. Laparotomy, pelvic packing, and angioembolization continue to play vital roles in hemorrhage management. Emerging techniques, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), anterior subcutaneous internal fixation (INFIX), and rescue screws, are increasingly included in treatment algorithms, while diagnostic peritoneal lavage (DPL) has become obsolete and is no longer listed in these algorithms. Conclusions: This review provides foundational insights toward the standardization of initial treatment for hemodynamically unstable pelvic ring fractures and holds significant importance in enhancing the consistency and efficiency of treatment. Future research should focus on accumulating higher-quality evidence to evaluate the effectiveness of standardized protocols and explore the applicability of new treatment methods. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Type IV fragility fractures of pelvis (FFP IV) are serious and complicated and the treatment is challengeable. Robotic‐assisted minimally invasive triangular fixation (RoboTFX) is a new and advanced technique to treat this injury. The objective of this report is to evaluate the clinical outcomes of FFP IV treated with RoboTFX.From March 2017 to December 2022, 22 consecutive patients with FFP IV were included in the study. Patients were divided into two groups according to the surgical method employed (RoboTFX or robotic‐assisted minimally invasive iliosacral screws, RoboISS). Between two groups, we compared clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, favorable fracture healing rate, implant loosening rate, and Majeed pelvic outcome score.All operations were undertaken from 3 to 15 days (average 5.7 ± 1.7 days) following primary injuries. All patients were followed up continuously 15 months. The average surgical time was 125.3 ± 15.5 (55–190) min in group RoboTFX, 137.1 ± 17.2 min in group RoboISS (p > 0.05). The average amount of intraoperative bleeding was 320.4 ± 25.2 (50–550) mL in group RoboTFX, 302.4 ± 21.5 (50–500) mL in Group 2 (p > 0.05). The average intraoperative fluoroscopy time of the two groups was 23.3 ± 4.5 (15–35) s in group RoboTFX and 40.3 ± 3.8 (10–75) s in group RoboISS (p < 0.05). No patients experienced loss of reduction, 5 of 40 screws had implant loosening in group RoboTFX, meanwhile 13 of 48 screws had implant loosening in Group 2. Four of 20 vertical sacral fractures were healed undesirable including 2 nonunion and the favorable healing rate of 80% in group RoboTFX, meanwhile 8 of 24 fractures were undesirable including 4 nonunion and the favorable healing rate was 66.7% in group RoboISS. Implant loosening rate in the RoboTFX group were all significantly better than those of the RoboISS group (p < 0.05). There were no occurrences of wound infection in both groups, and Majeed scores for the last follow‐up were 76.2 ± 3.4 in group RoboTFX and 74.2 ± 2.7 in group RoboISS (p > 0.05).RoboTFX has the advantages of less intraoperative fluoroscopy and implant loosening rate compared to RoboISS which is better than other methods. We thus recommend RoboTFX as an effective option for treating FFP IV. However, the indications of its operation should be strictly evaluated. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions There are many advantages to stabilize the posterior pelvic ring injuries with a transiliac‐transsacral (TITS) screw percutaneously. To identify the correct entry point and insert a guidewire accurately for a TITS screw, we propose a method of specifying the optimal entry point, and introduce a technique of enabling freehand placement of a guidewire with fluoroscopic guidance.In this retrospective study, 116 patients who underwent pelvic CT scans and pelvic lateral radiographs at our institution from January 2020 to April 2022 were enrolled. The optimal entry point for a TITS screw was formulated in the strict mid‐sagittal CT plane, and then transferred to the pelvic lateral radiograph relying on the sacral cortexes which were easily visible even in the poor fluoroscopy. The relative position of this point to other anatomical markers was checked to confirm its feasibility as an entry point. With the method to locate the entry point, 18 patients suffered the posterior pelvic ring injuries were treated with TITS screws through hammering a reverse Kirschner wire (K‐wire) to insert a guidewire assisted by a canula, followed by the validation of the screw placement accuracy.The transferred point in radiograph was consistently beneath the sacral alar slope, and located posteroinferior to the iliac cortical density (ICD) and anterosuperior to the sacral nerve root tunnel in all 116 patients. In clinical practice, 18 TITS screws were successfully placed in 18 patients without cortex violation. The average operative time for each screw was 20.11 ± 6.29 min, with an average of 14.11 ± 6.81 fluoroscopic shots per screw. At the 3‐month follow‐up, fracture healing was confirmed in all patients. The average Majeed score was 89.61 ± 6.90 at the final follow‐up.It's feasible to identify an entry point for a TITS screw based on the sacral cortexes, and hammering a reverse K‐wire assisted by a percutaneous kyphoplasty (PKP) canula is a safe and practical technique for guidewire insertion. [ABSTRACT FROM AUTHOR]

Background: Precise measurement of the intraosseous corridor within the superior pubic ramus is essential for the accurate percutaneous placement of a retrograde superior ramus screw (SRS). However, conventional manual measurement methods are often subjective, leading to variations in results among observers. Our goal was to develop an automated and dependable method for determining the retrograde SRS corridor. Methods: We developed an automated technique that utilized a computed tomography (CT) image-based search algorithm to identify the retrograde SRS corridor with the maximum diameter. We evaluated the reliability of this automated approach in comparison to a manual method using 17 pelves. Subsequently, we used both methods to measure the diameter, length, and orientation of the retrograde SRS corridor in 204 pelves in a Chinese population and assessed the intra- and interobserver agreement of each method by calculating the root-mean-square error (RMSE) and constructing Bland-Altman plots. We determined the screw applicability (percentages of hemipelves that could be treated with specific sizes of screws) for each method. Additionally, we investigated potential factors influencing the corridor, such as sex, age, height, and weight, through regression analysis. Results: The intra- and interobserver intraclass correlation coefficients (ICCs) for the automated method (0.998 and 0.995) were higher than those for the manual approach (0.925 and 0.918) in the assessment of the corridor diameter. Furthermore, the diameter identified by the automated method was notably larger than the diameter measured with the manual method, with a mean difference and RMSE of 0.9 mm and 1.1 mm, respectively. The automated method revealed a significantly smaller corridor diameter in females than in males (an average of 7.5 and 10.4 mm, respectively). Moreover, use of the automated method allowed 80.6% of the females to be managed with a 4.5-mm screw while a 6.5-mm screw could be utilized in 19.4%, surpassing the capabilities of the manual method. Female sex had the most substantial impact on corridor diameter (β = −0.583). Conclusions: The automated method exhibited better reliability than the manual method in measuring the retrograde SRS corridor, and showed a larger corridor diameter for screw placement. Females had a significantly smaller corridor diameter than males. Given the intricate nature of the automated approach, which entails utilizing different software and interactive procedures, our current method is not readily applicable for traumatologists. We are working on developing integrated software with the goal of providing a more user-friendly solution for traumatologists in the near future. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation. Methods: Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (α) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors. Results: Compared to the non-DVT group, the DVT group had decreased R and K values, while the α, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389–2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 − 2.709). Conclusions: The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures. Trial registration: The study was registered in the Chinese Clinical Trial Register (https://www.chictr.org.cn/bin/home) on April 16, 2024, with registration number ChiCTR2400083135. [ABSTRACT FROM AUTHOR]

While much is written about the consequences of motor vehicle accidents in the pregnant patient, less is documented regarding gynecological trauma after similar injuries. Though rare, gynecological trauma may be significant and include injuries to the uterus, adnexa, and vagina. Uterine avulsion may be diagnosed immediately or be recognized on re-presentation with secondary amenorrhea; surgical methods are described to restore anatomical continuity and possible fertility. Adnexal injuries are rare but should be evaluated intraoperatively. Vaginal injuries may be closely associated with pelvic fracture and may require antibiotic prophylaxis in addition to evaluation for repair. Careful attention is needed to this range of often occult gynecological injuries after motor vehicle accidents. [ABSTRACT FROM AUTHOR]

Background: The authors believe that the L5-S1 facet joint injury in the setting of pelvic fractures is underappreciated by orthopedic traumatologists. The purpose of this study was to draw attention to the L5/S1 facet joint in the setting of pelvic ring injuries. Methods: This was a retrospective comparative study of all patients greater than or equal to 18 years of age with an acute pelvic ring injury (AO/OTA 62 B to C) presenting to a single level I trauma center. The primary objective was to determine demographic and injury characteristics associated with L5-S1 facet joint injuries in patients with pelvic ring injuries. The secondary objective was to determine the proportion of L5-S1 facet joint injuries that were missed on initial radiographic workup. Results: There were 476 patients included in the analysis, 53 (11.1%) of whom had an L5-S1 facet joint injury. Patients with an L5-S1 injury were more likely to be younger (44.1 vs. 53.2 years, p = 0.001) and experience a high energy mechanism of injury (95.0% vs. 78.0%, p = 0.002). Certain injury patterns were associated with L5-S1 facet joint injuries: any sacral fracture (96.2% vs. 73.8%, p < 0.001), Denis zone 2 fractures (43.4% vs. 20.1%, p < 0.001), Denis zone 3 fractures (34.0% vs. 4.7%, p < 0.001), bilateral displaced sacral fractures (18.9% vs. 3.5%, p < 0.001), and L5 transverse process fractures (64.2% vs. 18.0%, p < 0.001). Only 16.0% of radiology reports identified an L5-S1 injury. Conclusions: Orthopedic traumatologists should scrutinize imaging for L5-S1 facet joint injuries in the presence of pelvic ring injuries, especially in patients with certain sacral fracture patterns. [ABSTRACT FROM AUTHOR]

Case: A 22-year-old man with a type IIIA open AO/OTA 61C2.2b pelvis fracture and hypotension received exploratory laparotomy, temporary open ligation of the bilateral internal iliac arteries, and retroperitoneal packing. After prompt fracture debridement, a pelvic binder was positioned over the thighs as a reduction aid and maintained for six hours during pelvis open reduction internal fixation. Bilateral anterior thigh compartment syndrome was diagnosed three hours after packing and binder removal. Conclusion: Prolonged application of a pelvic binder to the thighs as an intraoperative reduction tool, shortly after temporary internal iliac artery ligation, may be associated with reperfusion injury and thigh compartment syndrome. [ABSTRACT FROM AUTHOR]

Background/Objectives: 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. Methods: 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. A search was performed on four databases. The CARE checklist was used to investigate the reporting integrity of the included studies. Analysis was performed narratively, and this study was registered on the Open Science Framework. Results: 21 patients from 19 studies were included (17 females and 4 males) with an average age of 82.1 years. The 21 patients suffered a total of 29 fractures. Pubic ramus fractures were present in 48.3% of all fractures. In 42.9%, an active hemorrhage was reported. Arterial vessels were injured in direct anatomical relationship to the fracture. Abdominal pain and hemorrhagic instability were the main red flag symptoms reported. Active arterial hemorrhage was diagnosed by CT with angiogram and treated by embolization with or without additional surgery. Conclusions: Clinically relevant hemorrhage in pelvic fractures due to low-energy trauma is rare. However, these fractures, combined with clinically relevant hemorrhage, account for an increased mortality and morbidity in elderly people. This systematic review was able to create a clinical decision tree for hemorrhage in ramus pubic fractures. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to identify the impact of age on current trauma team activation (TTA) processes and outcomes for patients with pelvic fractures. Methods: Adult patients with moderate and/or severe pelvic fractures (Abbreviated Injury Scale ≥ 2) between 1 January 2016 and 31 December 2021 were included utilising major trauma hospital data in Queensland. Characteristics of older (age ≥ 65) and younger patients including TTA, interventions and outcomes were examined. Multivariate analysis was used to determine factors associated with TTA in older patients. Results: Data from 637 patients was included. Despite comparable injury severity, a TTA was activated in fewer older people (older: 65% vs. younger: 79%, P < 0.001). Older patients had more falls leading to the trauma presentation (54.4% vs. 22.6%, P < 0.001), with higher initial systolic BP (131 vs. 125 mmHg, P = 0.04). Outcomes were worse for older people, with greater rates of in‐hospital complications (27.2% vs. 16.4%, P = 0.004), and longer hospital stays (12 vs. 8 days, P = 0.04). Fewer older patients could be discharged independently to home (46.3% vs. 74.5%, P < 0.001). In older patients, falls and haemodynamic parameters were strongly associated with the reduced likelihood of TTA (fall mechanism [odds ratio (OR)] 0.33; 95% confidence interval [CI] 0.15–0.74; P = 0.01; systolic BP [OR 0.98; 95% CI 0.97–0.99; P = 0.03], heart rate [OR 0.97; 95% CI 0.95–0.99; P = 0.02]). Conclusion: Current TTA criteria based on higher energy mechanisms and traditional vital sign thresholds are inadequate for identifying injury in older patients. Sensitive triage criteria and increased clinician awareness are required to enhance injury recognition and improve outcomes in older trauma patients. [ABSTRACT FROM AUTHOR]

Introduction This report presents the recommendations of the European Calcified Tissue Society (ECTS) for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) in adults. Our starting point was that the recommendations be evidence based, focused on non-bone specialists who treat patients with glucocorticoid (GC) and broadly supported by ECTS. Methods The recommendations were developed by global experts. After a comprehensive review of the literature, 25 recommendations were formulated, based on quality evidence. For stratifying fracture risk and the most appropriate first line of treatment, we have classified patients into 3 categories: those at medium risk of fractures, ie, adults without a recent (in the last 2 years) history of fracture; those at high risk of fractures, ie, adults with recent history of fracture, and/or at least one vertebral fracture (grade ≥ 2 according to Genant classification); and those at very high risk of fractures, ie, adults aged ≥70 years with a recent hip fracture, pelvis fracture, and/or at least one vertebral fracture (grade ≥ 2 according to Genant classification). The subtopics in the recommendations include who to assess, how to assess, who to treat, how to treat, and follow-up and monitoring. Results General measures are recommended for all patients who are being prescribed GCs for ≥3 months, ie, calcium and protein intake should be normalized, a 25(OH) vitamin D concentration of 50-125 nmol/L should be attained, and the risk of falls be minimized. (1) Who to assess? (R1-2) A preliminary assessment of fracture risk should be routinely performed in patients likely to receive oral GCs for ≥3 months: (i) women and men ≥ 50 years and (ii) patients at increased risk of fracture (history of fragility fracture and/or have comorbidities or are on medications that are frequently associated with osteoporosis. (2) How to assess (fracture risk)? (R3-6) Clinical risk factors include history of fragility fracture, systematic vertebral imaging, and GC dose-adjusted FRAX, measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), fall risk, and biochemical testing. (3) Who to treat? (R7-12) Anti-osteoporosis treatment is indicated for women and men ≥ 50 years with (i) the presence of a recent history of vertebral and/or non-vertebral fracture (less than 2 years), (ii) and/or a GC dosage ≥ 7.5 mg/day, (iii) and/or age ≥ 70 years, (iv) and/or a T -score ≤ −1.5, (v) and/or 10-year probability risk above the country specific GC dose-adjusted FRAX® thresholds. In premenopausal women and men < 50 years with a Z -score ≤ −2 and/or a history of fragility fracture, it is recommended to refer the patient to a bone specialist. (4) How to treat? (R13-18) In women and men ≥ 50 years, (i) alendronate or risedronate is preferred as the first line of treatment in patients at medium risk of fractures, (ii) zoledronic acid or denosumab in patients at high risk of fractures, and (iii) teriparatide in patients at very high risk of fractures. It is imperative that sequential therapy be implemented in individuals receiving denosumab or teriparatide as their first-line treatment regimen. (5) Follow-up and monitoring (R19-25): in patients receiving anti-osteoporosis treatment, monitoring of clinical risk factors (eg, history of fragility fracture), systematic vertebral imaging, fall risk, BMD measurement using DXA, and biochemical testing should be performed regularly during follow-up. Conclusions The new, evidence-based recommendations by the ECTS for the prevention and treatment of GIOP provide clear and pragmatic advice to all health practitioners especially those who are not bone specialists. [ABSTRACT FROM AUTHOR]

To identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI). The trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least 1 postoperative cystogram or catheter removal were included. A univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was completed. Eighty-four patients with an EBI underwent CM. Seventy-eight (93%) patients had an associated pelvic fracture and 17 of 84 (20%) underwent embolization for pelvic hemorrhage. Thirty-four (41%) patients also had delayed-phase imaging, 17 (20%) of whom had extravasation from their bladder on delays. Six (7%) patients failed initial CM. There was no association between the composite outcome and pelvic fracture (P =.35) or embolization (P =.41). American Association for the Surgery of Trauma (AAST) grade 5 injuries (P =.01) and the presence of extravasation on delayed-phase Computed Tomography (P =.03) were associated with the composite outcome. Contrast extravasation on initial delayed-phase imaging despite urethral catheter drainage and AAST injury grade were associated with failed CM after EBI. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM. [ABSTRACT FROM AUTHOR]

A three-in-one protocol comprised of pelvic external fixation, retroperitoneal pelvic packing, and angiography with or without embolization has been developed and used in our centre to improve survival outcomes of hemodynamically unstable pelvic fractures since 2008. Fourteen paediatric patients over a period of 15 years are reviewed in this case series. The mean age is 11.6 and standard deviation is 4.6. The mean injury severity score is 31.6. Sixty four percent underwent three-in-one protocol management. The overall survival rate at index hospital admission and at one year is 85.7% which is higher than the adult group (81%) from a study conducted at our centre and comparable to the rate in paediatric group. One patient had pelvic external fixator pin tract infection and two had lower limb ischemia post embolization. At 6 months follow up, one patient had pelvic pain and one had hip protrusio. We conclude that improvement in survival outcome also applies to the paediatric population. Technical differences in the paediatric group is highlighted to minimize potential complications. [ABSTRACT FROM AUTHOR]

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. All patients underwent screw fixation alone or combined with other fixation methods for fracture fixation. The application of preoperative 3D printing planning in orthopedic surgical robot operations was described. The intraoperative screw drawing time, invasive operation time, number of fluoroscopies during invasive operation, postoperative evaluation of screw accuracy, fracture healing, complications, and functional outcomes were recorded and compared between the two groups. Results: All patients successfully underwent surgery, with one patient in the control group experiencing numbness in the sciatic nerve innervation area. All patients were followed up for 4–15 months, with an average of 8 months, and all fractures achieved healing. The experimental group had a total of 26 screws inserted, while the control group had 30 screws. In the experimental group, the intraoperative screw drawing time was 3.0 (3.0, 3.37) min, significantly shorter than 4.0 (3.6, 4.0) min in the control group (P < 0.05). The proportion of screws not penetrating the bone postoperatively was 88.5% in the experimental group, significantly higher than 63.3% in the control group (P < 0.05). In the experimental group, the postoperative screw position, compared to the planned screw position, had an average position deviation of 3.05 ± 0.673 mm and an average spatial angle deviation of 2.22 ± 0.605°. At the last follow-up, the Majeed score was used to assess function, with the experimental group having an excellent and good rate of 84.6%, slightly higher than 75.0% in the control group, but the difference was not statistically significant (P > 0.05). Conclusion: In the treatment of pelvic fractures using screw fixation, preoperative 3D printing technology planning combined with orthopedic surgical robots, compared to orthopedic surgical robot-assisted screw placement alone, can significantly reduce intraoperative screw drawing time, decrease drawing difficulty, enhance screw placement accuracy, and does not increase invasive operation time or the number of fluoroscopies. This approach makes the surgery safer and is a method worth applying. [ABSTRACT FROM AUTHOR]

In this review, we provide recommendations as well as summarize available data on the optimal time to initiate venous thromboembolism chemoprophylaxis after severe trauma. A general approach to the severe polytrauma patient is provided as well as in-depth reviews of three high-risk injury subgroups: patients with traumatic brain injury, solid organ injury, and pelvic fractures. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study were the retrospective evaluation of the compressive effect and complication rates of transsacral stabilization of osteoporosis-associated sacral fragility fractures in 106 patients using three different implants (6.0 mm sacral bar, n = 32; 7.3 mm screw, n = 26; 7.5 mm ISG-Rod System, n = 48) with regard to the image morphological and clinical-perioperative outcome. Methods: For this purpose, the sacral width was determined preoperatively and postoperatively using multiplanar CT reconstructions and correlated with the measured bone density (HU). The results were compared with each other on an implant-specific basis. Results: A significant compressive effect was found for all implants (6.0 mm sacral bar 7.1 ± 3.4 mm, 7.3 mm screw 6.9 ± 1.8 mm, 7.5 mm ISG-Rod System 8 ± 2.4 mm). No implant-specific difference in compression could be detected. Overall, the washers broke into the iliac cortex in 9% of cases. The subgroups did not differ significantly in this respect (6.0 mm sacral bar: 4 [13%], 7.3 mm screw 1 [1%], 7.5 mm ISG-Rod System (5 [10%], p = 0.581). A correlation between the degree of osteoporosis and the compressive effect could not be demonstrated. Significant implant-specific differences were found in the incision-suture time, with only ø0:39 ± 0:13 h required for implantation of the 7.5 mm ISG Rod System (6.0 mm sacral bar: ø1:09 ± 0:22 h, 7.3 mm screw: ø0:55 ± 0:20 h). The fluoroscopy time was significantly lower with the 7.3 mm screw (ø0:57 ± 0:23 min) and the 7.5 mm ISG Rod System (ø0:42 ± 00:17 min) than with the 6.0 mm sacral bar (ø1:36 ± 0:46 min). Conclusion: A significant compressive effect was demonstrated with all three implants. No implant-specific complications or surgical site complications were identified in either the overall cohort or the subgroups. The 7.5 mm ISG Rod System shows advantages with regard to the duration of surgery and fluoroscopy. [ABSTRACT FROM AUTHOR]

Bone fractures that occur in earthquakes threaten human life. The study aims to localize the fractures in earthquake victims according to anatomical regions in the earthquake centered in Kahramanmaraş 2023. The study included 137 patients aged between 1-90 years diagnosed with fractures by an orthopedic physician. Radiographs were taken of patients admitted to the emergency department after the earthquake. The fractures diagnosed patients were evaluated and classified in anatomical regions and fracture type. The fractures were observed in females with high rates of fragmented (49.6%) and s ingle fractures (75.9%). The fractures also occurred on the right side (58.4%), in the upper extremities (37.2%) and long bones (38.7%). In the specific anatomic region evaluation of fractures; high rates were observed in manus (19%), antebrachi (15.3%), crus (13.9%) and pes fractures (12.4%). In the region of the most common fragmentary fracture type (48.9%); omos (3%), brachium (1%), thorax (15%), viscerocranium (7%) and neurocranium (3%), in oblique fractures (25.5%); pes (26%), in transverse fractures (20.4%); antebrachi (21%), manus (32%) and vertebral column (4%), in spiral fractures; pelvis (14%), femur (14%) and crus (57%) region. We determined that fractures frequently occur on the right-side extremities and, besides sequentially high rates at manus, antebrachii, crus, and pes. We recommend providing information about the protection of these anatomical parts in the training given to people during the earthquake closure and post-earthquake panic times to reduce earthquake-related fractures. [ABSTRACT FROM AUTHOR]

An 11‐month‐old female, neutered domestic short‐haired cat was presented for non‐pruritic alopecia of the dorso‐lumbar area which had appeared 1 month after a road accident. After the trauma, a fracture of the left hind limb was demonstrated without dermatological lesions on the dorso‐lumbar area. One month later, hair loss was observed in this area. Four months later, clinical examination revealed dorso‐lumbar alopecia. Histopathological findings included an absence of all adnexae, a mild fibroplasia and fibrosis without oriented collagen deposition, individual to coalescing pyogranulomas at the dermo‐hypodermal junction and a moderately stenotic hypodermal artery. Clinical history, physical examination and histopathological findings were compatible with post‐traumatic dorso‐lumbar alopecia. Special features of this case include the location of the fracture and the more developed histopathological lesions with pyogranulomas at the dermo‐hypodermal junction, the absence of hair follicles and a stenosing arteriopathy. [ABSTRACT FROM AUTHOR]