PURPOUSE OF THE STUDY Pelvic ring fractures in the geriatric population are of increasing frequency. Often insufficiency fractures or occult fractures are described. With a classical injury mechanism the majority of these injuries are the result of a low energy trauma, typically a fall from standing or during walking.Clinically, many patients report immediate anterior groin pain but detailed clinical examination often shows significant posterior pelvic pain. CT evaluation often reveals posterior pelvic ring injury, in the majority of cases a sacral compression fracture. Despite adequate diagnostics, many of these patients suffer from persistent pain, which can be observed up to 8 weeks after injury. To asses the role of external fixator in pain relief and early mobilisation in this group of patients the study was performed. MATERIAL AND METHODS From the database of all patients with pelvic ring and acetabular injuries 25 patients > 65 years with type B injuries stabilized by a supraacetabular external fixator were analyzed. Prospectively demographic data including sex, patient age, cause of injury, frequency and type of concomitant injuries and diseases, injury severity .fracture type and complications were recorded. For evaluation of the pain course, the visual analog scale was used. Preoperative and postoperative mobility and the type of post-treatment were evaluated. RESULTS Stabilizing the pelvic ring with a simple external fixation procedure (supraacetabular one pin external fixator) allows immediate relief of pain, which allows early and successful mobilization of these patients. Normally, adequate mobilization is possible immediate after application of the fixator. CONCLUSIONS This simple operative procedure, therefore, can be used for pain control and sufficient mobilization to avoid secondary medical complications.
- MeSH
- acetabulum zranění MeSH
- externí fixátory * MeSH
- fraktury kostí chirurgie MeSH
- kompresivní fraktury chirurgie MeSH
- křížová kost zranění MeSH
- lidé MeSH
- management bolesti * MeSH
- osteoporotické fraktury chirurgie MeSH
- pánevní kosti zranění MeSH
- pooperační bolest terapie MeSH
- pooperační péče MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Injury to the acetabular growth plate is rare. Accordingly, data on the incidence in the literature are controverse. Other difficulties include the clear definition of a pediatrie acetabular injury. The modified classification according to Salter-Harris described by Bucholz is used in immature patients. The majority of these injuries can be treated conservatively. In severely displaced injuries or in the presence of intra-articular pathologies open procedures are recommended. The main long-term complication is the development of posttraumatic acetabular dysplasia which should be early detected by regular check-ups until the completion of growth. Overall, the long-term results are satisfactory.
- MeSH
- acetabulum * patologie radiografie zranění MeSH
- artróza kyčelních kloubů * epidemiologie etiologie MeSH
- dítě MeSH
- fraktury kyčle * klasifikace radiografie terapie MeSH
- lidé MeSH
- pánevní kosti * patologie radiografie zranění MeSH
- vnitřní fixace fraktury * metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOUSE OF THE STUDY Associated transverse and posterior wall fractures account for approximately 20% of all acetabular fractures. To asses the risk of these concommitant bone injuries on early joint failure despite a high rate of postoperative congruency. MATERIAL The analysis of 104 surgically treated patients with associated transverse and posterior wall fractures showed that more than half of these patients had associated injuries. The mean age was 35 years, and > 75% of these patients were male. A high energy trauma was the trauma mechanism in 94.2%. The mean ISS was 26.3 points. The majority of patients showed a juxta- or transtectal fracture line. The mean articular fracture displacement was 13.5 mm. 87.5% of the patients showed a femoral head dislocation. An acetabular roof comminution was present in 16.3%. 20.2% of patients received a fracture related preoperative nerve injury to the sciatic nerve. METHODS Osteosynthesis was performed 9.9 days after trauma. The Kocher-Langenbeck approach was used in > 90% for stabilization with a combination of plate and screw fixation in 71.1%. The mean operative time was 190 minutes with a blood loss of 855 ml. Postoperatively the hip joint was congruent in 90.3% with anatomical or near-anatomical joint reconstruction in > 90%. latrogenic nerve injury occurred in 12 patients (8.9%). RESULTS 67 patients (67.7%) could be followed after a mean of 42.7 months. The average subjective Visual Analog Scale pain score was 42.7. Mild or no pain was seen in 58.2%. The mean Merle d'Aubigne score was 15.4 with 56.7% of patients having a functionally perfect or good result. 52.2% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 32.8% of the patients. Analyzing only patients with anatomically reconstructed hip joints, patients showed comparable results with 61.3% having no or mild pain and 59.2% a good or excellent functional result. Posttraumatic arthrotic changes occur in only 26.5% of these patients. A joint failure was present in 32.7%. In this group, a joint failure was significantly more likely to be present with an additional acetabular comminution zone. CONCLUSION Associated transverse and posterior
- MeSH
- acetabulum * patologie radiografie zranění MeSH
- artróza kyčelních kloubů epidemiologie etiologie MeSH
- dospělí MeSH
- fraktury kyčle * chirurgie klasifikace radiografie MeSH
- intramedulární fixace fraktury * metody MeSH
- lidé MeSH
- pánevní kosti * patologie radiografie zranění MeSH
- polytrauma epidemiologie etiologie MeSH
- pooperační komplikace * epidemiologie etiologie MeSH
- skóre závažnosti úrazu MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- MeSH
- délka pobytu statistika a číselné údaje MeSH
- dítě MeSH
- externí fixátory MeSH
- fixace fraktur přístrojové vybavení metody MeSH
- fraktury kostí komplikace mortalita radiografie terapie MeSH
- lidé MeSH
- míra přežití MeSH
- mladiství MeSH
- nestabilita kloubu komplikace terapie MeSH
- otevřené fraktury terapie MeSH
- pánevní kosti zranění radiografie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Complete separation of all bony fragments around the acetabulum in both column fractures can lead to extra-anatomical orientation of these fragments around the femoral head with the potential of a "secondary congruence". No long-term data are known in the literature. We could follow 35 patients were a both column fracture was treated non-operatively due to different reasons. Demographics, fracture type, additional fracture lesions (comminution, marginal impaction), the clinical and radiological result and joint failure (severe arthrosis, FHN, esc. THR) were analyzed. The mean age was 38 years, 27 patients were male, eight female. All but four were multiply injured with a mean ISS of 22 points. 16 patients had additional pelvic ring injuries the majority of patients showed a C1-fracture of the acetabulum (anterior column multifragmentary, posterior column simple). 31 patients healed in secondary congruence (88%). Primary displacement was half (11,4 mm, 3-27 mm) compared to patients without secondary congruence (20 mm, 17-22 mm). 80% of the patients had none or only slight pain and 77% had an excellent or good functional result (Merle d'Aubigne Score). The rate of joint failure due to non-union, femoral head necrosis, posttraumatic degenerative changes or pain was relatively low with 17% after a mean of 5 years following trauma. In selected patients, conservative treatment of both column fractures can lead to acceptable long-term results with a high rate of secondary congruence.
- MeSH
- acetabulum * zranění MeSH
- fraktury kostí * radiografie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- ortopedické výkony metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure <70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels.
- MeSH
- fixace fraktur MeSH
- fraktury kostí komplikace terapie MeSH
- hemoragický šok diagnóza terapie MeSH
- hemostatické techniky MeSH
- krvácení etiologie terapie MeSH
- lidé MeSH
- pánevní kosti zranění MeSH
- poranění měkkých tkání komplikace terapie MeSH
- terapeutická embolizace MeSH
- urgentní služby nemocnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Both column fractures, defined as an acetabular fracture with no articular fragment in connection with the axial skeleton account for approximately 20% of all acetabular fractures. The typical type of a both column acetabular fracture is the C1.2 fracture with a multifragmentary anterior column fracture extending to the iliac crest and a large posterior column fragment in more than half of the patients. MATERIAL AND METHODS The analysis of 135 surgically treated patients with both column fractures showed that more than half of these patients had associated injuries. The mean age was 40 years, and two thirds of these patients were male. A high energy trauma was the trauma mechanism in 87.4%. The mean ISS was 14.2 points. The mean articular fracture displacement was 14.8 mm. 65.9% of the patients showed a central femoral head dislocation. An associated posterior wall fracture was present in 34.8% and an acetabular roof comminution in 34.1%. 8.9% of patients had a fracture related nerve damage. RESULTS Osteosynthesis was performed 9.6 days after trauma. Several approaches were used for stabilization with a combination of plate and screw fixation in 71.9%. The mean operative time was 287 minutes with a blood loss of 1796 ml. Postoperatively the hip joint was congruent in 94.7% with anatomical or near-anatomical joint reconstruction in 75.6%. latrogenic nerve injury occurred in 12 patients (8.9%). 89 patients (66.4%) could be followed after a mean of 54.6 months. The average subjective Visual Analog Scale pain score was 27.6. Mild or no pain was seen in 60.7%. The mean Merle d'Aubigné score was 15 with 60.7% of patients having a functionally perfect or good result. 61.8% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 25.8% of the patients. DISCUSSION Analysing only patients with anatomically reconstructed hip joints patients had better results with 69,8% having no or mild pain and a good or excellent functional result. Post-traumatic arthrotic changes occued in only 17.5% of these patients. A joint failure was present in 25.4%. In this group, a joint failure was significantly more likely to be present with an additional lesion of the femoral head and severe primary articular fracture displacement. CONCLUSIONS In contrast to other acetabular fracture types, both column fractures show worser results regarding joint reconstruction, and functional and radiological long-term results. The optimal results can be achieved with anatomic joint recontsruction.
