Objectives: OTA/AO 61C pelvic ring injuries are vertically unstable because of complete sacral fractures combined with anterior ring injury. The objective of this study was to compare the biomechanical characteristics of 4 transsacral screw constructs for posterior pelvic ring fixation, including one that uses a novel fixation method with a pair of locked washers with interdigitating cams.Methods: Type C pelvic ring disruptions were created on 16 synthetic pelvis models. Each pelvis was fixated with an S2 screw in addition to being allocated to 1 of 4 transsacral constructs through S1: (1) 8.0-mm screw, (2) 8.0-mm bolt, (3) 8.0-mm screw locked with a nut, and (4) 8.00-mm screw locked with a nut with the addition of interdigitating washers between the screw head and ilium on the near cortex, and ilium and nut on the far cortex. The anterior ring fractures were not stabilized. Each pelvis underwent 100,000 cycles at 250 N and was then loaded to failure using a unilateral stance testing model. The anterior and posterior osteotomy sites were instrumented with pairs of infrared (IR) light-emitting markers, and the relative displacement of the markers was monitored using a three-dimensional (3D) motion capture system. Displacement measurements at 25,000; 50,000; 75,000; and 100,000 cycles and failure force were recorded for each pelvis.
Results:The novel washer design construct performed better than the screw construct with less posterior ring motion at 75,000 (P = 0.029) and 100,000 cycles (P = 0.029).
Conclusions:The novel interdigitating washer design may be superior to using a screw construct alone to achieve rigid, locked posterior ring fixation in a synthetic pelvis model with a Type C pelvic ring disruption.
Background: Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a wellstudied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. Methods: Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. Results: Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P > 0.05) or reoperation rates (1.2% vs. 1.9%, P > 0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P = 0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio = 3.34; 95% confidence interval = 1.21-9.24, P = 0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P = 0.023), readmission rate (11.1% vs. 1.8%; P = 0.043), and reoperation rate (11.1% vs. 1%; P = 0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P = 0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio = 1.49; 95% confidence interval = 1.04, 2.14; P = 0.028) compared with nondiabetic patients in extremity deformity procedures. Conclusions: The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. Level of Evidence: Level III.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.