Purpose The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Methods Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Results Overall, three patients (8.3 %) died, and 31 patients (86 %) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97 %) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5 % of the patients, and a fair or poor for 35.5 %. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. Conclusions The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

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THA was associated with an increased surgical revision rate, but hip dislocation was documented only once. In most cases, a standard implant with a large 36-mm femoral head size was sufficient. Uncemented revision stem revealed significantly higher number of revisions-compared to standard cemented or uncemented stem. One-year mortality was lower than expected.

AIMTo analyze planning total hip arthroplasty (THA) with an additional anteroposterior hip view may increases the accuracy of preoperative planning in THA.METHODSWe conducted prospective digital planning in 100 consecutive patients: 50 of these procedures were planned using pelvic overview only (first group), and the other 50 procedures were planned using pelvic overview plus antero-posterior (a.p.) hip view (second group). The planning and the procedure of each patient were performed exclusively by the senior surgeon. Fifty procedures with retrospective analogues planning were used as the control group (group zero). After the procedure, the planning was compared with the eventually implanted components (cup and stem). For statistic analysis the χ2 test was used for nominal variables and the t test was used for a comparison of continuous variables.RESULTSPreoperative planning with an additional a.p. hip view (second group) significantly increased the exact component correlation when compared to pelvic overview only (first group) for both the acetabular cup and the femoral stem (76% cup and 66% stem vs 54% cup and 32% stem). When considering planning ± 1 size, the accuracy in the second group was 96% (48 of 50 patients) for the cup and 94% for the stem (47 of 50 patients). In the analogue control group (group zero), an exact correlation was observed in only 1/3 of the cases.CONCLUSIONDigital THA planning performed by the operating surgeon and based on additional a.p. hip view significantly increases the correlation between preoperative planning and eventual implant sizes.

The significantly younger age at onset and the frequency of invasive tumours at diagnosis indicate that spinal cord injury influences bladder cancer risk and prognosis as well. Early detection of bladder cancer in patients with spinal cord injury remains a challenge.

Background Traumatic spinal cord injury (SCI) is also a combat-related injury that is increasing in modern warfare. The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge, and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI. Methods A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients. General patient information, latency period, age at initial diagnosis, type of bladder management and survival of SCI patients with bladder cancer were collected and analysed. T category, grading and tumour entity in these patients were compared with those in the general population. Relevant bladder cancer risk factors in SCI patients were analysed. Furthermore, relevant published literature was taken into consideration. Results Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years (SD ± 10.7 years), i.e., approximately 20 years earlier as compared with the general population. These bladder cancers are significantly more frequently muscle invasive (i.e., T category ≥ T2) and present a higher grade at initial diagnosis. Furthermore, SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis. Consequently, the survival time is extremely unfavourable. A very important finding, for practical reasons is that, in the Hamburg study as well as in the literature, urinary bladder cancer is more frequently observed after 10 years or more of SCI. Based on these findings, a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. Conclusions The results showed that urinary bladder cancer in SCI patients differs considerably from that in able-bodied patients. The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.

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