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Fixation of comminuted vertically unstable sacral fractures continues to be a surgical dilemma. Although triangular osteosynthesis is a good construct and resists vertical translation, complications still occur. Herein, we introduce a new biplanar fixation technique, using segmental spinal instrumentation as an alternative to triangular osteosynthesis. This technique is remarkably valuable in cases with sacral morphology and/or complex fracture patterns that preclude safe percutaneous iliosacral screw insertion.

Purpose We evaluated the potential advantages of shortsegment fixation of certain anterior acetabular fracture patterns through a limited ilioinguinal approach. Methods Two patient groups were studied. The first group comprised 22 patients (20 men, two women; average age 36 years) treated using the short-segment fixation protocol through a limited ilioinguinal approach. We modified the use of short pelvic brim plates, spring plates and posterior-column screws as reduction and fixation tools (leaving the distal end of the fracture unfixed) to keep the dissection entirely lateral to the iliac vessels. The second (control) group comprised 31 patients with matched fracture patterns fixed through the standard ilioinguinal approach. All patients were followed up for a minimum of two years. The estimated amount of blood loss (primary outcome measure), operative time, postoperative radiographic assessment of reduction quality and functional score assessment (secondary outcome measures) were compared between groups. Results The short-segment-fixation group had significantly less blood loss (p<0.0001) and shorter operative time (p= 0.002) compared with the control group. However, there were no significant differences in the quality of fracture reduction and functional scores between groups at the final follow-up. No major complications were encountered in either group. Conclusion Short-segment fixation through a limited ilioinguinal approach is a safe and effective alternative for treating certain patterns of anterior acetabular fractures. Decreased blood loss and shorter operative time with less soft tissue dissection are the main advantages of this approach.

We believe that tertiary centers should be prepared for mass causalities. A variety of orthopaedic implants should be within reach and that personnel should be trained to work under stressful environments with a well laid disaster management plan.

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Objective. The aim of this study was to investigate the effect of lumbar repositioning feedback training (LRFT) on pain and joint position sense (JPS) in patients with chronic mechanical low back pain (CMLBP). Materials and Methods. Twenty-four patients, from both genders, suffering from CMLBP were assigned randomly into 2 equal groups. The lumbar repositioning feedback training (LRFT) group who received lumbar repositioning feedback training and conventional proprioception exercises on Swiss ball, and control group who received conventional proprioception exercises on Swiss ball only. Pain was assessed using visual analogue scale (VAS), and joint position sense was assessed using absolute repositioning error (ARE). All patients received treatment twice per week for 6 weeks. Assessments were carried out pre and post experimentally. Results. Pre- post treatment evaluations comparisons showed improvement of pain and joint position sense post- treatment compared to pre-treatment within both groups. However, pre-treatment between groups comparisons were non-significant, with significant post- treatment improvements of pain and joint position sense in favor of LRFT compared to control group. Conclusion. Patients in LRFT group showed significant pain reduction and improvement in joint position sense in patients with CMLBP than did patients in control group. Thus, LRFT might be a suggested component of treatment programs in managing patients with CMLBP.

Background. Distal humeral fractures are notorious injuries, and they require surgical fixation. The reliability of reconstruction devices has been a subject of debate. Our primary outcome was to detect differences, if any, between two different groups of patients using the patient-reported outcomes measurement information system (PROMIS) Global-10 form and to compare it with the Mayo elbow performance score (MEPS) results. Other secondary outcomes included the difference in union time between patients who received a reconstruction plate vs those who received a pre-contoured anatomical plate. Material and methods. It is a prospective randomised study which included a total of 30 cases equally distributed into two groups. Results. The mean PROMIS and MEPS scores for group A were 31.5 SD 6.6 and 77.7, respectively, compared to 33.7 SD 6.66 and 73, respectively, for the other group. Time to union was 13.4 weeks for group A and 12.6 weeks for the other group. There was no statistically significant difference between the groups regarding union and function. However, reconstruction plates were more cost effective. The correlation between the MEPS and PROMIS G scores in both groups was statistically significant. Conclusion. No superiority of one method of fixation versus the other was demonstrated in terms of patient-related outcomes. Reconstruction plates are a cost-effective alternative in simple fracture patterns.

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