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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