We created virtual three-dimensional reconstruction models from computed tomography scans obtained from patients with acetabular fractures. Virtual cylindrical implants were placed intraosseously in the anterior column, the posterior column and across the dome of the acetabulum. The maximum diameter which was entirely contained within the bone was determined for each position of the screw. In the same model, the cross-sectional diameters of the columns were measured and compared to the maximum diameter of the corresponding virtual implant. We found that the mean maximum diameter of virtual implant accommodated by the anterior columns was 6.4 mm and that the smallest diameter of the columns was larger than the maximum diameter of the equivalent virtual implant. This study suggests that the size of the screw used for percutaneous fixation of acetabular fractures should not be based solely on the measurement of cross-sectional diameter and that virtual three-dimensional reconstructions might be useful in pre-operative planning.

There was poor intraobserver agreement using the semiquantitative grading system. The parameters associated with the grade of stenosis assigned to the foramen were as follows: (1) the observer doing the grading, (2) the place it was imaged, and (3) the location of the foramen. There was poor correlation between measurements of the foramina carried out on MRI and the specimens.

We report a case series of three patients who sustained open Gustilo-Anderson Type IIIB tibia fractures associated with extensive segmental bone and soft tissue loss. The patients initially were treated with serial wound irrigations, débridements, and external fixation. After the soft tissue envelope was reconstructed successfully, each large segmental bone defect was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with a statically locked intramedullary nail. The mean segmental bone loss was 12.2 cm, and all patients had a minimum 1-year followup. One year after reconstruction, radiographs showed stable, well-aligned, healed constructs, and computed tomography images verified the presence of bony ingrowth throughout the cages. All patients were able to ambulate with full weightbearing, and had good ipsilateral knee, hip, and ankle range of motion. This technique seems to be a reasonable alternative for treating large segmental tibial bone defects.

This is a case report of a patient who sustained multiple gunshots resulting in a Gustilo Anderson type IIIB mid-shaft humeral fracture associated with extensive segmental bone and soft-tissue loss. The patient was treated initially by multiple irrigations, wound debridement, and a unilateral external fixator. After the soft tissue healed without infection, the mid-shaft humeral defect of approximately 8 cm segmental bone loss was reconstructed with a cylindrical titanium mesh cage packed with a composite of cancellous allograft and demineralized bone matrix putty and stabilized with limited contact dynamic compression plates. At 13 months follow-up, plain radiographs demonstrated a healed construct with good alignment, and computed tomography images demonstrated bony in-growth through the cage. The patient had full range of motion at the shoulder and the elbow. This technique may be a reasonable alternative when treating large segmental bone defects of the humerus.

A titanium mesh cage is a useful adjunct in the treatment of an extra-articular segmental defect in a long bone. Cite this article: Bone Joint J 2018;100-B:646-51.

The purpose of this article is to describe the complex anatomy of the pelvic ligaments. It uses schematics to display 10 color-coded ligaments in relation to the bony architecture. This atlas and the accompanying summary of the classification of pelvic ligamentous injuries is designed to encourage the use of magnetic resonance imaging in cases of pelvic ring trauma.

No abstract