Background: Successful surgical management of pelvic ring and acetabular fractures requires technical expertise to achieve an accurate reduction and stable fixation. The use of 3-dimensional (3D) intraoperative imaging (3DIOI) as an assessment tool has led to improved reduction and placement of implants. The purpose of this study was to assess the utility of using 3DIOI in the management of acetabular and pelvic fractures on the basis of outcomes reported in the literature.Methods: A literature search was performed using PubMed, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar using key terms. A network meta-analysis conducted using the frequentist approach allowed for statistical analysis of reported outcomes regarding screw position (in mm), fracture reduction (in mm), and complications.Results: A total of 9 studies were included in this analysis. When compared with conventional radiography, the mean radiation dose (in cGy•cm 2 ) was significantly higher in 3DIOI (mean difference, 82.72; 95% confidence interval [CI], 21.83 to 143.61; p 5 0.007). Use of 3DIOI yielded a 93% lower risk of developing medical complications (odds ratio [OR], 0.07; 95% CI, 0.02 to 0.35; p 5 0.014). Use of 3DIOI yielded higher odds of achieving accurate screw placement (OR, 4.21; 95% CI, 1.44 to 12.32; p 5 0.008) and perfect reduction (OR, 2.60; 95% CI, 1.19 to 5.68; p 5 0.016). In ranking the imaging modalities, 12 of the 13 parameters analyzed were in favor of 3DIOI over conventional fluoroscopy and 2D navigation imaging.Conclusions: Current literature supports the use of 3DIOI because of the decreased rates of misplaced implants, malreduced fractures, complications, and subsequent revision operations. The use of 3DIOI allows for improved visualization of pelvic anatomy when repairing pelvic and acetabular fractures, and helps surgeons to achieve favorable surgical outcomes.
<p class="abstract">Unstable pelvic ring fractures are challenging injuries regarding their reduction and stabilization. The presented study evaluates the results of a minimally invasive and quick one-stage stabilization of sacral fractures combined with bilateral pubic rami fractures during a period of national limited resources and decreased general security aiming at reduction of the duration of hospital stay and overall costs. Sixteen patients with unilateral sacral fractures and bilateral pubic rami fractures without lumbosacral dissociation were fixed by two retrosacral threaded transiliac rods and an anterior external fixator. Results were assessed with Majeed score and Matta-Tornetta radiologic criteria for post-operative reduction. The follow up period averaged 23 months. There were 9 cases excellent, 4 cases good and 3 cases fair. The duration of surgery and the number of intra-operative X-ray images were recorded. The presented technique is simple, reproducible and quick for one-stage fixation of the unstable pelvic bony disruption. It reduces the operative time, radiation exposure, duration of hospital stays and cost of care during a critical national period with limited resources. </p>
Hip fusion provides adequate pain relief for various end-stage hip pathologies. However, this comes at the expense of motion, restricting most of daily-living activities. Conversion to a THA has been shown to restore range of motion, relieve pain, and decrease stress in adjacent joints. Furthermore, THA can enhance quality of life, improve function, and restore the ability to perform activities of daily living. This systematic review study to evaluate the indications, clinical outcome, complications, overall satisfaction and change in quality of life in patients underwent conversion of hip fusion to total hip arthroplasty. The electronic database search yielded 2154 studies; 1352 studies were duplicated so removed. After removal of 422 for language and sampling defects, 380 were screened according to inclusion and exclusion criteria. Only 11 studies were eligible, so included in qualitative synthesis in the current systematic review. Regarding the outcome assessment, 8 out of 11 studies used Harris hip score (HHS) for outcome evaluation, 2 out of 11 studies used Mayo score and only one study out of 11 studies used Merle d'Aubigné scale. The all included studies showed significant improvements of the scores postoperative and enhanced outcomes. Despite the lack of well deigned studies on the conversion to total hip arthroplasty, the present systematic review provides some evidence that total hip arthroplasty can aid to restore range of motion, relieve pain, and decrease stress in adjacent joints.
Background: Jumper's knee, patellar tendinopathy, is a clinical term used to describe patellar tendon pain, swelling, and/or dysfunction resulting from acute injury or, more commonly, chronic overuse. This condition is prevalent among athletes. In patients with patellar tendinopathy in whom non-operative management is unsuccessful; surgery is an option to return to high levels of physical activity. Aim: This work aimed to evaluate the results of arthroscopic management of cases with chronic refractory patellar tendinopathy (jumper's knee). Methods: This is a prospective study that was done at Kafr El-Sheikh and Benha university hospital. 28 patients involved in sports activities with chronic patellar tendinitis aged 18-3o years with the mean age of 23.25 years were considered to have arthroscopic treatment to refractory chronic patellar tendinopathy after at least 3 months of conservation. All patients in the study underwent arthroscopic debridement of the Hoffa's bad fat, debridement of abnormal patellar tendon, with or without excision of the lower pole of the patella. Preoperative and postoperative evaluation was undertaken using the VAS score, Lysholm Scores and Victorian Institute of Sport Assessment-Patella (VISA-P) scores for all patients. No patients were lost to follow-up. Results: The VAS, Lysholm, and VISA-P scores all significantly improved at last follow-up. There were no postoperative complications. 27 patients of 28 were able to perform at their preinjury sports activities. One case was not able to return to preinjury sports activity. Conclusion: arthroscopic surgery for patients with patellar tendinopathy, refractory to non-operative management, appears to provide significant improvements in symptoms and function.
The current standard treatment of anterior column acetabular fractures includes formal open reduction with internal fixation (ORIF) through a variety of anterior approaches. Nonetheless, extensile introduction can prompt entanglements. Percutaneous negligibly obtrusive careful adjustment for a front section break of hip bone socket has become an acknowledged treatment strategy for as far back as quite a long while. The reason for this investigation is to give combined information about signs and results of percutaneous obsession of cracks of foremost segment of hip bone socket. This orderly survey comprised of 4 stages, including a methodical inquiry of the writing by utilizing PubMed and The Cochrane Library (Step1), determination of clinical investigations in the English language bound to cracks of hip bone socket which went through percutaneous obsession of foremost section (Step 2), study qualities were deliberately removed from the chosen papers (Step 3), and extraction of information on clinical results (Step 4). The inquiry yielded 14 papers qualified for our investigation. 68% were guys and 32% were females. The mean age of the patients was 52 yr. The primary system of injury is RTA 59%. The mean employable time was 43.4 min and the mean blood misfortune was 54.3 ml. Just 25 patients (5.8 %) had careful inconveniences. The majority of articles empower Partial weight-holding on for ROM practices in the first post-usable day. The mean HHS was 87.7 (acceptable). Post-usable radiological result was anatomical in 72% though radiological result in last visit was Excellent in 63% and Good in 20%. PCS obsession of breaks of the foremost segment of the hip bone socket with either traditional or mechanized route framework fluoroscopy could be applied not exclusively to non-uprooted cracks yet in addition to dislodged breaks amiable to shut or restricted open decrease. The mechanized route framework is better as it gives a multi-planar perspectives which give a 3D creative mind of the life structures of the pelvis, diminishing the quantity of pictures taken and this will diminish fluoroscopic time introduction and blood misfortune. Contrasted with ORIF, PCS obsession accomplishes a comparative nature of decrease and utilitarian result yet is related with less complexities, littler intraoperative blood misfortune, shorter usable time and permit early weight-bearing and recovery.
This study presents our experience of internal fixation of the acetabular fractures and pelvic fractures using a newly modified Stoppa approach, which provides closer visualization to the entire anterior column, quadrilateral surface and the pelvic brim portion of the posterior column, and permits stable internal fixation for the acetabular fracture patterns with main anterior displacement and the anterior and lateral parts of the pelvis. The present study was a prospective clinical study including 10 patients with acetabular fractures who were treated operatively using modified Stoppa approach . The classification of acetabular fractures described by Letournel and Judet. All operative data was recorded Patients were followed-up for 12 months after the operation. The maximum displacement of the bony fragment was measured in the unit of mm by using PACS, Marosis mview ver. 5.4 Our result shows the incidence of perioperative complication. Two patients developed DVT and two patients developed obturator nerve palsy. Our result shows the radiological outcomes of the included patients. The mean CT gap was 1.685 ±0.27mm. Eighty percent of the patients had anatomical Matta class. Our result shows the Merle D"Aubigne-Postel score of the included patients. Eighty percent of the patients had excellent score. The incidence of MVO after PPCI may be lowered by the addition of manual TA (6,24). The results of the present study show that the additional intracoronary administration of a high dose of adenosine may further improve STR up to 70%. Future larger studies with clinical endpoints are warranted to confirm the benefit of intracoronary administration of a high dose of adenosine in addition to glycoprotein IIb/ IIIa antagonist administration and TA in the setting of PPCI or rescue PCI.
Background: Trochanteric femoral fractures constitute 3% of all fractures and a large portion of fractures after the age of 60. Trochanteric femoral fractures in elderly usually occur due to a low-energy trauma and can be treated successfully with internal fixation or prosthesis depending on the patient's age and general condition and also the quality of the bone. Aim and Objective: This is a systematic review to evaluate different techniques of fixation used in management of intertrochanteric fracture, regarding the efficacy results and complication of each technique in the literature. Methods: A review was performed using the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE as database for search. Results: the results of the study revealed that the percent of changes were 44.69% of RT side group A, 45.26% of RT side group B, 40.86% of LT side group A, and 45.90% of LT side group B with no significant difference between the studied groups. included studies focusing on intertrochanteric fracture fixation in elderly patients as the main research point, if it was not the main point, paper was excluded. Conclusion: Prosthetic replacements can treat unstable intertrochanteric fracture well, if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.
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