Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.
Background The use of interlocked intramedullary nail has become the preferred method of treatment for intertrochanteric fracture of the femur. This study explored a new guide awl with a distal positioner assisting the guide wire insertion and opening canal, and verification the accuracy and security of our new guide awl.Methods 42 patients with intertrochanteric fracture treated by locking intramedullary nailing were retrospectively analyzed. Three patients with insufficient follow-up were excluded from analysis. 19 patients underwent the operation using the new guide awl, the other 20 patients in the control group were operated with the help of the conventional guide apparatus. Describe the new guide awl with a distal positioner usage in the operations. Operation time, the success rate of one-time insertion, fluoroscopy time, blood loss and bone healing time were recorded.Results 42 patients (25 males and 17 females) were treated with Gamma 3 and PFNA with the help of the new guide awl with a distal positioner or the conventional conventional guide apparatus. The surgical time in new guide awl group was significantly shorter compared to the control group. The success rate of one-time needle insertion in the new guide apparatus group was 89.5%, which was higher than the 65% of the control group. The fluoroscopy time in new guide apparatus group is obviously lower than in the control group. There was no significant difference in intraoperative blood loss and bone healing time.Conclusion The new guide awl with a distal positioner we designed could reduce the difficulty in opening the femur for inserting the interlocked intramedullary nail. It is especially suitable for obese patients.
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