Injury
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Between 1987 and 2005, 55 patients were treated operatively to correct 44 malunions and 11 nonunion of the pelvic ring. These pathologies were the consequence of a nonoperative initial treatment for 38 cases, or of an inappropriate indication, such as the use of an external fixator as the definitive treatment of an unstable pelvic fracture in 15 and symphysis cerclage wiring in 2. Three patients had undergone ORIF of the lumbar spine performed by neurosurgeons, but the pelvic fractures below were ignored. On the basis of damaging mechanisms and of the main instability plane, initial lesions were classified as follows: 32 shearing lesions, 11 rotatory by antero-posterior compression, 7 by lateral compression, 5 mixed. In 23 cases the site of the posterior lesion was the sacrum, 4 of which were H fractures type; 13 were sacroiliac joint dislocations, or rotatory instability of the joint (in 2 cases the lesion was bilateral), 8 were sacroiliac dislocation fractures (crescent fractures); 7 were fractures of the iliac wing. Four patients only had pubic symphysis diastasis. Indications for surgery were pain associated with deformity or instability. Surgery was performed through a multistage procedure. Mean surgery time was 6h (range: 2-10h), with a mean blood loss of 700ml (range: 200-5000ml). Follow-up ranged from a minimum of 16 months to a maximum of 14 years (mean: 5.85 years). ⋯ The most frequent cause of pelvic malunion or nonunion was inadequate treatment. To reduce the number and the percentage of disabilities, it is necessary that specialised centres provide patients with early treatment that is adequate and definitive.
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Based on low incidence and lack of personal experience only few evidence based studies exist on several questions in pelvic and acetabular surgery. As part of an international consensus pelvic and acetabular course personal preferences and experience of an distinguished faculty and senior participants were discussed and we summarize in the paper the consented opinions and trends. Topics included the emergency treatment of life threatening pelvic ring injuries, treatment strategies in unstable sacral fractures, preferred surgical methods for transiliosacral screw fixation of the posterior pelvic ring, the value of CT and conventional radiographs in diagnostic of acetabular fractures, the choice of approach for treatment of acetabular fractures, the open vs. arthroscopic treatment of the femoro acetabular impingement of the hip and the treatment modalities in pelvic and acetabular fractures in geriatric patients. One has to keep in mind that this statements may help in the process of personal decision making in this difficult surgical field, but should not act as evidence based recommendations.
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Review
Pelvic and acetabular surgery within Europe: the need for the co-ordination of treatment concepts.
Pelvic and acetabular injuries are rare and represent the tip of the trauma iceberg. They often present with other associated injuries. Their management can pose difficulties even to the most experienced trauma surgeons and well-developed trauma systems. ⋯ By means of sharing ideas and results, "learning curves" of individuals and nations could be shortened. As a result, better health quality and advanced medical facilities for our future patients may be anticipated. In this article we examine the current problems affecting the provision of a high quality pelvic and acetabular service and analyse the needs for the co-ordination of treatment concepts within the European Landscape.
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During the last decade navigation techniques in pelvic and acetabular surgery have been described. Nowadays, available techniques include CT-based navigation, 2D C-arm navigation and 3D C-arm navigation. The main indication is the navigated percutaneous SI screw fixation, but acetabular screw fixations are also reported. In this article, based upon a literature review and our own clinical experiences, the indications for and limitations of navigated techniques in pelvic and acetabular surgery are described.
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Case Reports Multicenter Study
Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules.
An experimental computer program for virtual operation of fractured pelvis and acetabulum based on real data of the fracture is presented. The program consists of two closely integrated tools, the 3D viewing tools and the surgeon simulation tools. Using 3D viewing tools the virtual model of a fractured pelvis is built. ⋯ The international study is still in progress. One case is presented demonstrating all the possibilities of the virtual planning and surgery. The presented computer program is an easily usable application which brings significant value and new opportunities in clinical practice (preoperative planning), teaching and research.