Archives of orthopaedic and trauma surgery
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Screw fixation of acetabular column fractures is a well-established alternative option to plate fixation providing comparable biomechanical strength and requiring less surgical exposure. For displaced acetabular fractures involving both columns open reduction and plate fixation of one column in combination with a column-crossing screw fixation of the opposite column via a single approach is a viable treatment option. Preoperative planning of posterior column screws (PCS) via an anterior approach is mandatory to assess the eligibility of the fracture for this technique and to plan the entry point and the screw trajectory. ⋯ A single view showing an extraarticular screw position is adequate to rule out hip joint penetration. The fluoroscopic assessment of cortical perforation of the posterior column requires several oblique views such as lateral oblique views, obturator oblique views and axial views of the posterior column or alternatively intraoperative CT scans. The application of PCS via an anterior approach is a technically demanding procedure, that allows for a relevant reduction of approach-related morbidity, surgical time and blood loss by using a single approach.
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Arch Orthop Trauma Surg · Oct 2024
Review Comparative StudyNavigation and 3D-imaging in pelvic ring surgery: a systematic review of prospective comparative studies.
Few literature reviews have been published focusing on navigation, robotic or pre-operative planning using 3D-imaging technology (3D-printing, 3D-planning). To our knowledge, no reviews have been performed to assess and compare all these modalities together versus control groups (conventional fluoroscopy) through high Randomized Control Trials (RCTs) and Prospective Control Studies (PCSs). The aim of this study was to assess and compare 3D-imaging technologies from pre-operative planning to per-operative navigation and robotic in the management of pelvic ring fractures through high level studies. ⋯ Systematic review of Level II studies.
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Femoral head fractures are rare, which limits the experience of individual surgeons with these injuries. This overview examines historical data, injury mechanisms, and classification systems, as well as epidemiological data from larger patient cohorts. ⋯ The literature is often inconsistent, as many studies fail to differentiate between specific fracture types and instead report aggregated results, leading to ambiguous conclusions about the most effective treatment strategies. Thus, this article reviews fracture-type-specific outcomes of both non-operative and operative treatments over the past 25 years and summarizes their clinical implications, with the aim of assisting surgeons in their decision-making processes.
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Arch Orthop Trauma Surg · Oct 2024
ReviewCombined pelvic ring and acetabular fractures - strategies and sequence of surgery. State of the art.
Combined injuries of the pelvic ring and the acetabulum are uncommon. Acute treatment should follow common protocols (ATLS e.g.) for pelvic ring injuries, although mechanical stabilization using pelvic binders or external fixators might be insufficient or even worsen the reduction in some combined fracture patterns. In case of mechanically connected acetabular and pelvic ring injury (MCAPI), surgical treatment might be demanding in lack of clear recommendations concerning the reduction and fixation sequence. ⋯ An "acetabulum first" sequence should be considered in relatively stable posterior ring injuries and acetabulum fractures in younger patients, where a perfect anatomical reduction is feasible. Definitive surgical treatment should be performed as soon as possible depending on concomitant injuries, ideally within 3-7 days. Mechanical understanding of the combined fracture pattern and accurate planning are mandatory for surgical repair.
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Arch Orthop Trauma Surg · Oct 2024
ReviewThe infraacetabular screw - anatomy, radiology, biomechanics and clinics.
Acetabular fracture surgery follows the primary aim of anatomic reduction and rigid stable fixation of the fracture. Infraacetabular screws (IAS) allow for an increased stability of the acetabular fixation by closing the periacetabular fixation frame without requiring an additional posterior approach. The osseous screw corridor for infraacetabular screws use the transition zone between the acetabular ring and the obturator ring. ⋯ The inlet view, the combined obturator oblique outlet view and a 1/3 iliac oblique outlet view may be used for the intraoperative radiological assessment for both the entry point and the screw trajectory of IAS. Several biomechanical studies have shown that IAS increase the stiffness of the internal fixation. Scientific proof for an improved clinical outcome is still missing.