Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 1996
Case ReportsSurgical treatment of pelvic nonunions and malunions.
From 1984 to 1995, 37 patients with nonunion, malunion, and combined nonunion malunion of the pelvic ring were treated. Included among the patients were many different initial injury patterns and subsequent variable combinations of malunion and malpositioned nonunion. The typical surgical repair was performed in multiple stages and often created uniquely to solve a patient's particular problem. Thirty-two of 37 patients were satisfied with their outcome, although 19% of the patients suffered complications.
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Clin. Orthop. Relat. Res. · Aug 1996
Outcome after fixation of unstable posterior pelvic ring injuries.
Between June 1989 and May 1995, the authors surgically treated 64 patients with unstable posterior pelvic in juries. Fracture types included Tile Type C1 (75%), C2 (8%), and C3 (17%). There were 19 sacroiliac dislocations, 12 sacral fractures, 4 transiliac fractures, and 29 sacroiliac fracture dislocations. ⋯ A 40-point pelvic outcome grading scale was developed based on physical examination, pain, radiographic analysis, and activity/work status. Scores obtained by this scale correlated closely with the Short Form-36 Health Survey scores. Patient functional outcome after posterior pelvic fracture was not associated with Injury Severity Score or fracture location.
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Clin. Orthop. Relat. Res. · Aug 1996
Techniques for reduction and fixation of pelvic ring disruptions through the posterior approach.
Open reduction and internal fixation through the posterior approach has an important role in the management of unstable Type C pelvic ring injuries. Using the described techniques, the goals of anatomic reduction and stable fixation can be attained. However, the potential exists for significant complications. Careful patient selection and attentiveness to detail minimize these risks.
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One hundred and seven unstable pelvic fractures were treated operatively. Reductions were graded by the maximal displacement measured on the 3 standard views of the pelvis. Criteria were: excellent 4 mm or less, good 5 to 10 mm, fair 10 to 20 mm, and poor more than 20 mm. ⋯ Open reduction and internal fixation within 21 days were associated with a higher percentage of excellent reductions than in reductions performed after 21 days (70% versus 55%). These differences were not statistically significant, however. Complications were infrequent using the techniques described.
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Clin. Orthop. Relat. Res. · Aug 1996
Operative stabilization of fracture dislocations of the sacroiliac joint.
Posterior fracture dislocations of the sacroiliac joint (crescent fracture) represent a subset of lateral compression pelvic fractures. The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the inferior 1/2 of the sacroiliac joint. The posterior superior iliac spine remains firmly attached to the sacrum by the strong posterior ligaments. ⋯ Stabilization of the pelvis may be achieved through either an anterior or a posterior approach with or without transarticular fixation. A posterolateral approach to the crescent fracture and a method of stabilization using extraarticular fixation, intertable lag screws and outer table antiglide plates are described. The results of using this technique in 22 patients are reviewed.