Injury
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Surgical techniques and fixation strategies for the treatment of unstable posterior pelvic ring injuries continue to evolve. The safety of the posterior surgical approach in particular has been questioned due to historically high rates of wound related complications. ⋯ These concerns for infection and wound necrosis have led, in part, to increased interest in closed reduction and percutaneous fixation for treatment of these injuries but an open posterior approach remains the optimal strategy in some injury patterns. We describe herein a modified posterior approach to the pelvis designed to minimize wound related complications and present our clinical results demonstrating wound complication rates consistent with contemporary publications.
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Anterior cruciate ligament (ACL) tears are common injuries. Despite the diagnosis being in essence a clinical one, this has often proved unreliable. The objective of this study was to ascertain the delay to diagnosis of ACL injury from initial presentation and subsequent delay to review by a knee specialist. ⋯ Despite 78% of the patients having a typical mechanism of ACL injury, and most attending acutely via the Emergency Department (ED), diagnosis of this common injury remains tardy. There has been at best only minor improvement in the diagnostic rate and delays, certainly of acute ACL injury, since a study in 1996. The overall clinical diagnostic rate remains disconcertingly low as does the delay to consulting a soft-tissue knee specialist.
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Due to the increasing life expectancy, orthopaedic surgeons are more and more often confronted with fragility fractures of the pelvis (FFPs). These kinds of fractures are the result of a low-energy impact or they may even occur spontaneously in patients with severe osteoporosis. Due to some distinct differences, the established classifications for pelvic ring lesions in younger adults do not fully reflect the clinical and morphological criteria of FFPs. ⋯ Also in the elderly, these criteria are the most important for the decision on the type of treatment as well as type and extent of surgery. The estimation of the degree of instability is based on radiological and clinical findings. The classification gives also hints for treatment strategies, which may vary between minimally invasive techniques and complex surgical reconstructions.
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External fixators continue to be essential tools in the urgent treatment of pelvic fractures for compression and stabilization of the pelvic ring. Current systems fail to produce simultaneous anterior and posterior compression. A modified application of an existing curved bar fixator is proposed using a specifically designed tensioner to pre-tense the bar prior to its connection to Schanz screws. Subsequent pre-tension release and elastic recovery of the bar could potentially compress the pelvis. The aim of this work was to determine if the modified application could produce greater simultaneous compression across the sacroiliac joint and the symphysis of an unstable fractured pelvis than the standard application without pretension. ⋯ To pre-tense a semi-circular bar before its use for external fixation of the fractured pelvis, is an effective means of applying compression simultaneously through the sacroiliac joint and the symphysis. The proposed method generates the highest compressive forces at the sacroiliac joint when the rod is subject to the highest pre-tension level not producing subluxation and is subsequently positioned as close as possible to the bone depending on patient's condition.
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Editorial Biography Historical Article
Who was Dr. Guillotin and why he should be remembered.