A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women.
Patients with hybrid external fixators had a similar risk of pin tract infection as patients who had unilateral fixators. The infection rate in the ring fixator group was significantly lower than the hybrid external and unilateral fixator groups.
A systematic review of the literature was performed in order to evaluate the role of reduction and internal fixation in the management of Lisfranc joint fracturedislocations. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Eleven articles were eligible for the final analysis, reporting data for the management of 257 patients. Injuries of the first three metatarsal rays were treated by closed reduction and internal fixation with screws in 16.3% of the patients, open reduction and internal fixation with screws in 66.5% and open reduction and internal fixation with Kirschner wires (K-wires) in 17.1% of the patients. The preferred method for the stabilisation of the fourth and fifth metatarsal rays was K-wires. Screw-related complications were common and were reported in 16.1% of the cases. The mean American Orthopaedic Foot and Ankle Society midfoot score was 78.1 points. Post-traumatic radiographic arthritis was reported in 49.6% of the patients, but only in 7.8% of them it was severe enough to warrant an arthrodesis. We conclude that open reduction and internal fixation of the first three metatarsal rays with screws is a reliable method for the management of Lisfranc injuries. This can be complemented by K-wires application in the fourth and fifth metatarsal rays if needed.
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