BackgroundAnterior pelvic ring fracture, as high-energy trauma, needs to be effectively treated. The purpose of the current study was to evaluate the clinical applications of modified pedicle screw-rod fixation and anterior pelvic external fixation for the treatment of anterior pelvic ring fracture.MethodsEither modified pedicle screw-rod fixation (modified PSRF group, N = 21) or anterior pelvic external fixation (APEF group, N = 22) was performed to 43 patients, with or without fixation of posterior ring. Clinical outcomes were evaluated via Majeed scores. Relevant clinical evaluation indicators including operation time, intraoperative blood loss, hospitalization duration, and complications were compared between these two groups.ResultsThe operation time in APEF group was significantly less than that in modified PSRF group (P < 0.0001). No significant difference with respect to intraoperative blood loss and hospitalization duration between the two groups was shown (P = 0.51 and P = 0.33, respectively). Six patients developed surgical site infection in APEF group. Three patients experienced loss of fixation, and two patients experienced loosening of fixator in APEF group. Temporary lateral femoral cutaneous nerve irritation occurred in three patients in modified PSRF group while two patients in APEF group. One patient experienced femoral nerve palsy in modified PSRF group. Fractures of all patients healed well eventually. No statistical difference regarding Majeed evaluation scores was found between two groups.ConclusionsApplication of both modified PSRF and APEF could provide similar satisfactory clinical outcomes for anterior pelvic ring fracture. Modified PSRF, a minimally invasive technique with the advantages of internal fixation, could be performed as an alternative method for instable pelvic fractures.Trial registrationResearch Registry UIN: researchregistry2776.
Acetabular fractures are a real challenge for junior doctors as well as experienced orthopedic surgeons. Correct fracture classification is crucial for appreciating the fracture type, surgical planning, and predicting prognosis. Although three-dimensional (3D) tutorial is believed to improve the understanding of the complex anatomy structure, there have been few applications and randomized controlled trials to confirm it in orthopedics. This study aims to develop a 3D interactive software system for teaching acetabular fracture classification and evaluate its efficacy. Participants were randomly but evenly allocated into either the experimental group (who learned the acetabular fracture classification using a 3D software) or the control group (who used a traditional two-dimensional [2D] tutorial). Both groups were then tasked to classify 10 acetabular fractures and complete a five-point Likert scale on their satisfaction of each learning modality. To calculate significance (P < 0.05), independent t-test was used for normally distributed data whereas Mann-Whitney U test for non-normally distributed data. The experimental group significantly outperformed the control group (t (28) = 2.526, P = 0.017) with identifying correct acetabular fracture classification. Moreover, Likert scale score in the experimental group was also significantly higher than in the control group (Z = 2.477, P = 0.013). This 3D classification software has objectively and subjectively showed an advantage over the traditional 2D tutorial, resulting in an improved classification accuracy and higher Likert scale score. The 3D software has the potential to improve both clinical knowledge as well as identifying correct patient management in orthopedics. Anat Sci Educ 12: 655-663.
Objective: To gain a better understanding of the traumatic mechanism and to develop appropriate treatment for dislocation of the shoulder joint with an ipsilateral humeral shaft fracture. Methods: This was an observational and descriptive study. Nine patients with traumatic shoulder dislocations associated with ipsilateral humeral shaft fractures who visited the emergency room and received treatment from January 2012 to June 2018 were retrospectively analyzed. CT with three-dimensional reconstruction was performed to provide precise anatomical information of the fractures. The traumatic event and the type of fracture of the humeral shaft were analyzed to help determine the trauma mechanism. Closed reduction of the dislocation was attempted at once under intravenous anesthesia. One patient died the following day due to unrelated causes. All humeral shaft fractures of the eight patients received internal fixation, and then reduction of the dislocation was performed again if previous attempts failed. The affected limb was immobilized in a sling for 3 weeks postoperatively, and then active and passive movement was encouraged. Patients were evaluated based on clinical and radiographic examinations, shoulder joint range of motion, Constant-Murley score, and subjective shoulder value. Results: Four cases in the present study could not give a clear description of the traumatic procedure. The other five patients suffered a second strike on their upper arms when they were hurt, with low mobility and high pain in the shoulder region. Seven cases were simple fractures and two were wedge fractures. According to the AO/OTA classification system, four cases were type 12-A2, three were type 12-A3, and two were type 12-B2. Six patients successfully obtained closed manipulative reduction of the shoulder dislocation in the acute stage. The follow-up time ranged from 18 to 31 months. No deep wound infections were encountered. All fractures healed uneventfully. The union time ranged from 4 to 6 months. At the final follow-up, shoulder range-of-motion values were found to range from 140 to 170 forward flexion, 30 to 40 extension, 40 to 45 adduction, 150 to 170 abduction, 50 to 60 internal rotation, and 50 to 60 external rotation; no recurrent instability of the shoulder joint occurred; the Constant-Murley score was 89.5 AE 3.7 points (range: 84-94 points); the subjective shoulder value was 89.4% AE 6.3% (range: 75%-95%). Conclusion: Shoulder dislocation most likely occurs first with an axial force or a direct posteroanterior force and a subsequent force results in the shaft fracture. For patients with mid-distal humerus fractures, closed manipulative reduction of the joint is usually effective. After success of closed reduction, surgery for the humeral shaft fracture is advocated to ensure stability and to make patient nursing convenient. In cases with fractures in the proximal third of the humeral shaft, fixation is suggested beforehand to help reduce the shoulder dislocation.
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