Minimally invasive total hip arthroplasty using a short skin incision is a subject of much debate in the literature. The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty (THA). One hundred and two patients were divided into three groups according to the type of surgery and length of incision: mini-incision (less than 10 cm) was performed in 38 patients; midi-incision (10-14 cm) in 43; and standard-incision (longer than 14 cm) in 21 patients. No statistical difference was found with regard to intraoperative and total blood loss, the rate of complications, and postoperative recovery. Significantly decreased body mass index (BMI), shorter operative time, and higher number of hips with malpositioning of the acetabular cup were found in the mini-incision group. These patients, however, experienced less pain in the early postoperative period and were highly satisfied with the cosmetic results. The length of incision was shortened and optimized (less than 14 cm) in 82% of patients, and miniincision was performed in 38 patients of this unselected cohort. Because of the understandable demand of the patients for less invasive intervention, the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well, without compromising the type of implants and the otherwise excellent long-term results. Randomized prospective studies are needed to explore the real value of the minimally invasive total hip arthroplasty.Résumé La chirurgie arthroplastie de la hanche par voie mini invasive est un sujet de débat et de controverse dans la littérature. Cette étude a pour but d'estimer la longueur minimale de la voie d'abord sur une suite de patients non sélectionnés et de comparer la technique de mini incision avec la technique d'incision traditionnelle antérolatérale. Cent deux patients ont été divisés en trois groupes, en fonction du type de chirurgie et en fonction de la longueur d'incision. Premier groupe: mini incision moins de 10 cm chez 38 patients, deuxième groupe: incision moyenne 10 à 14 cm chez 43 patients et troisième groupe: incision standard, supérieure à 14 cm chez 21 patients. Aucune différence statistique n'a été trouvée pour la perte sanguine et sur le taux des complications post-opératoires. Dans le groupe des mini incisions peu de sujets avaient une surcharge pondérale, par contre, il existait un grand nombre de hanches avec une mal position de la cupule. Ces patients ont cependant présenté moins de douleur dans la période post-opératoire et ont été très satisfaits du résultat cosmétique. La longueur de l'incision dans la chirurgie prothétique de la hanche peut être raccourcie et la longueur optimum peut être de moins de 14 cm chez 82% des patients. Une mini incision a été réalisé dans cette série, chez 38 patients du fait de la demande des patients pour une chirurgie mini invasive, les chi...

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Joint Diseases and Related SurgeryExperimental Study / Deneysel Çalışma Anahtar sözcükler: Sonlu eleman analizi; pelvis halkası; pubis kırığı; pubis plağı; retrograde pubis vidası.Objectives: This study aims to investigate whether surgical treatment of pubic rami fractures increases the stability of the posterior pelvis. Material and methods:A finite element pelvic model with improved geometric and material characteristics was analyzed. By imitating a standing position, a type I Denis sacrum fracture and a unilateral pubis fracture, we measured the differences in tension and displacement. The posterior injury was treated with a direct plate synthesis or transsacral plate synthesis, while the pubis fracture was left without fixation or fixed with either a retrograde pubic screw or plate synthesis. Results: The operative fixation of pubic rami fractures decreased the movement in the fracture gap not only at the site of the pubis fracture, but also at the site of the fixed sacrum fracture. The plate synthesis provided greater stability of the anterior fracture than the retrograde screw. The tensions in the implants were below the allowed values. Conclusion: We concluded that surgically fixation of pubic fracture increases the stability of the operated posterior pelvis.

Amaç: Bu çalışmada her türlü kırığın bilgisayarlı simülas-yonuna uygun olan ve güvenilir sonuçlar veren gerçekçi bir model yaratıldı. Hastalar ve yöntemler: İleri numune elde edebilmek için plastik bir pelvis modeli kullanıldı. Veriler sağlıklı bir pelvisin bilgisayarlı tomografi taramasından elde edildi. Üç boyutlu plastik pelvis taraması ile geometrik olarak kesin bir model oluşturuldu. Bilgisayarlı tomografi taramalarından elde edilen verilere göre kemikli kısımların materyal özellikleri modifiye edildi. Pelvis farklı segmentlere ayrıldı ve materyal özelliklerinin doğru olması için her segmentte kortikal ve kansellöz kemik maddesinin oranı tayin edildi. Pelvis modelinin doğrulanmasında, tip C pelvis hasarının simülasyonu yapıldı ve sakrum kırığı ve semfizyoliz plaklar ile stabilize edildi. Bu veriler daha önceki kadavra deneylerinden elde edilen veriler ile karşılaştırıldı. Bulgular: Yeni model üzerinde yapılan simülasyona göre, sakrum kırığının fragmanları arasındaki kayma değerleri, kadavra deneylerinde bildirilen değerlere yakındı ve artan gerilme tolere edilebilir aralıkta kaldı. Sonuç: Yeni sonlu eleman pelvis modelimiz, eski modele göre, pelvisi daha doğru yansıtmaktadır. Modelin doğ-rulaması başarılı olduğundan, güvenilir sonuçlar ile bu yöntem her türlü kırığın bilgisayarlı simülasyonu için uygundur.Anahtar sözcükler: Sonlu eleman analizi; kırık tespiti; pelvis kemiği. Objectives:In this study, we aimed to create a realistic model which is suitable for computerized simulation of any kind of fractures and provides reliable results. Patients and methods: We used a plastic pelvic model to construct advanced specimens. The data were retrieved from the computed tomography scans of a healthy pelvis. A geometrically exact model by the means of three-dimensional scanning of the plastic pelvis was obtained. The material properties of the bony parts based on the data retrieved from the computed tomography scans were modified. The pelvis was divided into distinct segments and the proportion of the cortical and cancellous bone substance in each segment were determined to make the material properties accurate. In the validation of the pelvic model, a type C pelvic injury was simulated and the fracture of the sacrum and the symphyseolysis were stabilized with plates. These data were compared with those of previously performed cadaver experiments. Results: Based on the simulation performed on the new model, the shift values between the fragments of the broken sacrum approximated the reported values of our cadaver experiments and also arising strains remained in the tolerable interval. Conclusion: Our new finite element pelvic model represents the pelvis more accurately than the former one. As the validation of the model was successful, it is suitable for computerized simulation of any kind of fractures offering reliable results.

In double column fractures, if the reduction does not require an anterior approach, it is not necessary to fix the iliac wing fracture only to improve the stability of the fixation. If the reduction does require an anterior approach, it is worth fixing the iliac wing fracture with the technically less demanding screw fixation.