Background Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes. Methods Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed. Results The average surgical time was 158 min (range, 117–230 min), with an intraoperative bleeding volume of 299 ml (range, 80–480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4–9.0 mm), to < 10 cm. Correction was retained in all cases. Conclusions Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.

Cranioplasty complications after decompressive craniectomy (DC) in infants are not fully recognized. We aimed to devise and assess the efficacy of a hinge and floating DC (HFDC) technique for treating infantile acute subdural hematoma. Five infants, aged 2-20 months, were included. Intracranial pressure was controlled below 20 mmHg, no additional surgery was required, and there was no incidence of surgical site infection or bone graft resorption.

BACKGROUND:The severity of rib fractures has been previously evaluated by combining categorical data, but these methods have only low predictive capability for respiratory complications and mortality. This study aimed to establish a more accurate method for predicting the development of pneumonia, a frequent complication in chest injuries, using anatomical relationships. METHODS:We analyzed three-dimensional reconstructed images of 644 consecutive trauma patients who underwent whole-body computed tomography (CT) in our institution within a 36-month study period from April 2017. The anatomical relationship between the right and left thoracic volumes of non-rib fracture patients was used to estimate thoracic volume changes on the injured side in unilateral rib fracture patients. The predictive capability of changes in thoracic volume for the development of pneumonia was evaluated according to the area under the receiver operating characteristic curve and compared with that of previous chest wall severity evaluation methods. RESULTS:Of the 644 patients, 133 and 478 patients had unilateral rib fractures and non-rib fractures, respectively. The amount of change in thoracic volume due to unilateral rib fractures was significantly greater in pneumonia patients (400 mL vs. 160 mL, p < 0.01). The area under the receiver operating characteristic curve for the development of pneumonia was 0.83, which tended to be higher than that of the previous severity scoring methods. CONCLUSION:The amount of change in chest volume, which can be estimated using CT images, has better predictive capability for pneumonia than previous severity assessment methods based on categorical data. The amount of change in chest volume measured using whole-body CT can be used to rapidly determine the optimal treatment for severe chest wall injuries.

BACKGROUND Symptomatic hygroma after decompressive craniectomy (DC) presenting with a mass effect has been reported as external brain tamponade (EBT). However, the pathology of EBT is unclear. OBJECTIVE To survey the clinical characteristics and explore the potential causes of EBT. METHODS The incidence, timing of onset, and symptoms of EBT were examined among 155 patients undergoing supratentorial DC at Nara Medical University. The factors associated with EBT were investigated and compared with those with hygroma to estimate the potentially causative mechanisms. RESULTS We identified 81 hygromas within 30 d after DC. Among them, 10 patients had EBT, including 7 with aneurysmal subarachnoid hemorrhage (aSAH), 2 with traumatic head injury accompanying skull base fracture, and 1 with a brain tumor. The median interval between DC and EBT was 3.5 d (range 1-21 d). Altered mental status was observed in 9, and oculomotor palsy was present in 3 patients. Univariate analysis demonstrated that risk factors for EBT were aSAH (P = .02) and lumbar spinal drainage (LSD; P &lt; .001). On the other hand, independent risk factors for hygroma included aSAH (odds ratio [OR]: 3.67, 95% confidence interval [CI]: 1.45-9.3, P &lt; .01) and ventricular drainage (OR: .14, 95% CI: .03-.802, P = .03). CONCLUSION Cerebrospinal fluid (CSF) hypovolemia after DC should be considered a potential cause of EBT, which includes brain herniation into the hiatus centralis and paradoxical formation of a hygroma. Correction of CSF dynamics and cranioplasty may be effective treatments for EBT.