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1دورية أكاديمية
المؤلفون: Giulia Maria Sassara, Amarildo Smakaj, Domenico De Mauro, Roberta Righini, Adele Arnone, Giuseppe Rovere, Omar El Ezzo, Pasquale Farsetti, Umberto Tarantino, Francesco Liuzza
المصدر: Journal of Clinical Medicine, Vol 13, Iss 11, p 3176 (2024)
مصطلحات موضوعية: pelvic fracture, sacral fractures, insufficiency fracture, fragility fractures, Medicine
الوصف: Background: Pelvic insufficiency fractures (PIF) are typical in geriatric populations with reduced bone quality, most commonly in elderly postmenopausal women. These fractures are usually caused by low-energy forces over the bones during ordinary life and cause disabling pain. Treatment options range from conservative to operative. The aim of this study is to assess the outcomes of treatments for pelvic insufficiency fractures, determining optimal approaches between surgical intervention and conservative management. Methods: This literature review systematically examines articles focusing on patients with PIF, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and using PubMed, Medline, and the Cochrane Library database. We took into account only full-text articles in indexed journals with available English abstracts, considering data about patient demographics, surgery, and outcomes. Results: After screening 128 articles, this study reviewed 20 manuscripts involving 1499 patients, mostly elderly females and focusing on sacrum fractures. Common treatments included conservative methods and sacroplasty, with a few complications reported. Osteoporosis was the prevalent comorbidity, and the survival rate post-treatment was high at 92.3%. Mobility outcomes varied, with some patients experiencing significant autonomy loss. The average follow-up period was over 17 months. Conclusions: This study found a cautious approach to surgery (timing of three weeks), which is reserved only for specific patterns, and it leads to increased autonomy and a lower risk of mortality. Due to the lack of pre- and postoperative scores as well as conflicting results, it is imperative to undertake further studies and research to be able to compare the alternative treatments efficiently.
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: Luca Lebert, Alexander Martin Keppler, Jan Bruder, Leon Faust, Christopher Alexander Becker, Wolfgang Böcker, Carl Neuerburg, Adrian Cavalcanti Kußmaul
المصدر: Journal of Clinical Medicine, Vol 12, Iss 16, p 5199 (2023)
مصطلحات موضوعية: fragility fractures of the pelvis, orthogeriatric, sacral fractures, trauma surgery, iFuse Implant System®, Medicine
الوصف: The incidence of fragility fractures of the pelvis (FFPs) is currently rising. Surgical treatment, which is performed using sacroiliac screws, is complicated by compromised bone quality, oftentimes resulting in implant failure. The iFuse implant system aims to improve attachment and durability with promising results for sacroiliac dysfunction, though data for its feasibility on FFPs are rare. Consequently, this study aims to evaluate the feasibility of the iFuse for FFPs. A total of 10 patients with FFPs were treated with the iFuse in this study. Pre- and postoperatively, both mobility using an established insole force sensor for an inpatient gait analysis and general well-being and pain using questionnaires were evaluated. When comparing pre- and postoperative findings, this study demonstrated a significant increase in the average (8.14%) and maximum (9.4%) loading (p < 0.001), a reduction in pain, as measured by the visual analog scale (VAS), from 4.60 to 2.80 at rest (p = 0.011) and from 7.00 to 4.40 during movement (p = 0.008), an increase in the Barthel Index by 20 points (p < 0.001) and an increase in the Parker Mobility Score by 2.00 points (p = 0.011). All this contributes to the possibility of early postoperative mobilization and improved general well-being, ultimately preventing the late consequences of postoperative immobilization and maintaining patients autonomy and contentment.
وصف الملف: electronic resource
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3دورية أكاديمية
المؤلفون: Ajoy Prasad Shetty, Karukayil Ramakrishnan Renjith, Ramesh Perumal, Sri Vijay Anand, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran
المصدر: Asian Spine Journal, Vol 15, Iss 5, Pp 575-583 (2021)
مصطلحات موضوعية: unstable sacral fractures, spinopelvic dissociation, surgical management, lumbopelvic fixation, sacroiliac screw, Medicine
الوصف: Study Design This is a retrospective study. Purpose Recent advances in intraoperative imaging and closed reduction techniques have led to a shifting trend toward surgical management in every unstable sacral fracture. This study aimed to evaluate the clinicoradiological outcome of the sacroiliac (SI) screw and lumbopelvic fixation (LPF) techniques and thereby delineate the indications for each. Overview of Literature Optimal management guidelines for unstable sacral fractures are still lacking probably due to the rarity of these injuries and varying fixation trends. Methods Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon’s four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed’s functional grading system and Matta’s radiological criteria. The minimum follow-up period was 2 years. Results Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved. Conclusions Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.
وصف الملف: electronic resource
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4دورية أكاديمية
المؤلفون: Morteza Bidaki, Farzad Vosoughi, Mohammad Zarei, Seyed Hadi Kalantar
المصدر: Journal of Orthopedic and Spine Trauma, Vol 6, Iss 3 (2021)
مصطلحات موضوعية: Bone Fracture, Pelvis, Sacral Fractures, Lumbopelvic Fixation, Medicine
الوصف: No abstract is available.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Sina Javidmehr, Mohammad Reza Golbakhsh, Babak Siavashi, Parham Talebian, Morteza Dehnokhalaji, Mohammad Javad Zehtab, Mohammadreza Bozorgmanesh
المصدر: Asian Spine Journal, Vol 12, Iss 1, Pp 119-125 (2018)
مصطلحات موضوعية: Pelvic ring fractures, Sacroiliac screws, Sacral fractures, Medicine
الوصف: Study DesignMethodological study.PurposeTo our knowledge, this is the first study to introduce a new modified method for inserting iliosacral screws and to compare its results with those of a conventional method.Overview of LiteraturePrevious techniques, such as open reduction and internal fixation, are associated with perioperative hemorrhage, postoperative infection, and neurological deficits. Although percutaneous iliosacral screw insertion confers the advantage of being minimally invasive, leading to less blood loss and a low postoperative infection rate, it harbors the risk of screw malpositioning due to narrow sacral proportions and a high interindividual variability.MethodsNine cadaveric pelvises were included in this study, with one hemipelvis of each being assigned to the new modified method and the other to the conventional iliosacral screw insertion method. In the new modified method, the guidewire entry point was determined using a lateral sacral X-ray. To do so, we first identified the anterosuperior quadrant of the S1 body on one hemipelvis. The anterosuperior quadrant was further divided into four imaginary quadrants, and the guidewire was inserted into the posteroinferior quadrant. The guidewire trajectory was perpendicular to the sagittal plane so that the guidewire resembled a single point in the lateral sacral view. Guidewires were inserted into corresponding hemipelves using the conventional method as described in the literature. Subsequently, an axial computed tomography scan with 1-mm fine cuts was obtained, and sagittal and coronal views were reconstructed. The distance of the guidewire from the sacral canal, anterior sacral cortex, and first sacral foramen was measured in axial, sagittal, and coronal views. The minimum measurement among different views was defined as the safety index of the insertion methods. The conventional and new modified methods were then compared in terms of safety and duration of the procedure.ResultsThe minimum distance of the guidewire from the S1 foramen and anterior sacral cortex was not significantly different between the two methods. However, the minimum distance between the guidewire and sacral canal was significantly greater in the new modified method than in the conventional method. The duration of guidewire insertion was significantly shorter in the new modified method than in the conventional method.ConclusionsThis new modified method of iliosacral screw insertion could be safely and simply implemented while taking less surgical time than the conventional methods.
وصف الملف: electronic resource
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المؤلفون: Salvatore Cicero, Marco Teli, Maurizio Passanisi, Gianfranco Longo, Marco Fricia, Giuseppe Emmanuele Umana, Giancarlo Ponzo, Santino Ottavio Tomasi, Giovanni Federico Nicoletti, Angelo Spitaleri, Massimiliano Visocchi, Gianluca Scalia, Bipin Chaurasia
المصدر: Journal of Craniovertebral Junction & Spine
Journal of Craniovertebral Junction and Spine, Vol 12, Iss 2, Pp 149-156 (2021)مصطلحات موضوعية: medicine.medical_specialty, business.industry, medicine.medical_treatment, sacral fractures, posterior fusion, Diseases of the musculoskeletal system, Sacrum, Surgery, sacral dislocation, RC925-935, Lumbopelvic fixation, Male patient, medicine, In patient, Original Article, Neurology (clinical), Pelvic injury, Endovascular treatment, business, Reduction (orthopedic surgery), vascular injury, Fixation (histology)
الوصف: Background: Roy-Camille reported only three patients in their Type 3 posttraumatic transverse sacral fracture (TSF) classification. A modified Roy-Camille classification has been already proposed by other authors suggesting further categorization of the TSFs as partially displaced or completely displaced to predict the rate of neurological recovery following lumbopelvic fixation. Materials and Methods: We reported three adult cases of surgical fixation of fracture–dislocation (3A and 3B) of the sacrum due to traumatic injuries and submitted to lumbopelvic posterior reconstruction. A case of a 15-year-old male patient affected by Type 3C with vascular pelvic injury was also reported. A comprehensive literature search was performed on evaluation and management of Type 3 TSFs. Results: In Type 3A, there is a minimal anterior dislocation and the reduction is feasible with good chance of recovery. In Type 3B, the anterior dislocation is severe, neurological deficits are present, reduction is difficult, and there is a risk of vascular injury both at the trauma and during the surgical reduction. In Type 3C, the anterior dislocation is massive, and the risk of vascular injury is very high requiring prompt vascular or endovascular treatment. Open reduction and posterior instrumentation are technically feasible in patients affected by Type 3 high TSFs. Conclusions: In our opinion, a modified Roy-Camille classification could be useful in the assessment of prognostic and therapeutic aspects of such fractures, In our opinion, a modified Roy-Camille classification could help assess the prognostic and therapeutic aspects of such fractures, in which the severity of the dislocation affects the surgical technique, the chance of neurological recovery, and the patient's life expectancy.
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المصدر: Egyptian Spine Journal, Vol 33, Iss 1, Pp 14-25 (2020)
مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_specialty, Foot drop, Percutaneous, medicine.diagnostic_test, business.industry, Radiography, sacral fractures, Physical examination, ilio-sacral screw, musculoskeletal system, Surgery, body regions, Fixation (surgical), medicine.anatomical_structure, medicine, Neurosurgery, Implant, Neurology. Diseases of the nervous system, medicine.symptom, business, RC346-429, Pelvis, percutaneous fixation
الوصف: Background Data: Sacral fractures constitute a major entity of pelvic fractures. 50% of these sacral fractures are not recognized on initial physical examination of the traumatized patients. The most important prognostic factor in management of sacral fractures is the presence or absence of neurological deficit. Some studies adopt the concern regarding fixation of sacral fractures in poly-traumatized patients to avoid systemic effects and complications of recumbency. Purpose: Evaluation of the efficacy and safety of the minimally invasive percutaneous ilio-sacral fixation technique in management of initial twenty cases of sacral fractures at department of Neurosurgery in Alexandria University. Study Design: Retrospective clinical case cohort study. Patients and Methods: Between March 2017 and January 2019; 20 patients were presented at Neurosurgery Department in Alexandria University hospitals with traumatic sacral fractures. They were 13 males and 7 females with the mean of 34 years (ranged from 18-55 years). Plain X ray of pelvis including antero-posterior, inlet and outlet views of pelvis, CT scan with 3D reconstructions were done. We used Dennis classification and Roy-Camille classification in our study. Stabilization of sacral fracture was done percutaneously using 7 mm cannulated partially threaded ilio-sacral screws. Clinical, neurologic and radiographic examinations were performed in the follow up period (6 months) to assess healing, evaluate clinical improvement and to detect any implant changes. Results: Total 39 percutaneous ilio-sacral screws were placed in 20 patients. Partially threaded cancellous 7.0-millimeter cannulated screws were used. Fifteen patients had unilateral double screws; one patient had unilateral triple screws; two patients had bilateral single screws for bilateral sacral fracture and two patients had unilateral single screw. Two Misplaced screws out of thirty-nine screws were found in the post-operative CT. One patient developed post-operative foot drop. All fractures healed clinically and radio-graphically except one case fixed by single screw and did not show radiological healing. Conclusion: Percutaneous ilio-sacral fixation for sacral fractures is a safe minimally invasive method for management of sacral fractures. It is effective regarding pain relief with high fusion rate. It needs a long learning curve. Single screw fixation is not a rigid fixation and may lead to hardware failure. (2019ESJ193)
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::996e45e800ccbdc56909a6d3fe7ec933
https://www.esj.journals.ekb.eg/article_85041_fa8ef9f1bf2b9e8365e79424877baad7.pdf -
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المؤلفون: Mohammad Zarei, Farzad Vosoughi, Morteza Bidaki, Seyed Hadi Kalantar
المصدر: Journal of Orthopedic and Spine Trauma, Vol 6, Iss 3 (2021)
مصطلحات موضوعية: medicine.anatomical_structure, Nuclear magnetic resonance, Chemistry, Lumbopelvic fixation, medicine, Medicine, Bone fracture, medicine.disease, Pelvis, Dissociation (chemistry), Bone Fracture, Sacral Fractures, Lumbopelvic Fixation
الوصف: The article's abstract is not available.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::098c2bffafbcfd329d3eceeddfbc998a
https://doi.org/10.18502/jost.v6i3.4967 -
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المؤلفون: Wael Sadek Taha, Majed Abaalkhail, Sami Al Eissa, Faisal Konbaz, Fahad Alhelal, Mohammed Benmeakel, Abdulaziz Saud Al Turki
المصدر: Trauma Case Reports, Vol 29, Iss, Pp 100338-(2020)
Trauma Case Reportsمصطلحات موضوعية: medicine.medical_specialty, Dissociation (neuropsychology), medicine.medical_treatment, Spinopelvic dissociation, lcsh:Surgery, Case Report, Critical Care and Intensive Care Medicine, 03 medical and health sciences, External fixation, 0302 clinical medicine, medicine, Spinopelvic fixation, Orthopedics and Sports Medicine, Displacement (orthopedic surgery), L5 Vertebra, Pelvis, 030222 orthopedics, business.industry, 030208 emergency & critical care medicine, Sacral fractures, lcsh:RD1-811, Surgery, Traumatic L5 sacralization, medicine.anatomical_structure, Orthopedic surgery, Emergency Medicine, Presentation (obstetrics), business, Lumbosacral joint
الوصف: Background Spinopelvic dissociation is considered a very complex orthopedic injury. The presence of intrapelvic displacement and L5 traumatic sacralization makes our report a very rare presentation. The case A 60-year-old gentleman presented with a rare traumatic fracture dislocation of the lumbosacral complex with intrapelvic displacement and L5 sacralization; treated with two surgical stages: 1) pelvic external fixation and posterior pelvic tension band plate, and 2) T10 to pelvis posterior fixation. Conclusion Intrapelvic displacement of S1 in the presence of spinopelvic dissociation is very rare injury that requires high mechanism of injury, surgical management is important to improve functional outcome.
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المؤلفون: Alpesh A. Patel, Andrei Fernandes Joaquim
المصدر: Global Spine Journal
مصطلحات موضوعية: 030222 orthopedics, medicine.medical_specialty, business.industry, diagnosis, sacral fractures, pelvic fractures, Surgery, lumbar fusion, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Medicine, Orthopedics and Sports Medicine, Neurology (clinical), business, Review Articles, 030217 neurology & neurosurgery, management
الوصف: Study Design: Systematic literature review. Objectives: To evaluate risk factors, diagnosis, and management of sacral and pelvic fractures (SPFs) after instrumented fusions. Methods: A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using the PubMed database. Articles with patients with an SPF after a lumbar instrumented fusion were included. The articles addressing specifically proximal junctional kyphosis were excluded. Eleven small cases series (level of evidence IV) were reviewed. Results: The incidence of SPF was 1.86% in one study. The risk factors reported were elderly patients, multilevel surgery, long fusions stopping at L5 or S1 instead of the ilium, osteoporosis, obesity, and sagittal imbalance. Computed tomography scan was the preferential image modality for diagnosing. Nonsurgical treatment may be used in patients with tolerable pain and nondisplaced fracture. Persistent pain was an indication for surgery, as well as fracture displacement. The most common surgical treatment reported was an extension of the fusion to the iliac using iliac screws. Conclusion: SPFs after lumbar instrumented fusion are rare but clinically meaningful complications. The risk factors, diagnosis, and management of SPFs are described in our review.
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