Sacral Fractures and Associated Injuries.

STUDY DESIGN: Literature review. OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome. METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures. RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration. CONCLUSIONS: Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management

Biomechanical Evaluation of Anterior Cruciate Ligament Femoral Fixation Techniques

Background: A number of different femoral anterior cruciate ligament fixation techniques are currently in use. Slippage of the graft caused by excessive early loading or aggressive rehabilitation may negate benefits of surgery and result in a knee with undesirable laxity. Hypothesis: Anterior cruciate ligament femoral graft slippage varies by fixation technique and amount of cyclic loading. Study Design: Controlled laboratory study. Methods: Graft slippage in 5 different soft tissue anterior cruciate ligament femoral fixation techniques (Bio-TransFix cross-pin technique, Stratis ST cross-pin technique, Bilok ST transverse femoral screw, Delta tapered bio-interference screw, and single-loop TensionLok) was compared by cyclic loading of double-bundle grafts in porcine femurs. Graft slippage was measured using a differential variable reluctance transducer. Results: The Bio-TransFix had significantly less (P = .002) total graft slippage (1.14 +/- 0.43 mm) compared to the Delta (3.74 +/- 3.25 mm), Bilok ST (3.92 +/- 2.28 mm), and TensionLok (5.09 +/- 1.12 mm) but not the Stratis ST (1.92 +/- 1.55 mm). All techniques showed the greatest amount of dynamic excursion (P < .001), slippage (P < .001), and percentage of total slippage (mean 68%, P < .001) during the first 100 cycles of loading. The TensionLok had the greatest amount of dynamic excursion during the first 100 cycles (4.15 +/- 1.00 mm) followed by the Bilok ST (3.37 +/- 2.07 mm), Delta (1.76 +/- 0.93 mm), and Stratis ST (1.75 +/- 0.96 mm); the Bio-TransFix demonstrated the least (1.26 +/- 0.48 mm). There was no statistical difference in failure load between repair techniques (P = .103). Conclusion: Graft slippage was statistically different between anterior cruciate ligament femoral fixation techniques for static and dynamic loading. All techniques exhibited the greatest amount of slippage during the first 100 cycles of loading. The differential variable reluctance transducer permitted evaluation of dynamic graft-construct-bone displacement during experimental loading, simulating the loading experienced during early rehabilitation. Clinical Relevance: The optimal method of graft fixation for anterior cruciate ligament reconstruction remains unknown. In the current study, cross-pin constructs appeared to be superior to certain other available fixation systems

Streamlining Trauma Research Evaluation With Advanced Measurement (STREAM) Study: Implementation of the PROMIS Toolbox Within an Orthopaedic Trauma Clinical Trials Consortium

Level of evidencePrognostic Level II

Description and Reliability of the AOSpine Sacral Classification System.

BACKGROUND: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons. METHODS: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3). RESULTS: Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20). CONCLUSIONS: To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment