Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review

Unstable U-shaped sacral fractures and vertical shear Tile C pelvic ring disruptions are characterized by rare lesions occurring in patients with severe trauma. Because the initial damage-control resuscitation primarily aims to stop life-threatening bleeding, emergency treatment often includes an anterior external pelvic fixator. Delayed surgery is mandatory to allow early mobilization, reduce mortality, and improve functional outcomes. Regarding U-shaped sacral fractures, although Roy-Camille type 1 U-shaped sacral fractures can be treated with iliosacral screws, types 2 (posteriorly displaced, equivalent to AO Spine C3) and 3 (anteriorly displaced, equivalent to AO Spine C3) fractures require spinopelvic triangular fixation. Besides, proper reduction of type 2 and some type 3 sacral fractures is mandatory to prevent wound complications. In patients with neurological deficits, the need for sacral laminectomy is left at the discretion of the surgeon, given the indirect decompression already obtained with fracture reduction. Tile C pelvic disruptions with posterior ring injury located lateral to the sacral foramen can be treated with either iliosacral screws or triangular spinopelvic fixation, combined with anterior pelvic fixation. Conversely, Tile C pelvic disruptions with posterior ring injury located at, or medial, to the sacral foramen (Denis zone II or III) induce vertical lumbosacral instability and thus require spinopelvic triangular fixation with anterior pelvic osteosynthesis. Although minimally invasive techniques have been developed, open surgeries are still required for inexperienced operators and in case of major displacement. The complication rate reaches approximately 33.33% of the cases, and complications include hardware malposition, wound infection or dehiscence, hardware prominence, and sometimes hardware failure

Pierwotny śródczaszkowy pozaszkieletowy chirzęstniakomięsak śluzowaty

Extraskeletal myxoid chondrosarcomas (EMC) are extremely rare and are usually located in the deep soft tissues of the lower extremities. Less than 10 cases of intracranial EMC have been reported in the literature, making their management and early diagnosis difficult. We present a new case of intracranial EMC occurring in a 70-year-old woman presenting with a right frontal mass initially assumed to be a brain metastasis from breast adenocarcinoma. The optimal management of these tumours is also discussed. Analysis from the literature suggests that complete resection should be recommended, whenever feasible. Although the high risk for relapse after surgery encourages postoperative treatments, relative resistance to both radiotherapy and chemotherapy characterizes EMC. Future perspectives might include multimodal treatments with highly conformal radiotherapy modalities for dose escalation strategies or use of new molecules. Knowledge of these unusual malignant tumours will be the first step for improving patients’ outcome.Pozaszkieletowy chrzęstniakomięsak śluzowaty to wyjątkowo rzadki guz, który występuje zwykle głęboko w tkankach miękkich kończyn dolnych. Opisano mniej niż 10 przypadków tego guza umiejscowionych śródczaszkowo, co utrudnia wczesne rozpoznanie i leczenie. W pracy przedstawiono nowy przypadek śródczaszkowego chrzęstniakomięsaka śluzowatego u 70-letniej kobiety z guzem okolicy czołowej prawej, traktowanym początkowo jako przerzut gruczolakoraka sutka do mózgu. Omówiono optymalne leczenie tych guzów. Analiza piśmiennictwa wskazuje, że w miarę możliwości powinno się zalecać całkowite wycięcie. Duże ryzyko wznowy po leczeniu chirurgicznym skłania do podejmowania dodatkowego leczenia, ale guz charakteryzuje się względną opornością na radioterapię i chemioterapię. Przyszłe wielorakie metody leczenia mogłyby wykorzystywać radioterapię konformalną w celu zwiększenia dawki promieniowania lub zastosowanie nowych cząsteczek. Wiedza o tych rzadkich nowotworach złośliwych będzie pierwszym krokiem do poprawy wyników leczenia

The relationship between eruptive activity, flank collapse, and sea level at volcanic islands: A long-term (>1 Ma) record offshore Montserrat, Lesser Antilles

Hole U1395B, drilled southeast of Montserrat during Integrated Ocean Drilling Program Expedition 340, provides a long (>1 Ma) and detailed record of eruptive and mass-wasting events (>130 discrete events). This record can be used to explore the temporal evolution in volcanic activity and landslides at an arc volcano. Analysis of tephra fall and volcaniclastic turbidite deposits in the drill cores reveals three heightened periods of volcanic activity on the island of Montserrat (?930 ka to ?900 ka, ?810 ka to ?760 ka, and ?190 ka to ?120 ka) that coincide with periods of increased volcano instability and mass-wasting. The youngest of these periods marks the peak in activity at the Soufrière Hills volcano. The largest flank collapse of this volcano (?130 ka) occurred towards the end of this period, and two younger landslides also occurred during a period of relatively elevated volcanism. These three landslides represent the only large (>0.3 km3) flank collapses of the Soufrière Hills edifice, and their timing also coincides with periods of rapid sea-level rise (>5 m/ka). Available age data from other island arc volcanoes suggests a general correlation between the timing of large landslides and periods of rapid sea-level rise, but this is not observed for volcanoes in intra-plate ocean settings. We thus infer that rapid sea-level rise may modulate the timing of collapse at island arc volcanoes, but not in larger ocean-island settings

Approche de l'ostéopathie en médecine vétérinaire équine

LYON1-BU Santé (693882101) / SudocSudocFranceF

Traumatisme crânien de l’adulte et l’enfant

International audienc