Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Isolated iliac wing fractures: are they really that benign?

 Background: The aim of this study was to review the incidence, management and outcome of isolated iliac wing fractures and to compare them with other type A, B and C fractures. Methods: From 2004 to 2015, the data of 547 patient with a pelvic fracture regarding age, gender, RTS, ISS, treatment, complications and mortality were analyzed and a comparison was made between iliac wing fractures and the other pelvic fractures. Results: We encountered 30 isolated iliac wing fractures. The ISS, shock class, transfusion rate, complications and mortality were comparable to those of patients with an unstable pelvic fracture. Concomitant injuries were observed in 93% of the patients. None of the fractures were operatively stabilized. Conclusion: Isolated iliac wing fractures are rare, and operative stabilization of the fracture itself is often not necessary. However, these fractures are serious injuries with characteristics resembling those of patients with an unstable pelvic ring injur

Research on relation of mortality and hemodynamics in patients with an acute pelvic ring fracture

AbstractObjectiveTo study the treatment pathway of hemodynamic unstable patients with a pelvic ring fracture and analyze the causes of death in this group.MethodsRetrospectively, all data of hemodynamic unstable patients with a pelvic ring fracture in the period 1 January 2003 till 1 June 2010 were analyzed. For all patients the treatment protocol was assessed and compared with our protocol.ResultsThe data of 268 patients were analyzed. Among them, 89 cases presented as hemodynamic unstable. A total of 22/89 patients died (25%). Seven patients died because of an isolated circulatory problem, 1 of an isolated neurotrauma. Fourteen patients died because of a combination of vital injuries, in which 11 sustained extensive hemorrhage. Hemorrhage contributed to mortality in 18/22 patients (82%). In 12 of the 22 patients who died, the treatment protocol was not followed. This was significantly higher than in the group survivors (P < 0.01).ConclusionsMortality in patients with a pelvic fracture is most often caused by hemorrhage or sequelae from hemorrhage. A standardized treatment protocol reduces mortality

The value of 3D reconstructions in determining post-operative reduction in acetabular fractures: a pilot study

Abstract Background In patients with acetabular fractures, the reconstructed three-dimensional (3D) model of the contralateral acetabulum could be used as a mirrored template for the anatomical configuration of the affected joint. This has not been validated. Objective To investigate whether the right and left acetabula, as reconstructed 3D models, are valid mirrored duplicates that can be used as a reference model for the contralateral side. Methods CT scans of twenty patients with unaffected acetabula were used. The symmetry of the generated 3D models was evaluated through: (1) mirroring of the acetabulum; (2) initial rough matching; (3) automatic optimisation of the matching via surface-based matching; (4) calculation of distances between surfaces by evaluating the Euclidean (straight-line) error distance between the closest points between left and right. The percentages of surface points of the left and right acetabulum with a distance smaller than 0.5, 1.0, 1.5 and 2.0 mm were calculated and evaluated, in relation to Matta’s criteria, for acetabular fracture reductions. Results The mean distance deviation was less than 0.75 mm in all 40 comparisons. The calculated distances in 90.7% of the surface points of the left and right acetabulum were below the tolerance threshold of 1.0 mm, based on Matta’s anatomical reduction criteria, and 98.7% of the surface points scored below Matta’s imperfect tolerance threshold of 2.0 mm. Conclusion This study demonstrates 3D reconstructed models of healthy left and right acetabula are highly similar and could potentially be used as mirrored duplicates. The next step will be to investigate these results in patients with reduced acetabular fractures. </jats:sec