Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures.

BACKGROUND AND PURPOSE Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. PATIENTS AND METHODS The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n = 957 with vs n = 4,542 without). Furthermore, the subgroups with secondary surgery (n = 713 vs n = 1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n = 24 vs n = 219). Calculated odds ratios were adjusted for potential confounders. RESULTS Patients treated by CC/EF were younger (45 ± 20 vs 62 ± 24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3 mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p < 0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. INTERPRETATION Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use

Flat-Plate PHP with Gravity-Independent Performance and High Maximum Thermal Load

In many energy-related applications, components with high heat loads, such as power electronics, play an important role. Pulsating heat pipes (PHPs) are an effective solution to deal with the increasing heat load of these components. In many real-life applications, the PHP must work against gravity and still be able to operate efficiently. However, the majority of present flat-plate PHP designs do not perform well under this condition. Therefore, this paper presents a flat-plate PHP with a conventional channel design optimized for gravity-independent operation. The PHP was capable of transmitting a heat output of 754 watts in all orientations, while the testing heater in use never exceeded a temperature of 100 °C. No indications of dryout were observed, implying that the maximum thermal load the PHP can handle is even higher. Additionally, three different condenser zone sizes were tested with the PHP. Previously published results indicated that there is a specific range of suitable condenser zone sizes, and performance problems will occur if the condenser zone size falls outside of this range. The findings from this work point in the same direction

Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis

<div><p>Background</p><p>Fractures of the proximal humerus in patients under the age of 18 years show a low incidence; existing clinical studies only comprise small patient numbers. Different treatment methods are mentioned in the literature but a comparison of the outcome of these methods is rarely made. Up to now, no evidence-based algorithm for conservative and operative treatment is available. The aim of this systematic review with meta-analysis was therefore to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome.</p><p>Methods and findings</p><p>The OVID database was systematically searched on September 30th in 2016 in order to find all published clinical studies on the subject of proximal humerus fractures of patients ≤18 years. Exclusion criteria were previously defined. The Coleman Methodology Score was used to evaluate the quality of the single studies. 886 studies have been identified by the search strategy. 19 studies with a total of 643 children (mean age: 11.8 years) were included into the meta-analysis with a mean Coleman Methodology Score of 71 ± 7.4 points. 18 of the 19 studies eligible for inclusion were retrospective ones, of the best quality available (mean follow-up ≥ 1 year, mean follow-up rate ≥ 65%). 56% of the patients were male. Proximal humerus fractures were treated conservatively in 41% and surgically in 59% of the cases (Elastic Stable Intramedullary Nailing (ESIN): 31%; K-wires: 20%; 8% other methods, e.g. plate osteosynthesis, olecranon traction). The overall success rate (good/excellent outcome) for all treatment methods was 93%. The success rate of ESIN (98%) and of K- wire fixation (95%) was significantly higher (p = 0.01) than the success rate of conservative treatment options (91%). A subgroup analysis of severely displaced fractures (Neer grade III/IV, angulation ≥ 20°) resulted in a change of success rates, to the disadvantage of conservative treatment methods (conservative treatment 82%, ESIN 98%, K-wires 95%; p < 0.001). Complication rates did not differ to a significant extent. 9% of the complications occurred in the patients treated by K-wire fixation, 8% if a conservative treatment option was chosen and 7% in the fractures that were stabilized by ESIN. A change from a one-nail technique to a two-nail technique reduced the complication rate of ESIN significantly. Follow-up X- rays without residual deformity could be found in 96% of the patients treated by ESIN, a rate which was higher than in the patients treated conservatively (93%) or by K-wire fixation (88%). The rate of arm length discrepancies at final follow- up was lower if the fractures were stabilized by ESIN (4%) than if they were treated conservatively (9%) or by K-wires (19%). An evaluation of age-dependent treatment options was performed.</p><p>Conclusions</p><p>By performing this meta-analysis an evidence-based treatment algorithm could be introduced to treat the fractures according to the severity of displacement and according to the patient's age. For severely displaced fractures ESIN is the method of choice, with the best clinical and radiological outcome.</p></div

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Sub-group analysis of severely displaced fractures.

<p>Success rates of functional outcome.</p

Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents—A systematical review and meta-analysis - Fig 2

<p><b><u>a-e</u></b><b>Funnel plots of the meta-analyses</b>. (a) Radiological Outcome (b) Arm length discrepancy (c) Complication rate (d) Functional Outcome (e) Subgroup analysis of severly displaced fractures. A publication bias of the five meta-analyses could not be excluded.</p

Algorithm for the treatment of proximal humeral fractures in children and adolescents.

<p>Algorithm for the treatment of proximal humeral fractures in children and adolescents.</p