Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis

From January 2004 to July 2007, 21 patients with injuries at the posterior pelvic ring were treated with locking compression plate osteosynthesis through a minimally invasive approach and followed up for a mean of 12.2 months. Preoperative and postoperative radiography was conducted to assess the reduction and union. The mean operation time was 60 minutes (range: 40–80). Intraoperative blood loss was 50–150 ml. All patients achieved union at the final follow-up. The overall radiological results were excellent or good in 17 patients (85%). The functional outcome was excellent or good in 18 patients (90%). There was no iatrogenic nerve injury, deep infection or failure of fixation. We believe that fixation with a locking compression plate is an effective method for the treatment of injuries of the posterior pelvic ring in view of its convenience, minimal traumatic invasion and lower morbidity

Pretensioning of quadruple flexor tendon grafts in two types of femoral fixation: quasi-randomised controlled pilot study

Pretensioning of the flexor tendon graft of the knee is used to improve the stability of anterior cruciate ligament (ACL) reconstructions. The objective was to demonstrate the pretensioning of grafts of the semitendinosus and gracilis in situ with range of flexion and extension of 0–110°, and determine the appropriate number of cycles in two types of femoral fixation. ACL reconstruction was performed in 60 patients, aged 16–48 years, 90% male, with 50% right knees and 50% left knees, divided into two groups of 30 patients: One with the femur fixed using interference screws (direct form) and the other with the transcondylar cross-pin screw (from a distance). Total length of the grafts, their circumference and the measurements on the radiographs of length of the grafts submitted to pretensioning and the measurements with ten, 25 and 50 cycles of flexion and extension were determined. There was no significant difference in relation to the total tendon lengths and their circumferences. The lengths of the portions submitted to pretensioning were significantly different: 7.90 cm for the interference and 10.92 cm for the transcondylar (mean). After tensioning, in the interference and transcondylar groups, respectively, lengthening was 3.57 mm/3.97 mm with ten, 6.30 mm/7.03 mm with 25, and 6.83 mm/7.7 mm with 50 cycles. The greater the length of the graft, the greater the lengthening on pretensioning throughout the substance; the shorter the length, the earlier the end of the lengthening was achieved, close to 25 cycles; more than ten cycles were necessary, 25 being sufficient

Postoperative evaluation of tibial footprint and tunnels characteristics after anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers

Following anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts, 38 consecutive patients were evaluated with high-speed three-dimensional computed tomography. Scans were performed within 3 days following surgery. The length and width of the reconstructed ACL footprint were measured on axial images. Then, 3D images were converted into 2D with radiologic density for measurement purposes. Tunnel orientation was measured on AP and lateral views. In the sagittal plane, the center of the anteromedial (AMB) and posterolateral bundle (PLB) tibial attachment positions was calculated as the ratio between the geometric insertion sites with respect to the sagittal diameter of the tibia. In addition, the length from the anterior tibial plateau to the retro-eminence ridge was measured; the relationship of this line with the centers of the AM and PL tunnels was then measured. The AP length of the reconstructed footprint was 17.1 mm +/- A 1.9 mm and the width 7.3 mm +/- A 1.2 m. The distance from retro-eminence ridge to center of AM tunnel was 18.8 mm +/- A 2.8 mm, and the distance from RER to center of PL tunnel was 8.7 mm +/- A 2.6 mm. The distance between tunnels center was 10.1 mm +/- A 1.7 mm. There were no significant differences between the intra- and inter-observer measurements. The bone bridge thickness was 2.1 mm +/- A 0.8 mm. In the sagittal plane, the centers of the tunnel apertures were located at 35.7% +/- A 6.7% and 53.7% +/- A 6.8% of the tibia diameter for the AMB and PLB, respectively. The surface areas of the tunnel apertures were 46.3 mm(2) +/- A 4.4 mm(2) and 36.3 mm(2) +/- A 4.0 mm(2) for the AM and PL tunnels, respectively. The total surface area occupied by both tunnels was 82.6 mm(2) +/- A 7.0 mm(2). In the coronal plane, tunnel orientation showed the AM tunnel was more vertical than the PL tunnel with a 10A degrees divergence (14.8A degrees vs. 24.1A degrees). In the sagittal plane, both tunnels were almost parallel (29.9A degrees and 25.4A degrees for the AM and PL tunnels, respectively). When using anatomic aimers, the morphometric parameters of the reconstructed tibial footprint in terms of length and distances to the surrounding bony landmarks were similar to the native ACL tibial footprint. However, the native footprint width was not restored, and the surface area of the two tunnel apertures was in the lower range of the published values for the native footprint area