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

The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

Study Design Survey study. Objective To determine the global perspective on controversial aspects of sacral fracture classifications. Methods While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons\u27 answers to the four key questions of the survey, and then the data was modeled through multivariable logistic regression analysis. Results A total of 474 surgeons answered all questions in the survey. Overall 86.9% of respondents felt that the proposed hierarchical nature of injuries was appropriate, and 77.8% of respondents agreed that that the risk of neurologic injury is highest in a vertical fracture through the foramen. Almost 80% of respondents felt that the separation of injuries based on the integrity of L5-S1 facet was appropriate, and 83.8% of surgeons agreed that a nondisplaced sacral U fracture is a clinically relevant entity. Conclusion This study determines the global perspective on controversial areas in the injury patterns of sacral fractures and demonstrates that the development of a comprehensive and universally accepted sacral classification is possible

Synthesis of Well-Defined, Surfactant-Free Co₃O₄ Nanoparticles:The Impact of Size and Manganese Promotion on Co₃O₄ Reduction and Water Oxidation Activity

Abstract: A surfactant-free synthetic route has been developed to produce size-controlled, cube-like cobalt oxide nanoparticles of three different sizes in high yields. It was found that by using sodium nitrite as salt-mediating agent, near-quantitative yields could be obtained. The size of the nanoparticles could be altered from 11 to 22 nm by changing the cobalt concentration and reaction time. These surfactant-free nanoparticles form ideal substrates for facile deposition of further elements such as manganese. The effect of size of the cobalt oxide nanoparticles and the presence of manganese on the reducibility of cobalt oxide to metallic cobalt was investigated. Similarly, the effect of these parameters was investigated with a visible light promoted water oxidation system with cobalt oxide as catalyst, together with [Ru(bpy) 3] 2+ light harvester dye and an electron acceptor. Graphical Abstract: A novel surfactant-free synthetic route has been developed to produce size-controlled, cube shaped cobalt oxide nanoparticles in high yields. [Figure not available: see fulltext.]. </p

Acetabular Fractures: The Role of Arthroplasty

Acetabular fractures are generally treated with open reduction and internal fixation, with the goals of anatomic reduction and preservation of the native hip joint. Modern techniques of internal fixation have resulted in good to excellent outcomes in the vast majority of patients when anatomic reduction can be obtained. Total hip arthroplasty (THA) has a role in the treatment of these injuries in 2 general situations: the acute fracture in the elderly patient with joint impaction, and for the sequelae of acetabular fracture, namely posttraumatic arthritis or osteonecrosis. Preoperative planning with plain radiographs and computed tomography (CT) scanning, including 3-dimensional reconstructions, is recommended. Recent data show that fractures in the elderly that exhibit joint impaction of the acetabular dome (the so-called gull sign) or impaction of the femoral head generally did not benefit from internal fixation attempts. Restoration of columnar continuity, typically with plates and uncemented acetabular components with multiple screw fixation, remains the preferred strategy. Cemented acetabular components have demonstrated a high failure rate in this setting and should be avoided. Plating of the posterior column will usually provide continuity of the acetabular dome, the quadrilateral plate, and ishium, which will facilitate stable uncemented acetabular component implantation. Rarely, an antiprotrusio device is necessary. Liberal use of autograft from the resected femoral head is recommended for acetabular defects. For posttraumatic sequelae, the surgeon must be prepared for heterotopic bone, scarring, bony defects, and retained hardware. Preoperative CT scanning can help localize heterotopic bone or bony defects. Hardware that does not interfere with acetabular component implantation can generally be left in situ. Copyright 2010, SLACK Incorporated