Percutane schroeffixatie voor osteoporotische sacrumfracturen bij oudere patiënten

Abstract: In older patients, pubic rami fractures resulting from low-impact falls are generally considered to be stable and treated non-operatively. An associated sacral fracture is easily missed on plain radiography but can result in debilitating pain. The objective of this report is to present our experience with percutaneous sacro-iliac screw fixation in 2 elderly patients with (missed) osteoporotic sacral fractures. We conclude that "isolated" pubic rami fractures in elderly patients should prompt careful investigation to rule out an associated sacral fracture particularly in patients with lower back or sacral pain. In the presence of a sacral fracture, early percutaneous sacro-iliac screw fixation to allow rapid mobilization should be considered in selected patients

Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship

ntroduction Computed tomography (CT) is more accurate than plain pelvic radiography (PXR) for evaluating acetabular fracture reduction. As yet unknown is whether CT-based assessment is more predictive for clinical outcome. We determined the independent association between reduction quality according to both methods and native hip survivorship following acetabular fracture fxation. Materials and methods Retrospectively, 220 acetabular fracture patients were reviewed. Reductions on PXR were graded as adequate or inadequate (0–1 mm or >1 mm displacement) (Matta’s criteria). For CT-based assessment, adequate reductions were defned as <1 mm step and <5 mm gap, and inadequate reductions as ≥1 mm step and/or ≥5 mm gap displacement. Predictive values and Kaplan–Meier hip survivorship curves were compared and risk factors for conversion to total hip arthroplasty (THA) were identifed. Results Mean follow-up was 8.9 years (SD 5.6, range 0.5–23.3 years), and 52 patients converted to THA (24%). Adequate reductions according to CT versus PXR assessment were associated with higher predictive values for native hip survivorship (92% vs. 82%; p=0.043). Inadequate reductions were equally predictive for conversion to THA (33% for CT and 30% for PXR; p=0.623). For both methods, survivorship curves of

The Value of 3D Printed Models in Understanding Acetabular Fractures

Acetabular fractures are complex and difficult to classify. Although the Judet-Letournel classification is designed to increase the understanding of acetabular fractures, it remains prone to error when using conventional medical imaging. We hypothesize that three-dimensional (3D) printing, as a new diagnostic imaging tool, will lead to an increased understanding and knowledge of acetabular fractures and an optimal surgical approach. Digital data (DICOM) of 20 acetabular fractures were converted into 3D files [standard tessellation language (STL) data]. These STL files were used to prepare 3D prints of life-size hemipelvic models with acetabular fractures. Seven senior trauma surgeons specializing in pelvic and acetabular surgery, 5 young fellowship-trained trauma surgeons, 5 senior surgical residents, 5 junior surgical residents, and 5 interns classified 20 acetabular cases using X-ray/two-dimensional (2D) computed tomography (CT), 3D reconstructions, and 3D printed models according to the Judet-Letournel classification. Furthermore, all junior and senior surgeons were instructed to evaluate their surgical approach and the positioning of the patient during operation. Time to classify each case was recorded. Calculations were done using Fleiss' κ statistics. Only slight and fair interobserver agreements for senior surgeons (κ = 0.33) and interns (κ = 0.16) were found when using X-ray/2D CT. However, 3D printed models showed moderate and substantial interobserver agreements for senior surgeons (κ = 0.59), junior surgeons (κ = 0.56), senior surgical residents (κ = 0.66), junior surgical residents (κ = 0.51), and interns (κ = 0.61). Compared with X-ray/2D CT, the interobserver agreement regarding the surgical approach for junior surgeons using 3D printed models increased by κ = 0.04 and κ = 0.23, respectively. Except for the interns, a significant time difference for classification was found between X-ray/2D CT and 3D CT and 3D printed models for junior and senior surgical residents and junior and senior surgeons (p < 0.001). 3D printing is of added value in the understanding, classification, and surgical evaluation of acetabular fractures. We recommend the implementation of 3D printed models in trauma surgery training

Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article

Pelvic fractures are potentially life-threatening injuries with high mortality rates, mainly due to intractable pelvic arterial bleeding. However, concomitant injuries are frequent and may also be the cause of significant blood loss. As treatment varies depending on location and type of hemorrhage, timely imaging is of critical importance. Contrast-enhanced CT offers fast and detailed information on location and type of bleeding. Angiography with embolization for pelvic fracture hemorrhage, particularly when performed early, has shown high success rates as well as low complication rates and is currently accepted as the first method of bleeding control in pelvic fracture-related arterial hemorrhage. In the current review imaging workup, patient selection, technique, results and complications of pelvic embolization are described

Krakatau

par R.D.M. VerbeekTextbd.: [1] Bl., 567 S. ; Mappe: Titelblatt, [1] Bl., 11 lose Tafel, 12 lose Karte