Abstract:
PURPOSE:Comminuted iliac fractures are uncommon and difficult to treat. The purpose of this study is to further delineate the fractures, to present a management protocol, and to evaluate the results of treatment. DESIGN:Retrospective clinical study. SETTING:Level one trauma center at Harborview Medical Center. PATIENTS:During a sixty-eight-month period, 695 patients with pelvic ring disruptions were treated at a level one trauma center. Thirteen (1.9%) of these patients had a severely comminuted iliac fracture. All patients were men, ranging in age from twenty to eighty years (mean, 38 years). These patients were polytraumatized and had a mean Injury Severity Score of 23. Eleven of the thirteen patients had severe iliac and flank degloving injuries. Five patients had open fractures, one with fecal contamination requiring diverting colostomy. Six patients with clinical signs of hemodynamic instability had local arterial injuries associated with their fractures. All five patients with extension of the fracture into the greater sciatic notch were found to have a local arterial injury on angiography. One patient had a lumbosacral plexopathy on the fractured side. Four patients had traumatic brain injuries. INTERVENTION:All thirteen patients were treated operatively. Routine pelvic external fixation was not possible because of the iliac comminution. Stable internal fixation was accomplished by an anterior iliac surgical exposure using lag screw and plate combinations. The open wounds and degloving injuries were treated with irrigation, debridement, and closed suction drainage. MAIN OUTCOME MEASUREMENTS:Healing and stability of fixation were assessed clinically and on pelvic radiographs. RESULTS:Comminuted iliac fractures were divided into two patient groups, according to associated pelvic ring disruption. Follow-up evaluations were available for all patients at a mean of eighteen months after injury. There were no deaths. All of the fractures healed clinically and radiographically. In one patient, fecal contamination caused a polymicrobial wound infection, and this patient had an associated delay in union of the fracture. Another patient with an open fracture developed a deep wound infection. Both infections responded to local management and antibiotics. There were no complications associated with the degloving injuries. CONCLUSIONS:Comminuted iliac fractures occur in two distinct patterns and are associated with numerous local injuries that complicate management. Management protocols should include early open reduction and stable internal fixation. Traumatic open wounds should not be closed primarily. Primary closure with closed suction drainage is effective in the management of associated degloving injuries. Extension of the fracture into the greater sciatic notch warrants further evaluation with pelvic angiography.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Switzer JA,Nork SE,Routt ML Jrdoi
10.1097/00005131-200005000-00008subject
Has Abstractpub_date
2000-05-01 00:00:00pages
270-6issue
4eissn
0890-5339issn
1531-2291journal_volume
14pub_type
杂志文章abstract:OBJECTIVE:The objective of this study was to analyze the appropriateness of transfer of patients with orthopaedic injuries to a Level I trauma center from surrounding Level II to IV centers. DESIGN:A prospective study was conducted over a 5-month period by collecting data on all orthopaedic patients being transferred ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181b18b89
更新日期:2010-06-01 00:00:00
abstract::Damage to the brachial artery associated with closed elbow dislocation but without accompanying fracture is rare. Only 25 cases have been reported to date. We present a case that responded well to brachial artery vein grafting, and review the literature on this subject. Operative repair is recommended in this uncommon...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-199312000-00012
更新日期:1993-01-01 00:00:00
abstract::Ipsilateral femoral shaft and tibial plateau fractures, termed a "floating knee" are rare and challenging injuries. There is limited literature guiding the operative technique and the outcomes associated with these injuries. The author's preferred technique is early intramedullary of the femoral shaft fracture with kn...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001944
更新日期:2020-09-01 00:00:00
abstract::Nail plate combination technique can be applied in the setting of periprosthetic and interprosthetic fractures to promote reliable healing with a biomechanically favorable construct. Here, technical aspects and discussion of the technique are reviewed through a case of an 87-year-old woman who suffered from an interpr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001571
更新日期:2019-09-01 00:00:00
abstract::Femoral neck nonunions are a difficult complication in the treatment of femoral neck fractures and have traditionally been managed using an intertrochanteric valgus osteotomy and blade plate. We propose an alternative method, a proximal femoral valgus osteotomy using a sliding hip screw instead of a blade plate. This ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200608000-00006
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVES:Evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized the overall number of orthopaedic trauma encounters (OTE), the number of OTEs related to both high and low severity injuries, as well as the...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001860
更新日期:2020-06-08 00:00:00
abstract::Seat belt legislation has resulted in increased restraint use by passengers in automobiles in Washington State. At Harborview Medical Center in Seattle, we have observed an increased incidence of seat belt-related injuries. Twenty cases of Chance-type thoracolumbar flexion-distraction fractures were reviewed retrospec...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199105020-00006
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVES:Tibia fractures are the most common long bone fracture. Criteria for closed and open reduction are based on the amount of fracture shortening, angulation, and rotation, with high success rates achieved if acceptable alignment is maintained. However, there exists limited data available regarding the long-term...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000603
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To investigate whether a long bone cortex of well-defined thickness can be regenerated by using an anatomically designed membranous resorbable "tube-in-tube" implant and to establish the functions of membranes in the healing of segmental diaphyseal bone defects larger than the "critical size." DESIGN:Bone he...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199903000-00006
更新日期:1999-03-01 00:00:00
abstract::Periprosthetic fractures after shoulder arthroplasty occur in up to 2% of patients. In patients with stable components who fail or cannot undergo nonoperative management, stable fixation is required. We present a new technique to obtain proximal fixation around the humeral component using a 4.5-mm large fragment plate...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000935
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral ra...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318148c665
更新日期:2007-09-01 00:00:00
abstract::Successful management of intramedullary long bone osteomyelitis remains a challenge for both surgeons and patients. Patients are often immune compromised and have endured multiple surgeries. Treatment principles include antibiotic administration (systemically ± locally), surgical debridement of the infection site, and...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000587
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To determine if locking compression plates (LCP) are mechanically advantageous compared to low-contact dynamic compression plates (DCP) when used as a bridging plate in a synthetic model of osteoporotic bone. METHODS:Five synthetic bars (Synbone Osteoporotic bone) were initially tested in compression and the...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318160c84c
更新日期:2008-02-01 00:00:00
abstract::A disaster is a catastrophic event that disrupts normal infrastructure to such a degree that normal response mechanisms and capabilities cannot manage what is required to respond appropriately to the event. Launched after the largest urban disaster in modern history--the 2010 Haiti Earthquake--the American Academy of ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000405
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:To determine whether severe open tibial fractures in children behave like similar fractures in adults. DESIGN AND SETTING:A combined retrospective and prospective review evaluated treatment protocol for type II and type III open tibial fractures in children over a ten-year period from 1984 to 1993. PATIENT...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199707000-00010
更新日期:1997-07-01 00:00:00
abstract::Femoral shaft fractures are commonly treated with closed reduction and reamed intramedullary nailing. However, some reductions are difficult to obtain or maintain, especially in muscular or large patients. When closed methods fail to achieve reduction, percutaneous techniques are extremely useful. In addition, the use...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000890
更新日期:2017-08-01 00:00:00
abstract::Salvage of limb length following oblique proximal foot amputations is presented. The technique, results, and follow-up of this procedure are described and compared with other standard procedures. A prospective study was done on 3 adolescents who presented consecutively during years 1999 and 2000. The salvage procedure...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000164168.94365.49
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVES:To determine the most commonly associated injuries, complications, and healing rates of patients sustaining segmental tibial shaft fractures. DESIGN:Retrospective review. SETTING:Two Level I trauma centers. PATIENTS:A total of 108 patients with segmental tibial shaft fractures were identified between 2005...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,多中心研究
doi:10.1097/BOT.0000000000001132
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVES:To compare the Disability of the Arm, Shoulder, and Hand (DASH) and Constant scores, time to union, rate of union, patient cosmetic satisfaction rate, and the need for secondary procedures between 2.7- and 3.5-mm anteroinferior plating for Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma A...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182693f32
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:To radiographically demonstrate the upper sacral nerve root tunnel (USNRT) in both cadaveric specimens and a clinical cohort and to quantify its clinical relevance. SETTING:Level 1 trauma center and anatomy laboratory. PATIENTS AND PARTICIPANTS:Eleven cadaveric pelves and 23 consecutive patients who underw...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181a2e419
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS:Seven hund...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000554
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To quantify intrapelvic surface symmetry in reference to a preshaped suprapectineal acetabular implant. METHODS:In this cross-sectional study, an anatomically preshaped acetabular fracture implant was fitted on 3D surface models of 516 pelvises from a preexisting bone database using a software tool for autom...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001373
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000193
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVES:To introduce a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for acute displaced humeral shaft fractures and to evaluate the clinical and radiological outcomes. DESIGN:: Prospective clinical series study. SETTING:University hospital. PATIENTS:Twenty-one patients with acut...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318254895f
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the loss of strength in the distal humerus that resulted from the creation of two different entry portals used for retrograde humeral nailing. DESIGN:Nine pairs, treated as blocks of size two, of fresh frozen humeri from individuals free of musculoskeletal disease w...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200002000-00005
更新日期:2000-02-01 00:00:00
abstract::Forty-three patients with 43 comminuted femoral shaft fractures treated with the Brooker-Wills interlocking nail were followed through bony union to determine the device's ability to maintain length and rotational control of these difficult injuries. Only severely comminuted fractures, types III and IV, were included....
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-198702010-00002
更新日期:1987-01-01 00:00:00
abstract:INTRODUCTION:External rotation and gravity stress radiographs have been described to distinguish stable supination-external rotation-II (SER-II) ankle fractures from unstable SER-IV fractures. It has been previously shown that both external rotation and gravity stress views are equivalent in their ability to diagnose d...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000817
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation. DESIGN:Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318225e8d0
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:This study was designed to determine the clinical relevant accuracy of CT-based navigation for drilling. DESIGN:Experimental model. SETTING:Laboratory. METHODS:Twelve drills of varying lengths and diameters were tested with 2 different set-ups. Group 1 used free-hand navigated drilling technique with foam ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:Comparison between a Less Invasive Stabilization System (LISS) using monocortical screws with angular stability and two conventional plate systems Condylar Buttress Plate (CBP) and Dynamic Condylar Screw (DCS) for the treatment of distal femoral fractures with respect to biomechanical properties. DESIGN:Biom...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200109000-00004
更新日期:2001-09-01 00:00:00