Pelvic ring injuries with rotational and translational instability are complex and often result from high-energy trauma, posing significant challenges in management. Internal fixation has emerged as the preferred approach, with traditional methods such as iliosacral screw fixation exhibiting drawbacks like implant-related morbidity and hardware complications. This paper presents a modified minimally invasive transiliac plating technique aimed at addressing these challenges. The surgical technique involves careful preoperative planning, precise patient positioning, and meticulous exposure of the posterior pelvic structures. Key steps include osteotomy of the posterior superior iliac spine (PSIS), formation of a subcutaneous tunnel, contouring and placement of the plate, and fixation with strategically positioned screws. Additionally, the modified technique incorporates the replacement of the osteotomized PSIS bony fragment, providing secondary stability and minimizing the risk of implant back out. This modification aims to enhance biomechanical stability, reduce implant-related morbidity, and ensure optimal functional outcomes. The technique’s efficacy is supported by biomechanical principles and clinical studies, indicating its potential as a promising alternative in the management of unstable pelvic ring injuries. Overall, this modified approach offers improved patient comfort, reduced surgical risks, and enhanced long-term outcomes, contributing to advancements in pelvic ring fracture management.

Pelvic ring injuries with rotational and translational instability are complex and often result from high-energy trauma, posing significant challenges in management. Internal fixation has emerged as the preferred approach, with traditional methods such as iliosacral screw fixation exhibiting drawbacks like implant-related morbidity and hardware complications. This paper presents a modified minimally invasive transiliac plating technique aimed at addressing these challenges. The surgical technique involves careful preoperative planning, precise patient positioning, and meticulous exposure of the posterior pelvic structures. Key steps include osteotomy of the posterior superior iliac spine (PSIS), formation of a subcutaneous tunnel, contouring and placement of the plate, and fixation with strategically positioned screws. Additionally, the modified technique incorporates the replacement of the osteotomized PSIS bony fragment, providing secondary stability and minimizing the risk of implant back out. This modification aims to enhance biomechanical stability, reduce implant-related morbidity, and ensure optimal functional outcomes. The technique’s efficacy is supported by biomechanical principles and clinical studies, indicating its potential as a promising alternative in the management of unstable pelvic ring injuries. Overall, this modified approach offers improved patient comfort, reduced surgical risks, and enhanced long-term outcomes, contributing to advancements in pelvic ring fracture management.

Pelvic ring injuries with rotational and translational instability are complex and often result from high-energy trauma, posing significant challenges in management. Internal fixation has emerged as the preferred approach, with traditional methods such as iliosacral screw fixation exhibiting drawbacks like implant-related morbidity and hardware complications. This paper presents a modified minimally invasive transiliac plating technique aimed at addressing these challenges. The surgical technique involves careful preoperative planning, precise patient positioning, and meticulous exposure of the posterior pelvic structures. Key steps include osteotomy of the posterior superior iliac spine (PSIS), formation of a subcutaneous tunnel, contouring and placement of the plate, and fixation with strategically positioned screws. Additionally, the modified technique incorporates the replacement of the osteotomized PSIS bony fragment, providing secondary stability and minimizing the risk of implant back out. This modification aims to enhance biomechanical stability, reduce implant-related morbidity, and ensure optimal functional outcomes. The technique’s efficacy is supported by biomechanical principles and clinical studies, indicating its potential as a promising alternative in the management of unstable pelvic ring injuries. Overall, this modified approach offers improved patient comfort, reduced surgical risks, and enhanced long-term outcomes, contributing to advancements in pelvic ring fracture management.

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared. Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up. Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm. Conclusion Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared. Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up. Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm. Conclusion Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared. Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up. Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm. Conclusion Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

PURPOSE: Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. METHODS: Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. RESULTS: Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554). CONCLUSION A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Adult ; Compartment Syndromes ; prevention & control ; Connective Tissue ; physiopathology ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Knee ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Tibial Fractures ; physiopathology ; surgery ; Treatment Outcome