Fractures, Bone ; diagnosis ; diagnostic imaging ; surgery ; therapy ; Humans ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography

Regardless of the method of treatment, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. However, there is not much information in the literature on the management of these late complications. Because they cause disabling symptoms and socioeconomic problems, some patients with malunion or nonunion of pelvic fractures need to undergo surgery. We report our experience with satisfactory results of surgery for pelvic malunion and nonunion in four patients. The key to successful reconstruction is thorough preoperative planning and methodical surgical intervention.
Adult ; Female ; Fracture Fixation, Internal/*instrumentation/*methods ; Fractures, Malunited/radiography/*surgery ; Fractures, Ununited/radiography/*surgery ; Humans ; Pelvic Bones/injuries/radiography/*surgery

OBJECTIVETo study the clinical results of surgery for rotationally and vertically unstable pelvis fracture.

METHODSThirty-four patients with rotationally and vertically unstable pelvis fractures were treated. There were 23 male and 11 female,with the average age of 36 years ranging from 13 to 56 years. There were 9 cases of type APC III, 14 cases of type LC III, and 11 cases of type VS according to Young-Burgess Classifiction. All patients' pelvis were treated with temporary external fixation after hospitalization, and were treated with open reduction and internal fixation through anterior approach after stabilization of body condition.

RESULTSAll patients were followed up for 12 to 48 months (average 21 months). All the incisions healed well, and the fractures got union for 3 to 6 months. According to the Majeed evaluation, the results were excellent in 21 cases, good in 10, fair in 3. All patients were not remained deformity of rotation and dislocation. But 3 patients remained lameness, 4 remained low back pain, 3 remained both leg and feet numbness.

CONCLUSIONIn the management of the rotationally and vertically unstable pelvis fractures, a stable pelvis can be reconstructed by effective open reduction and internal fixation through the anterior approaches, so that further sequelae can be reduced.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; classification ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography ; Treatment Outcome

OBJECTIVETo investigate the applications of percutaneous screw fixation for the treatment of pelvic fractures and its related surgical considerations.

METHODSFrom June 2010 to June 2012,19 patients with pelvic fractures were treated with percutaneous hollow screws. There were 13 males and 6 females, with an average age of 41 years (ranged from 22 to 58 years). Fractures were caused by traffic accidents in 11 cases, by falling down from high place in 8 cases. Based on the Tile classification, there were 15 cases of Tile C type and 4 case of Tile B type. The indexes such as screw inserting time, intraoperative blood loss, complications, functional recovery and reduction conditions were observed. Fixation methods included sacroiliac screws, cannulated screw fixation of the pubic ramus and cannulated screw fixation of the pubic symphysis separation.

RESULTSAnatomical reduction achieved in 7 cases, satisfactory reduction 11 cases, and unsatisfactory reduction 1 case. Union time of fracture union ranged from 8 to 12 weeks (mean 10 weeks). Wound infection,ununion of fracture and nerve injuries were not found. According to the Majeed standards, 12 patients obtained an excellent results, 6 good and 1 fair.

CONCLUSIONPercutaneous screw fixation for the treatment of pelvic fractures under fluoroscopy has several advantages such as less trauma, less blood loss, fewer rates of complications, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but it needs adequate preoperative preparation and high requirements for the surgeon.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography ; Young Adult

OBJECTIVE: To table a proposal for select using the medical imaging methods to evaluate pelvic injury in forensic field, by studying the structure of pelvis and radiological methods in common use. METHODS: A study of several cases of pelvic injury was done, in which biomechanics and classification of pelvic injury were analyzed, moreover imaging methods were compared with each other, such as fluoroscopy, X-ray photography, computerized tomography (CT) and so on. RESULTS: Four cases of pelvic injury are all multiple injuries, confirmed by X-ray photography and CT examination approvingly. CONCLUSIONS Authors advocate that pelvic injury mechanism and biomechanics should be considered accordingly, multiple injuries should be attracted notice, so as to select suitable imaging methods to evaluate pelvic injury exactly.
Adult ; Biomechanical Phenomena ; Female ; Forensic Medicine ; Fractures, Bone/diagnostic imaging* ; Humans ; Magnetic Resonance Imaging ; Male ; Multiple Trauma/diagnostic imaging* ; Pelvic Bones/injuries* ; Radiography/methods* ; Tomography, X-Ray Computed

OBJECTIVETo discuss feasibility of minimal-invasive surgical treatment of the pelvis fractures.

METHODSTwenty-six patients with pelvis fractures were treated by micro-surgical treatment. There were 15 male and 11 female with an average age of 40 years ranging from 20 to 62 years. All patients were closed fractures, 17 patients were hemi-pelvis fractures, 9 patients were bilateral-pelvis fractures. The fracture type of posterior ring of pelvis as follows:8 patients were sacro-iliac joint dislocation, 12 patients were vertical section fractures in the outboard of the sacrum. The fracture type of anterior ring of pelvis as follows: 9 patients were hemi-fracture of rami ossis pubisi or hemi-fracture of rami ischi, 7 patients were bilateral-fracture of rami ossis pubisi or bilateral-fracture of rami ischii, 6 patients were separation of symphysis pubis. Six patients accompanied with shock. Anterior ring of pelvis was fixation by lag screw via superior ramus of pubis and pubic symphysis; Posterior ring of pelvis was fixation by lag screw via sacroiliac joint or intrasacral rod via ilium. X-ray films and multi-slice spiral CT of pelvis was obtained in order to understand exterior and inner details about pelvis fractures. Adopt orientation in body and inducted by C-arm digital subtracting X-ray system when operating.

RESULTSBlood loss was about 10 to 50 ml (mean 30 ml). Operation time was 30 to 50 minutes. Time of fracture union was 8 to 12 weeks (mean 11 weeks). Wound infection, ununion of fracture and nerve injuries had not been found.

CONCLUSIONMinimally invasive operation has the merit of short operation time, fine effect, soon recovering and few complication.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnostic imaging ; surgery ; Fractures, Closed ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Pelvic Bones ; diagnostic imaging ; injuries ; surgery ; Radiography

Adult ; Aged ; Aged, 80 and over ; Fractures, Bone ; complications ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Middle Aged ; Pelvic Bones ; blood supply ; diagnostic imaging ; injuries ; Radiography ; Venous Thrombosis ; diagnostic imaging ; drug therapy ; prevention & control ; Young Adult

OBJECTIVE: To analyze the relevance of Tile type of pelvic fracture and the degree of disability and explore how to understand the malunion and severe malunion of pelvic fracture for the injured in the traffic accidents. METHODS: Eighty-six cases of pelvic fractures caused by traffic accidents from August 2008 to August 2011 in Forensic Judical Appraisal Institute of Suzhou Municipal Hospital were collected. At first, the grade of disability for every case was evaluated by 3 senior forensic experts independently. Then, the Tile type of pelvic fractures for every case was determined by 3 radiologists independently. At last, the correlation of the types of the fracture with the grades of disabilities was analyzed. RESULTS: In all the cases there were 19 cases determined as A-type fracture and evaluated as non-grade disability. There were 43 cases determined as B-type fracture. And in these cases there were 41 cases determined as tenth grade of disability, one case as non-grade disability and one case as ninth grade disability. There were 24 cases determined as C-type fracture. And in these cases there were 14 cases evaluated as tenth grade disability and 10 cases evaluated as ninth grade disability. There was a correlation between the grade of disability and the type of the fracture (r = 0.760). CONCLUSION The disability degree caused by pelvic fracture correlates significantly with the type of the fracture. The finding is potentially useful to understand the malunion and severe malunion of pelvic fracture in forensic practice.
Accidents, Traffic ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Disability Evaluation ; Female ; Forensic Medicine ; Fracture Healing ; Fractures, Bone/epidemiology* ; Fractures, Malunited/epidemiology* ; Humans ; Male ; Middle Aged ; Pelvic Bones/injuries* ; Radiography ; Retrospective Studies ; Trauma Severity Indices ; Young Adult

OBJECTIVETo introduce the location and course of S1, S2 sacral nerve root tunnel and to clarify the significance of the anterior aspect of sacral nerve root tunnel on placement of iliosacral screw on the standard lateral sacral view.

METHODSFirstly the data of 2.0 mm slice pelvic axial CT images were imported into Mimics 10.0, and the sacrum, innominate bones, and sacral nerve root tunnels were reconstructed into 3D views respectively, which were rotated to the standard lateral sacral views, pelvic outlet and inlet views. Then the location and course of the S1, S2 sacral nerve root tunnel on each view were observed.

RESULTSThe sacral nerve root tunnel started from the cranial end and anterior aspect of the vertebral canal of the same segment and ended up to the anterior sacral foramen with a direction from cranial-posterior-medial to caudal-anterior-lateral. The tunnel had a lower density than the iliac cortex and greater sciatic notch on the pelvic X-rays,especially on the standard sacral lateral view, on which it showed up as a disrupted are line and required more careful recognition.

CONCLUSIONIt can prevent the iliosacral screw from penetrating the sacral nerve root tunnel and vertebral canal when recognizing the anterior aspect of sacral nerve root tunnel and choosing it as the caudal-posterior boundary of the "safe zone" on the standard lateral sacral view.

Adult ; Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; diagnostic imaging ; injuries ; innervation ; surgery ; Radiography ; Sacrococcygeal Region ; diagnostic imaging ; innervation ; surgery ; Sacrum ; diagnostic imaging ; injuries ; innervation ; surgery ; Spinal Nerve Roots ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVE: To evaluate the frequency and relevance of the "sentinel clot" sign on CT for patients with traumatic intraperitoneal bladder rupture in a retrospective study. MATERIALS AND METHODS: During a recent 42-month period, 74 consecutive trauma patients (45 men, 29 women; age range, 12-84 years; mean age, 50.8 years) with gross hematuria were examined by the use of intravenous contrast-enhanced CT of the abdomen and pelvis, followed by retrograde cystography. Contrast-enhanced CT scanning was performed by using a helical CT scanner. CT images were retrospectively reviewed in consensus by two radiologists. The CT findings including the sentinel clot sign, pelvic fracture, traumatic injury to other abdominal viscera, and the degree of intraperitoneal free fluid were assessed and statistically analyzed using the two-tailed x2 test. RESULTS: Twenty of the 74 patients had intraperitoneal bladder rupture. The sentinel clot sign was seen for 16 patients (80%) with intraperitoneal bladder rupture and for four patients (7%) without intraperitoneal bladder rupture (p < 0.001). Pelvic fracture was noted in five patients (25%) with intraperitoneal bladder rupture and in 39 patients (72%) without intraperitoneal bladder rupture (p < 0.001). Intraperitoneal free fluid was found in all patients (100%) with intraperitoneal bladder rupture, irrespective of an associated intraabdominal visceral injury, whereas 19 (35%) of the 54 patients without intraperitoneal bladder rupture had intraperitoneal free fluid (p < 0.001). CONCLUSION: Detection and localization of the sentinel clot sign abutting on the bladder dome may improve the accuracy of CT in the diagnosis of traumatic intraperitoneal bladder rupture, especially when the patients present with gross hematuria.
Abdominal Injuries/diagnosis/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Contrast Media/administration & dosage ; Extravasation of Diagnostic and Therapeutic Materials/diagnosis/etiology ; Female ; Fractures, Bone/diagnosis/etiology ; Hematuria/etiology ; Humans ; Image Processing, Computer-Assisted ; Iohexol/diagnostic use ; Male ; Middle Aged ; Observer Variation ; Pelvic Bones/injuries/radiography ; Predictive Value of Tests ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Rupture/diagnosis ; Tomography, Spiral Computed/*methods ; Urinary Bladder/*injuries/*radiography ; Wounds, Nonpenetrating/complications/*diagnosis