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.

Objective: To analyze tumour response and toxicity with respect to cumulative radiotherapy dose to target and organs at risk (OARs) with computed tomography (CT)-based image guided adaptive brachytherapy planning for locally advanced carcinoma cervix. Methods: Patients were treated with two-dimensional concurrent chemoradiotherapy to whole pelvis followed by intracavitary brachytherapy (ICBT) with dose prescription to point ‘A’. CT image-based delineation of high-risk clinical target volume (HR-CTV), urinary bladder, rectum and sigmoid colon was done with generation of dose-volume histogram (DVH) data and optimization of doses to target and OARs. Follow up assessments were done for response of disease and toxicity with generation of data for statistical analysis. Results: One hundred thirty-six patients were enrolled in the study. Delineated volume of HR-CTV ranged from 20.9 to 37.1 mL, with median value of 30.2 mL. The equivalent dose in 2 Gy per fraction (EQD2) for point ‘A’ ranged from 71.31 to 79.75 Gy with median value of 75.1 Gy and EQD2 HR-CTV D90 ranged from 71.9 to 89.7 Gy with median value of 85.1 Gy. 69.2% of patients showed complete response and after median follow-up of 25 months, 50 patients remained disease free, of whom, 74.0% had received ≥85 Gy to HR-CTV D90 versus 26.0% receiving <85 Gy to HR-CTV D90. Conclusions Amidst the unavailability of magnetic resonance imaging facilities in low middle income countries, incorporation of CT-image based treatment planning into routine practice for ICBT provides the scope to delineate volumes of target and OARs and to generate DVH data, which can prove to be a better surrogate for disease response and toxicity.

Background: In recent years, medical thoracoscopy has been well established to play an important role in undiagnosed pleural effusion; however, this procedure is underutilized due to limited availability of the instruments it requires. This study analysed the outcome of single port rigid thoracoscopy in patients with undiagnosed pleural effusions. Methods: This study retrospectively analysed the outcomes of all patients with undiagnosed pleural effusion presenting to our centre between 2016 to 2020 who underwent single port rigid medical thoracoscopy as a diagnostic procedure. Results: In total, 92 patients underwent single port rigid medical thoracoscopy. The most common presenting symptom was shortness of breath. A majority of the patients had lymphocytic exudative pleural effusion. The average biopsy sample size was 18 mm, and no major complication was reported in any of the patients. Conclusion Single port rigid thoracoscopy is a safe and well-tolerated procedure that yields a biopsy of a larger size with high diagnostic yield. Moreover, the low cost of the instruments required by this procedure makes it particularly suited for use in developing countries.

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.

The spleen is one of the organs most commonly affected by blunt abdominal trauma. Splenectomy is often indicated for high-grade post-traumatic injuries and in patients who are hemodynamically unstable, while non-operative management (NOM) is considered for the remaining cases. Patients who have undergone splenectomy are at an increased risk of overwhelming post-splenectomy infection, leading to a shift in the consensus toward managing splenic trauma with spleen-preserving NOM approaches, such as splenic artery embolization, when possible. Patients with grade IV and V splenic injuries who are hemodynamically stable and do not have an active bleed are often candidates for prophylactic angioembolization. This intervention reduces the risk of re-bleeding, preserves splenic function, and decreases the likelihood of requiring a splenectomy. However, not all facilities have access to interventional radiology (IR). Through this case report, we emphasize the importance of using the period of conservative management to either consult with an IR specialist or transfer the patient to a center equipped with IR, given the high risk of re-bleeding or delayed rupture of the spleen. An additional unusual finding in our case was a re-bleed occurring beyond the typical interval for NOM as reported in most literature.