2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries - a case series

<p>Abstract</p> <p>Background</p> <p>Screw fixation of pelvic ring fractures is a common, but demanding procedure and navigation techniques were introduced to increase the precision of screw placement. The purpose of this case series was the evaluation of screw misplacement rate and functional outcome of percutaneous screw fixation of pelvic ring disruptions using a 2D navigation system.</p> <p>Methods</p> <p>Between August 2004 and December 2007, 44 of 442 patients with pelvic injuries were included for closed reduction and percutaneous screw fixation of disrupted pelvic ring lesions using an optoelectronic 2D-fluoroscopic based navigation system. Operating and fluoroscopy time were measured, as well as peri- and postoperative complications documented. Screw position was assessed by postoperative CT scans. Quality of live was evaluated by SF 36-questionnaire in 40 of 44 patients at mean follow up 15.5 ± 1.2 month.</p> <p>Results</p> <p>56 iliosacral- and 29 ramus pubic-screws were inserted (mean operation time per screw 62 ± 4 minutes, mean fluoroscopy time per screw 123 ± 12 seconds). In post-operative CT-scans the screw position was assessed and graded as follows: I. secure positioning, completely in the cancellous bone (80%); II. secure positioning, but contacting cortical bone structures (14%); III. malplaced positioning, penetrating the cortical bone (6%). The malplacements predominantly occurred in bilateral overlapping screw fixation. No wound infection or iatrogenic neurovascular damage were observed. Four re-operations were performed, two of them due to implant-misplacement and two of them due to implant-failure.</p> <p>Conclusion</p> <p>2D-fluoroscopic navigation is a safe tool providing high accuracy of percutaneous screw placement for pelvic ring fractures, but in cases of a bilateral iliosacral screw fixation an increased risk for screw misplacement was observed. If additional ramus pubic screw fixations are performed, the retrograde inserted screws have to pass the iliopubic eminence to prevent an axial screw loosening.</p

Rasch analysis of the Dutch version of the Oxford elbow score

Jeroen de Haan1, Niels Schep2, Wim Tuinebreijer2, Peter Patka2, Dennis den Hartog21Department of Surgery and Traumatology, Westfriesgasthuis, Hoorn, the Netherlands; 2Department of Surgery and Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the NetherlandsBackground: The Oxford elbow score (OES) is a patient-rated, 12-item questionnaire that measures quality of life in relation to elbow disorders. This English questionnaire has been proven to be a reliable and valid instrument. Recently, the OES has been translated into Dutch and examined for its reliability, validity, and responsiveness in a group of Dutch patients with elbow pathology. The aim of this study was to analyze the Dutch version of the OES (OES-DV) in combination with Rasch analysis or the one-parameter item response theory to examine the structure of the questionnaire.Methods: The OES-DV was administered to 103 patients (68 female, 35 male). The mean age of the patients was 44.3 &amp;plusmn; 14.7 (range 15&amp;ndash;75) years. Rasch analysis was performed using the Winsteps&amp;reg; Rasch Measurement Version 3.70.1.1 and a rating scale parameterization.Results: The person separation index, which is a measure of person reliability, was excellent (2.30). All the items of the OES had a reasonable mean square infit or outfit value between 0.6 and 1.7. The threshold of items were ordered, so the categories can function as intended. Principal component analysis of the residuals partly confirmed the multidimensionality of the English version of the OES. The OES distinguished 3.4 strata, which indicates that about three ranges can be differentiated.Conclusion: Rasch analysis of the OES-DV showed that the data fit to the stringent Rasch model. The multidimensionality of the English version of the OES was partly confirmed, and the four items of the function and three items of the pain domain were recognized as separate domains. The category rating scale of the OES-DV works well. The OES can distinguish 3.4 strata. This conclusion can only be applied to elbow dislocations, which were the largest group of patients studied.Keywords: elbow, questionnaire, quality of life, traumatology, modern test theory, reliability, outcome

Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

OBJECTIVE: Percutaneous iliosacral screw placement allows for minimally invasive fixation of posterior pelvic ring instabilities. The objective of this study was to describe the technique for screws in S1 and S2 using conventional C-arm and to evaluate perioperative complications. METHODS: Thirty-eight consecutive patients after percutaneous pelvic ring fixation with cannulated screws in S1 and S2 using conventional C-arm fluoroscopy were analysed. Accuracy of screw placement, nerval lesions, need for second surgery, operation time, and time to full weight bearing were assessed postoperatively and during regular follow-up examinations. RESULTS: Twenty-one patients underwent unilateral screw fixation and 17 patients underwent bilateral screw fixation. In total, 83 screws were placed. Mean age of the patients was 52 ± 19 years. Mean operation time was 16 ± 7 min/screw. Mean follow-up was 5 ± 3 months. Time to full weight bearing in 28 patients was 9 ± 4 weeks. Eight patients were still not able to support full weight bearing, partially due to concomitant injuries. Patients without concomitant injuries that affected walking were able to bear full weight after 8 ± 4 weeks (n = 17). Two patients had persistent postoperative hypaesthesia. No motor weakness was apparent and no postoperative bleeding was observed. Secondary surgery due to screw malpositioning or loosening had to be performed in four patients. The presence of a screw in S2 was not indicated for perioperative complications. CONCLUSIONS: Percutaneous iliosacral screw fixation is a rapid and definitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm fluoroscopy was also found to be safe for screws placed in S2