Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries:A randomized controlled trial

Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical outcome (excellent outcome withOR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion: The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament.Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation,but with less morbidity (shorter operation time,lower amount of blood,and no records of postoperative wound infection).

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.

Distal femoral physeal crush injury with metaphyseal comminution - A report of two cases and a new perspective to physeal injury

The physis of a long bone may get ＇sandwiched＇ and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radio- logically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample ＇breathing space＇ to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technque used bv us.