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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 58 - 58
1 May 2012
N. KK H. BT R. M P.V. G
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The straddle fractures represent a distinct anatomical pattern of pelvic trauma. Their specific clinical characteristics, associated injuries and clinical outcome remain mostly underreported and ambiguous.

Over a 3-year period all straddle fractures were identified from a prospective database of a tertiary referral hospital. For all cases, excluding children < 16 years and pathologic fractures, demographic characteristics, associated trauma, ISS-2005, transfusion requirements, surgical procedures, post-operative course, complications and clinical outcome were recorded over a median follow-up of 19 months (7-36). All fractures were classified by the two senior authors separately.

Of 280 pelvic fractures, 31(11%) straddle fractures were identified. The median age was 38 years (17-88) and the male/female ratio was 1.38. Half of them were classified as lateral-compression (51.6%), 19.4% as anteroposterior-compression, and 29% combined mechanism of injury. 9 cases had an intra-articular extension to one or both acetabula. Median ISS was 21 (9-57), while 71% had a serious (AIS>2) associated thoracic injury, 48.4% head injury, 38.7% abdominal injury, 51.6%- lower extremity fracture, and 38.7% significant urogenital injuries. Six underwent acute embolisation, and the mean transfusion rates over the initial 72hrs were 7.5 units-cRBC, 2.3 units-FFP, 0.5 units-PLTs. All cases were treated operatively, either with ORIF (14 cases), closed reduction and percutaneous screw fixation (10 cases), while an external fixator was used in 21 cases. The median length of stay was 21 days (1-106). The mortality rate was 6.5% (one on the day of admission and another after 15 days at the ICU). Eight superficial infections, 2 deep sepsis of pfannestiel wounds, as well as 1 asymptomatic nonunion of an inferior pubic rami were recorded. 5 cases underwent further surgery for late urogenital repair and 4 cases have chronic incontinence and sexual dysfunction symptoms.

Straddle fractures represent a severe type of pelvic trauma, associated with severe mostly thoracic, head and extremity trauma, severe urogenital complications, and suggest pelvic ring instability that requires surgical stabilisation in the acute setting. They are easily identifiable at the initial radiological investigations and should alert the clinician for multidisciplinary assessment and early referral.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 17 - 17
1 May 2012
R. M D. K V. K
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Introduction

Recently, femoroacetabular impingement has been postulated as an important cause for the development of primary osteoarthritis of the hip. Various studies have shown that primary osteoarthritis of the hip is rare amongst Asians including Indians. We conducted an anthropometric study to evaluate prevalence of abnormal head-neck offset in Indian population and to correlate it with the low prevalence of primary osteoarthritis in Indian population.

Material and Methods

We retrospectively evaluated three dimensional CT scans of hips conducted as a part of another project done over a period of two years at our institute. An axial image was created parallel to the central axis of the femoral neck and passing through the centre of the femoral head using coronal scout view. This image was then used to calculate Alpha and Beta angles and head-neck offset ratio.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 144 - 144
1 May 2012
T. R R. M J. M C. A
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Introduction

In degenerative lumbar spine, it seems possible that foraminal stenosis is over-diagnosed as axial scanning is not performed in the plane of the exiting nerve root. We carried out a two-part study to determine the true incidence of foraminal stenosis.

Patients and Methods

Initially we performed a retrospective analysis of radiology reports of conventional Magnetic Resonance Imaging in 100 cases of definite spinal stenosis to determine the incidence of reported ‘foraminal stenosis’. Subsiquently we performed a prospective study of MRI including fine slice T2 and T2 STIR coronal sequences in 100 patients with suspected stenosis. Three surgeons and one radiologist independently compared the diagnoses on conventional axial and sagittal sequences with the coronal scans.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 26 - 26
1 May 2012
H. WJ J. W R. M B. D N. C J. C T. A
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Introduction

Although good mid-term results have been reported with some metal on metal hip replacements, reported complications due to metal on metal (MOM) related reactions are a cause for concern. We have assessed the early clinical outcome and results of routine metal artefact reduction MRI findings in a consecutive series of patients with a modern large head metal on metal hip replacement.

Methods

62 ASR XL Corail total hip replacements (THR) and 17 ASR resurfacings were performed at our hospital between 2005 and 2008. All patients were reviewed and assessed with an Oxford hip score (OHS), a plain radiograph and a MRI imaging was obtained on 76 (96%) hips. Implant position was assessed using Wrightington cup orientation software.