Pelvic x-ray is a routine part of the primary survey of Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard in the diagnosis of pelvic fractures. This study aims to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis, in favour of later pelvic CT scan.

A retrospective analysis of polytraumatized patients in our emergency room was conducted between 2005 and 2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and clinically stable pelvis. We excluded patients requiring immediate intervention.

We reviewed the records of 452 patients. 91 fulfilled inclusion criteria (56% male, mean age 45 years). 43% were road traffic accidents and 47% falls. In 68/91 (75%) patients, both pelvic x-ray and CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None false positive pelvic x-ray was detected. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23).

In hemodynamically stable patients with clinically stable pelvis, x-ray sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination. The results support the safety and utility of our modified ATLS algorithm

Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause for postoperative anterior knee pain. We compared patellar blood flow before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores to ascertain whether disrupted patellar blood flow correlates with anterior knee pain following TKA. Blood flow measurements were performed at full extension and at 30°, 60°, 90° and 110° of flexion prior to and after medial arthrotomy in 50 patients (21 male, 29 female; mean age 73.1±8.6 years) undergoing TKA. Anterior knee pain was assessed using the pain intensity numeric rating scale. A significant decrease in blood flow was detected at 60°, 90°, and 110° of flexion (p values: 0.00314,< 0.0001,< 0.0001 respectively). The medial arthrotomy did not have a statistically significant influence on patellar blood flow in the Students’ t-test (margin of significance p& #61603;0.05) Nineteen patients exhibited an average 14% (range 1%–54%) increase in patellar blood perfusion at knee flexions of 90° and 110° after medial arthrotomy (p value: 0.32) Prior to TKA, 16 of the 50 patients (32%) complained of anterior knee pain (average NRS 7.12, range 5–10). At 6-month follow up, 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7, range 5–6), while 8 of 16 (50%) patients reported discomfort (average NRS 3.5, range 2–4) around the patella. No statistically significant correlation was found between intraoperative findings on patellar blood flow and the presence of anterior knee pain

Introduction: Ruptured anterior cruciate ligaments (ACL) are generally thought not to heal after treatment so that the ligament must be replaced by a graft. We developed and evaluated a surgical technique that restores knee stability using the self-healing capacity of the ruptured ACL.

Methods: The ACL was cut close to the femoral insertion in 14 sheep. The contralateral, nonoperated side served as the control. After microfracturing at the femoral foot print, the ACL was stabilized using the dynamic intraligamentary stabilization (DIS) technique. A strong intraligamentary suture was attached on the femoral side with a button and on the tibial side by means of an intraosseous spring-loaded screw with a preload of 85 N. In 7 of 14 sheep the ruptured ligament was covered with a collagen membrane. The joint was not immobilized postoperatively. Histological evaluation, magnetic resonance imaging (MRI) and biomechanical testing were performed after 3 months.

Results: Three days postoperative all animals showed no lameness and regularly used the operated leg. Macroscopically, all repaired ACLs appeared healed. Histological and MRI examinations confirmed the healing response of the ACL after DIS. The collagen membrane exhibited a more hypertrophic scare tissue reaction. Biomechanical testing showed an average increase of the operated anterior drawer 2.4 mm (range 0 mm – 4.5 mm) greater than on the control side. No lesions of the meniscus and cartilage were detected.

Conclusions: A ruptured ACL has the biological potential to heal after DIS in a sheep model. The surgical technique achieved a stable knee joint with free range of motion and full weight bearing during the healing period without signs of osteoarthritis or other intraarticular damage at follow up.

Purpose: Fractures of the distal tibia are high energy fractures, associated with marked soft-tissue trauma. Management of these fractures is challenging. The purpose of this study is to present our experience on the treatment of these fractures using hybrid external fixation, with or without open reduction and minimal internal fixation of the fibular fracture.

Patients and Methods: Forty eight patients with a distal tibial fracture were admitted to the authors’ institution since 2005. There were 33 men and 15 women. According to AO there were 24 A, 10 B and 14 C fractures. The mean age of the patients was 45.6 years. Eight patients had an open pilon fracture; according to the Gustilo classification, 1 patient had a grade I, 5 patients had a grade II, and 2 patients had a grade III open fracture. In all patients, the pilon fracture was treated using hybrid external fixation; in 18 patients, open reduction and minimal internal fixation of the fibular fracture using plate and screws was also done.

Results: Mean follow-up was 14 months (range, 9 to 36 months). In all patients, the mean duration of the application of the external fixation was 2.85 months, followed by the application of a below-knee cast. In 42 patients, radiographic evidence of union was observed at 3,6 months (range, 3 to 9 months). Time for union was different between patients with closed and grade I open fractures compared to patients with grade II and grade III open fractures (union at 3.5 and 6 months, respectively). There were 5 non-unions (10,4%) with 3 of them septic (6,25%). All three deep infections were low grade and occurred in open fractures.Delayed union was observed in 3 patients; in these patients, solid union of the fracture was observed at 7 months (range, 6 to 9 months). Pin track infection was observed in 7 patients (14.6%).

Conclusion: Based on the present study, hybrid external is associated with satisfactory results for the management of distal tibial fractures with acceptable complications.