The anterior pelvic internal fixator is increasingly used for
the treatment of unstable, or displaced, injuries of the anterior
pelvic ring. The evidence for its use, however, is limited. The
aim of this paper is to describe the indications for its use, how
it is applied and its complications. We reviewed the case notes and radiographs of 50 patients treated
with an anterior pelvic internal fixator between April 2010 and
December 2015 at a major trauma centre in the United Kingdom. The
median follow-up time was 38 months (interquartile range 24 to 51).Aims
Patients and Methods
We report the use of a 15° face-changing cementless
acetabular component in patients undergoing total hip replacement
for osteoarthritis secondary to developmental dysplasia of the hip.
The rationale behind its design and the surgical technique used
for its implantation are described. It is distinctly different from
a standard cementless hemispherical component as it is designed
to position the bearing surface at the optimal angle of inclination,
that is, <
45°, while maximising the cover of the component by
host bone.
Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial.
We prospectively studied the outcome of a protocol of prophylaxis for deep vein thrombosis (DVT) in 103 consecutive patients undergoing surgical stabilisation of pelvic and acetabular fractures. Low-molecular-weight heparin (LMWH) was administered within 24 hours of injury or on achieving haemodynamic stability. Patients were screened for proximal DVT by duplex ultrasonography performed ten to 14 days after surgery. The incidence of proximal DVT was 10% and of pulmonary embolus 5%. Proximal DVT developed in two of 64 patients (3%) who had received LMWH within 24 hours of injury, but in eight of 36 patients (22%) who received LMWH more than 24 hours after the injury (p <
0.01). We conclude that LMWH, when begun without delay, is a safe and effective method of thromboprophylaxis in high-risk patients with major pelvic or acetabular fractures.
