Introduction & Aim. The use of All-Poly Tibia has been in practice since the early 1970's. Recently due to the reports on wear and osteolysis in other articulations, this component has generated significant interest. In the current study we aim to report early medium-term results of All-poly Tibial components in elderly (>70 years) patients. Method. Study of 455 cases done between 2005-2020. All the cases were performed by a single surgeon. All-Poly Tibial component implantations were performed using Standard mechanical jigs and the same posterior-stabilized implant was used for all cases. Results. 20 cases were lost to follow-up. 25 patients died due to natural causes. Mean age at index surgery was 74 years (70 - 91 years). Preop KSS average was 47 (31- 62). Post operative at the last follow up was 87 (71- 93). Of the 410 cases there were 8 revisions, 6 for deep sepsis and 2 for periprosthetic fractures. There were no revisions for aseptic loosening or osteolysis. All cases are performing well functionally and clinically. 18 cases had a non-progressive radiolucent line beneath the Tibial component. The combination of perfect alignment and soft tissue balance creates an environment for a successful TKR. The choice of the All-Poly Tibial component for functionally low demand age group patients reduces the chances of premature wear and osteolysis. In elderly patients the implant should outlive the patient. Here it is observed that at 5-7 years aseptic loosening and subsequent revision chances are low. The all-poly Tibial component is significantly cheaper as compared to its metal back counterpart. Conclusion. An excellent clinical result in our hands for this group of patients supports the continued use of this implant strongly

Aims

The aims of this study were to evaluate the incidence of postoperatively restricted weight-bearing and its association with outcome in patients who undergo surgery for a fracture of the hip.

Obtaining primary wound healing in total joint arthroplasty (TJA) is essential to a good result. Wound healing disturbances (WHD) can occur and the consequences can be devastating to the patient and to the surgeon. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as Type A: no healing compromises and Type B: systemic or local healing compromise factors present. Local factors include traumatic arthritis with multiple previous incisions, extensive scarring, lymphodema, poor vascular perfusion, and excessive local adipose deposition. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. Low serum albumin, total lymphocyte count, and low transferrin increase WHD. In high risk situations the surgeon should encourage positive patient choices such as smoking cessation and nutritional supplementation to modify healing responses. Use of tourniquet in obese patients also increases WHD. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thusly, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We do all potentially complicated TKA's without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems do occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (less than 2500), differential (less than 60% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound

Prophylactic antibiotics can decrease the risk of wound infection and have been routinely employed in orthopaedic surgery for decades. Despite their widespread use, questions still surround the selection of antibiotics for prophylaxis, timing and duration of administration. The health economic costs associated with wound infections are significant, and the judicious but appropriate use of antibiotics can reduce this risk.

This review examines the evidence behind commonly debated topics in antibiotic prophylaxis and highlights the uses and advantages of some commonly used antibiotics.

Cite this article: Bone Joint J 2016;98-B:1014–19.

Introduction. Various implant designs and bearing surfaces are used in TKR. The use of All Poly Tibia and poly moulded on Tibial metal base plate has been in practice since long. Recently due to the reports on wear and osteolysis in modular articulations, these components have generated significant interest. Aim. To report early medium term results in elderly (>70 years) patients. Method. Study of 130 cases done between 2005–2009. All cases were performed by the author. Inclusion Criteria:. Patients with physiological age > 70 years. Patients with low functional demand. Good bone quality. Exclusion Criteria: Inflammatory arthropathy. Osteoporosis and poor bone quality. High functional demand. All Poly Tibial component/ Moulded Metal back Tibia implantations were performed. A PS design was used in all cases fixed with CMW 1 gentamicin cement. Results. 12 cases were lost to follow up. 11 patients deceased due to medical conditions. This left us with 107 cases at the time of the last follow up. Mean age at index surgery was 72.5 years.(70–91 years). Preop KSS average was 42 (25–62). Post operative at the latest Follow up was 89 (68–97). Of 107 cases there were 4 revisions - two for deep sepsis and two for periprosthetic fractures. There were no revisions for aseptic loosening or osteolysis. All 103 cases are performing well functionally and clinically. 19 cases have a nonprogressive radiolucent line beneath the Tibial component. Discussion. Use of Monobloc Tibia is somewhat controversial. The first Total condylar Knee was an all poly design in early 70s. 1. The monobloc tibia eliminates backside wear. The overall thickness of polyethylene in this implant is 2 to 4mm thicker in allpoly tibia design. The metal base plate with compression moulded polyethylene dissipates stresses evenly in osteopaenic bones. The polywear and osteolysis are two most important factors for aseptic loosening. If Symptomatic, loosening warrants a revision surgery. Metal back fixed bearing implant has a disadvantage that it wears from both the surfaces. The highly polished trays are supposed to reduce the wear but it is too early for a statistically significant conclusion. Functionally low demand patients have lesser stresses as compared to their counterparts. The surgical technique for insertion of these implants is slightly demanding as compared to modular implants. The combination of perfect alignment and soft tissue balance creates an environment for a successful TKR. The choice of Monobloc Tibial component for functionally low demand age group patients reduce the chances of premature wear and osteolysis. In elderly patients the implant should outlive the patient. Here it is observed that at early medium term (5 to 9 yr.s) aseptic loosening and subsequent revision chances are low. The Monobloc Tibial component is cheaper as compared to its metal back counterpart. Conclusion. An excellent clinical result in our hands for this group of patients supports the continued use of this implant strongly

Background. Hospital acquired MRSA is globally endemic and is a leading cause of surgical site infection (SSI). Of great concern is the emergence of community acquired MRSA (CA MRSA) with its unique virulence characteristics. Infected hip or knee prostheses due to MRSA are associated with multiple reoperations and prolonged hospital stay. Few studies have been done to assess for risk of SSI in MRSA carriers undergoing elective orthopaedic surgery following decolonisation. However in these studies, the eradication status was not confirmed prior to proceeding for surgical intervention. Aim. The purpose of the study was to evaluate the incidence of SSI in MRSA carriers undergoing elective hip and knee arthroplasty, who had confirmed eradication of MRSA carrier status and to compare it with incidence of SSI in non MRSA carriers. Material and Methods. This is a retrospective analysis of 6613 patients who underwent elective hip (3347) and knee arthroplasty (3266) at our institution between January 2008 and August 2012. A cohort of patients who were preoperatively colonised with MRSA was identified. These patients were offered decolonisation protocol and successful eradication was ensured prior to surgery. The MRSA negative patients served as the control group and we looked into the incidence of SSI in both groups up to one year after surgery. Categorical variables were investigated between groups using chi-squared tests and p value of < 0.05 was taken as significant. Results. Out of 6613 patients, MRSA colonisation was observed in 83 patients (a mean age of 76 years with a M:F ratio of 1:1.2) pre-operatively with a colonisation rate of 1.3%. A total of 79 patients had confirmed eradication of carrier status prior to surgical intervention. Of these 38 were THRs and 41 were TKRs. Total number of MRSA negative patients were 6530 with 3307 THRs and 3223 TKRs in control group. Teicoplanin was used for antibiotic prophylaxis in these patients. 5 of 79 patients had “deep SSI” within 1 year of surgery giving an infection rate of 6.32%. There were 2 MRSA infections in hip replacements with an infection rate of 5.26%. There were 2 MRSA and 1 MSSA infection in TKR resulting in an infection rate of 7.31%. These patients did not belong to the “high-risk” group for MRSA colonisation. A significant statistical difference in infection rates from MRSA negative control group was noted, which had a deep sepsis rate of 1.17% (p value − 0.03) in THRs and 0.87% in TKRs (p value − 0.0016). Conclusions and Clinical Implication. In spite of a selective treatment program for carriers and confirmed eradication in terms of achieving a reduction in the rate of SSI, there is still a significantly increased risk of SSI in MRSA colonised patients undergoing hip and knee replacements. Also, should infection develop, MRSA is the most likely causative organism. Patients should be made aware of this higher risk of infection and the serious consequences of developing MRSA SSI

Obtaining primary wound healing in Total Joint Arthroplasty (TJA) is essential to a good result. Wound healing problems can occur and the consequences can be devastating to the patient and to the surgeon. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as Type A: no healing compromises and Type B: systemic or local healing compromises factors present. Local factors include traumatic arthritis with multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion, and excessive local adipose deposition. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high risk situations the surgeon should encourage positive patient choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thusly, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We do all potentially complicated TKAs without tourniquet to enhance blood flow and tissue viability. The use of peri-operative anticoagulation will increase wound problems. If wound drainage or healing problems do occur immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count [less than 2500], differential [less than 60% polys], and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound

We report on 397 consecutive revision total hip replacements in 371 patients with a mean clinical and radiological follow-up of 12.9 years (10 to 17.7). The mean age at surgery was 69 years (37 to 93). A total of 28 patients (8%) underwent further revision, including 16 (4%) femoral components. In all 223 patients (56%, 233 hips) died without further revision and 20 patients (5%, 20 hips) were lost to follow-up. Of the remaining patients, 209 (221 hips) were available for clinical assessment and 194 (205 hips) for radiological review at mean follow-up of 12.9 years (10 to 17.7).

The mean Harris Hip Score improved from 58.7 (11 to 92) points to 80.7 (21 to 100) (p <  0.001) and the mean Merle d’Aubigné and Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to 6) and 4.3 (2 to 6), respectively for pain, mobility and function. Radiographs showed no lucencies around 186 (90.7%) femoral stems with stable bony ingrowth seen in 199 stems (97%). The survival of the S-ROM femoral stem at 15 years with revision for any reason as the endpoint was 90.5% (95% confidence interval (CI) 85.7 to 93.8) and with revision for aseptic loosening as the endpoint 99.3% (95% CI 97.2 to 99.8).

We have shown excellent long-term survivorship and good clinical outcome of a cementless hydroxyapatite proximally-coated modular femoral stem in revision hip surgery.

Cite this article: Bone Joint J 2014;96-B:730–6.

The National Institute for Health and Clinical Excellence (NICE) has thus far relied on historical data and predominantly industry-sponsored trials to provide evidence for venous thromboembolic (VTE) prophylaxis in joint replacement patients. We argue that the NICE guidelines may be reliant on assumptions that are in need of revision. Following the publication of large scale, independent observational studies showing little difference between low-molecular-weight heparins and aspirin, and recent changes to the guidance provided by other international bodies, should NICE reconsider their recommendations?

Cite this article: Bone Joint Res 2014;3:146–9.

We report the short-term follow-up, functional outcome and incidence of early and late infection after total hip replacement (THR) in a group of HIV-positive patients who do not suffer from haemophilia or have a history of intravenous drug use. A total of 29 patients underwent 43 THRs, with a mean follow-up of three years and six months (five months to eight years and two months). There were ten women and 19 men, with a mean age of 47 years and seven months (21 years to 59 years and five months). No early (< 6 weeks) or late (> 6 weeks) complications occurred following their THR. The mean pre-operative Harris hip score (HHS) was 27 (6 to 56) and the mean post-operative HHS was 86 (73 to 91), giving a mean improvement of 59 points (p = < 0.05, Student’s t-test). No revision procedures had been undertaken in any of the patients, and none had any symptoms consistent with aseptic loosening. This study demonstrates that it is safe to perform THR in HIV-positive patients, with good short-term functional outcomes and no apparent increase in the risk of early infection.

Cite this article: Bone Joint J 2014; 96-B:462–6.

We compared the postoperative wound discharge rates and 3 months clinical results of three types of wound closure and dressing – 2-octylcyanoacrylate with Opstie (G+O), 2-octylcyanoacrylate with Tegaderm (G+T), and Opsite without 2-octylcyanoacrylate (O) in patients having primary total hip arthroplasty. We randomised 141 patients scheduled for primary total hip arthroplasty into 3 arms of this study- G+O, G+T, or O. The extent of wound discharge was recorded on a diagrammatic representation of the dressing in situ on paper and graded each day. Dressings were left in-situ provided the extent of wound discharge allowed for this. The patient was clinically reviewed at 3 months to assess their scar length, cosmesis, scar discomfort, and evidence of superficial or deep wound sepsis. A greater number of patients dressings remained dry on day 1 postoperatively in the two groups with 2-octylcyanoacrylate compared to the no glue group p=0.001. G+T group had a significantly lower proportion of patients with increased leakage of wounds on 2. nd. postoperative day p=0.044. At 3 months review, there was no statistical difference in the Hollander score or scar discomfort. In patients who have had primary total hip arthroplasty, usage of 2-octylcyanoacrylate for wound closure along with Tegaderm dressing reduces wound discharge. The same effect is not noted in glue with Opsite group. Whilst dressing changes required in the non-glue group compared from the two glue groups did not reach statistical significance, this may have clinical relevance for patients and nursing staff. No effect on postoperative length of stay, or wound complications was noted

Material and methods:. Fifteen patients sustaining high energy Gustilo 3B injuries of the tibia were treated from 2003 to 2009 with initial debridement followed by application of an external fixation device allowing immediate acute shortening of the bone gap. The bone defects ranged from 3 cm to 5 cm. Wound management was achieved with a vacuum assisted closure device (VAC) until granulation tissue covering the exposed bone made coverage with split skin grafting possible. A delayed progressive lengthening procedure was used to equalize the leg length discrepancy after wound cover was achieved. Results:. The mean age of the 15 patients was 30 years and treatment times varied from 4 to 12 months. All fractures united with acceptable alignment and equalization of the leg length discrepancy. One patient required repeat procedures for a pin site infection by changing a wire. There was no deep sepsis. Conclusion:. This method is a satisfactory and safe alternative for the acute management of the compound wound, when plastic surgery skills are either unavailable or flap cover is contraindicated in the presence of sepsis or as a salvage procedure following flap failure. Wire placement needs to be carefully planned in order to accommodate initial VAC placement, followed by final definitive fixation after wound cover has been achieved

Purpose of Study. We intended to determine our rates of deep infection and non-union in severe open tibial fractures treated at our institution with Ilizarov frames. Methods. We retrospectively reviewed the case notes and radiographs of sixty consecutive cases of severe (Gustillo-Anderson Grade III) open fractures of the tibia treated in our tertiary referral unit with the ‘Flap and Frame’ technique. This technique involves early aggressive soft tissue and bone debridement and temporary skeletal stabilisation, followed by soft tissue coverage and then, when the soft tissues have settled, definitive skeletal stabilisation with the Ilizarov frame. The primary outcome measures were the presence of deep infection, occurence of union with the index frame, and any requirement for secondary amputation. Results. Mean average age was 43.3 years (range 16–89). None had neurovascular injuries requiring repair, while three quaters required soft tissue coverage procedures. Half of the fractures had significant bone loss following debridement, with a mean average loss of 28.1 mm (range 5–125). Mean followup was 10.3 months. The deep sepsis rate was 1.7 percent, or 5 percent including cases with significant soft tissue infection but no confirmed bone infection, with a 5 percent non-union rate. Conclusion. In our centre management of severe open fractures of the tibia treated with the ‘Flap and Frame’ technique, with Ilizarov, fixation achieves rates of deep infection and union which compare favourably with previously reported results

Obtaining primary wound healing in Total Joint Arthroplasty (TJA) is essential to a good result. Wound healing problems can occur and the consequences can be devastating to the patient and to the surgeon. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as Type A: no healing compromises and Type B: systemic or local healing compromises factors present. Local factors include traumatic arthritis with multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion, and excessive local adipose deposition. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immune compromise, steroids, smoking, and poor nutrition. In high risk situations the surgeon should encourage positive patient choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We do all potentially complicated TKAs without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems do occur immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count, and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound. Options available for coverage of complex wound problems include myocutaneous flaps, pedicled skin flaps, and skin grafts. Wet, occlusive dressings and wound VACs encourage epithelisation of chronic wounds

Introduction. Negative remodelling of the femoral cortex in the form of calcar resorption due to stress shielding and cortical hypertrophy at the level of the tip of the implant, due to distal load transfer, is frequently noted following cemented total hip replacement, most commonly with composite beam implants, but also with polished double tapers. The C-stem polished femoral component was designed with a third taper running from lateral to medial across and along the entire length of the implant, with the aim of achieving more proximal and therefore more natural loading of the femur. The hoop stresses generated in the cement mantle are transferred to the proximal bone starting at the calcar, which should theoretically minimise stress-shielding and calcar resorption, as well as reducing distal load transfer, as signified by the development of distal femoral cortical hypertrophy. Materials/Methods. We present the results of a consecutive series of 500 total hip replacements performed between March 2000 and December 2005 at a single institution, using a standard surgical technique and third generation cementing with Palacos-R antibiotic loaded cement. Data was collected prospectively and the patients remain under annual follow-up. 500 arthroplasties were performed on 455 patients with an average age of 68.3 years (23–92). 77 patients have died (73 arthroplasties) and the average duration of follow-up for the entire series is 81 months (52–124). Results. Only 2 femoral implants have been revised - one for deep sepsis and the other as part of a revision procedure for a loose acetabulum, although the femoral component itself was not loose. One implant is currently loose following a periprosthetic fracture treated by internal fixation, but none of the other remaining implants demonstrates any progressive radiolucencies in any Gruen zones, or any features suggestive of current or future loosening. Rounding of the calcar has been observed, but there have been no cases with obvious loss of calcar height and no cases of distal femoral cortical hypertrophy. Conclusion. The C-stem femoral component has therefore performed well in clinical practice and the objective of eradicating negative bone remodelling has been achieved. The study is ongoing

The purpose of the study was to identify factors that affect the incidence of deep wound infection after hip fracture surgery. Data from a hip fracture database of 7057 consecutively treated patients at a single centre was used to determine the relationship between deep wound sepsis and a number of factors. Fisher's exact test and the unpaired T test were used. All patients were initially followed up in a specialist clinic. In addition a phone call assessment was made at one year from injury to check that no later wound healing complications had occurred. There were 50 cases of deep infection (rate of 0.7%). There was no significant difference in the rate of deep sepsis with regards to the age, sex, pre-operative residential status, mobility or mental test score of the patient. Specialist hip surgeons and Consultants have a lower infection rate compared with surgeons below Consultant grade, p=0.01. The mean length of anaesthesia was longer in the sepsis group (76minutes) compared to the no sepsis group (65minutes), this was significant, p=0.01. The patient's ASA grade and fracture type were not significant factors. The rate of infection in intracapsular fractures treated by hemiarthroplasty was significantly greater than those that had internal fixation, p=0.001. The rate of infection in extracapsular fractures fixed with an extra-medullary device was significantly greater than those fixed with an intra-medullary device, p=0.021. The presence of an infected ulcer on the same leg as the fracture was not associated with a higher rate of deep infection. In conclusion we have found that the experience (seniority) of the surgeon, the length of anaesthesia and the type of fixation used are all significant factors in the development of deep sepsis. These are all potentially modifiable risk factors and should be considered in the treatment of hip fracture patients

Negative remodelling of the femoral cortex in the form of calcar resorption due to stress-shielding, and femoral cortical hypertrophy at the level of the tip of the implant due to distal load transfer, is frequenly noted following cemented total hip replacement, most commonly with composite beam implants, but also with polished double tapered components. The C-stem polished femoral component was designed with a third taper running from lateral to medial across and along the entire length of the implant, with the aim of achieving more proximal and therefore more natural loading of the femur. The implant is designed to subside within the femoral cement mantle utilising the cement property of creep, generating hoop stresses, which are transferred more proximally to the femoral bone, starting at the level of the medial calcar. The intention is to load the proximal femur minimising stress-shielding and calcar resorption, as well as reducing distal load transfer as signified by the lack of distal femoral cortical hypertrophy. We present the results of a consecutive series of 500 total hip replacements using C-stem femoral components, performed between March 2000 and December 2005 at a single institution. Data was collected prospectively and all patients remain under annual follow-up by a Specialist Arthroplasty Practitioner. The operations were performed using a standard surgical technique with third generation cementing using Palacos-R antibiotic loaded cement. 500 arthroplasties were performed on 455 patients with an average age at the time of surgery of 68.3 years (23-92). There were 282 (62%) female and 173 (38%) male patients with osteoarthritis being the predominant diagnosis. 77 patients have died (73 hips) and the average duration of follow-up for the entire series is 81 months (52-124). Only 2 femoral implants have been revised - one for deep sepsis and the other as part of a revision procedure for a loose acetabulum, although the femoral component itself was not loose. One implant is currently loose following a periprosthetic fracture treated by internal fixation, but none of the remaining implants demonstrates any progressive radiolucencies in any Gruen zones or any features suggestive of current or future loosening. Calcar rounding has been observed, but there have been no cases with obvious loss of calcar height and no cases of distal femoral cortical hypertrophy. The C-stem femoral component has therefore performed well in clinical practice and the objective of eradicating negative bone remodelling has been achieved. The study is ongoing

This paper reports the clinical outcomes and survivorship of a prospective series of Advantim cementless TKR performed at the RAH between 1993 and 2005. There were 210 knees in 176 patients. All procedures were performed or supervised by a single surgeon. All patients were followed up at regular intervals, up to 15 years later, with Knee Society Cinical Rating System and X-Rays. No patients were lost to follow-up. The knee rating improved from a median of 47 to 90. The median range of motion was 0–100. At 11 years the survivorship of the tibial component was 95.5% and femur was 93.7%. There were two major revisions and three minor revisions for polyethelene exchange. There was no deep sepsis. There was no knee stiffness requiring arhrolysis or manipulation. No screw osteolysis observed. Advantim was the best perfoming TKR in the AOA registry in 2008 with 0.3 revisions per 100 observed component years. Conclusions. Advantim has excellent clinical outcomes and survivorship. Screws provide rigid initial and ongoing stability to tibial implant-bone construct. Screw osteolysis should not be a concern in a good implant design

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