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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 87 - 87
1 Sep 2012
Alolabi B Studer A Gray A Ferreira LM King GJ Athwal GS
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Purpose

There have been a number of described techniques for sizing the diameter of radial head implants. All of these techniques, however, are dependent on measurements of the excised native radial head. When accurate sizing is not possible due to extensive comminution or due to a previous radial head excision, it has been postulated that the proximal radioulnar joint (PRUJ) may be used as an intraoperative landmark for correct sizing. The purpose of this study was to: 1) determine if the PRUJ could be used as a reliable landmark for radial head implant diameter sizing when the native radial head in unavailable, and (2) determine the reliability of measurements of the excised radial head.

Method

Twenty-seven fresh-frozen denuded ulnae and their corresponding radial heads (18 males, 9 females) were examined. The maximum diameter (MaxD), minimum diameter (MinD) and dish diameter (DD) of the radial heads were measured twice, 3–5 weeks apart, using digital calipers. Two fellowship-trained upper extremity surgeons, an upper extremity fellow and a senior orthopedic resident were then asked to independently select a radial head implant diameter based on the congruency of the radius of curvature of the PRUJ to that of the radial head trial implants. The examiners were blinded to the native radial head dimensions. This selection was repeated 3–5 weeks later by two of the investigators. Correlation between radial head measurements and radial head implant diameter sizes was assessed using Pearsons correlation coefficient (PCC) and inter and intra-observer reliability were assessed using intra-class correlation coefficient (ICC).


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 140 - 140
1 Feb 2004
Studer A Resines-Erasun C Caba-Dossoux P Leòn-Baltasar JL Vidart-Anchía M Aroca-Peinado M
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Introduction and Objectives: High-energy fractures of the pelvis carry a high mortality and pose a diagnostic and therapeutic challenge in modern orthopaedic trauma. A multidisciplinary approach has reduced mortality in the past two decades. In cooperation with the polytrauma ICU, we have developed a diagnostic-therapeutic algorithm to determine indications for laparotomy, external fixation, and angiography, in terms of clinical evolution and fracture type.

Materials and Methods: This is a retrospective study of 67 patients with pelvic fractures and persistent hae-modynamic instability who were treated in our centre between 1994 and 2002. The following parameters were analyzed: personal data, AIS, ISS, RTS, type of fracture (Young and Burgess classification), associated injuries, haematologic requirements, and degree of adherence to the algorithm in terms of diagnostic and therapeutic measures. The following results variables were examined: mortality, incidence of systemic complications associated with traumatic illness (MOF, ARDS, DIC), and length of hospital stay.

Results: The study involved a total of 67 patients, all with pelvic fractures and persistent haemodynamic instability. Average age was 37.7 years, and average time in the ICU was 13.8 days. In 53.7% of cases, patients were transported to the centre by ambulance, 41.8% by helicopter, and the remaining 4.5% by other means. Adjusted mortality was 25%. External fixation was used on 42 patients (62%) and angiography in 36 (53%). Both techniques were used in combination in 17 patients. Of the 36 patients who underwent angiography, 33 showed positive findings (91.7%). Exploratory laparotomy was required in 23 patients due to positive findings on abdominal ultrasound, which yielded positive results in 20 cases. Mortality in these patients was 45%. Average ISS was 29.

Discussion and Conclusions: Rapid evaluation and a multidisciplinary approach are necessary in handling patients with pelvic fracture and haemodynamic instability. External fixation is a rapid procedure that is safe and simple, permitting the control of haemody-namic instability, which should be considered more as an emergency stabilisation technique than a reconstructive procedure. Abdominal ultrasound is a very sensitive method when deciding whether or not to perform an exploratory laparotomy. In cases with rotational instability of the pelvis, laparatomy should be done only after pelvic fixation. A diagnostic-therapeutic algorithm has been designed for the management of pelvic instability, with particular emphasis on indicators of a poor prognosis.