High-energy pelvic ring fractures are associated with polytrauma where staged surgery is recommended. While temporary skeletal stabilisation is part of the acute management, definitive care is done in a later phase. The purpose of this study was to evaluate the safety and efficacy of acute pelvic ORIF by comparing its short term outcome with those who were stabilised late. A 45-month retrospective review of the prospective pelvic fracture database of a level one trauma centre was performed. All high-energy trauma patients who were potential candidates for minimally invasive internal fixation of the pelvic ring were included. Patients were categorised as acute ORIF (<24 hrs) or late ORIF (>24 hrs). Demographics, ISS, pelvic AIS, 24 hour pack cell transfusions, physiological parameters, time to operating theatre, angiography requirement, LOS and mortality were recorded. Data was presented as mean+/−SD or percentages. Statistical significance was determined at ∗p<0.05 based on univariate analysis. Forty-three patients met inclusion criteria, seventeen patients had acute definitive ORIF (5.5 hrs to OT) and twenty-six late definitive ORIF (5 days to OT). Acute and late ORIF patients had statistically not different demographics (age: 48+/−22 years vs 40+/− 14, gender: 82% vs 79% males), injury severity (ISS: 30+/−18 vs 24.5+/−13, pelvic AIS: 3.7+/− 1 vs 3.4+/− 1.1) and 24 hour transfusion (4.7+/−5 U vs 6.6+/−4 U). Initial shock parameters were significantly worse in the acute ORIF group (∗SBP 69.7+/−17 vs 108+/−21 mmHg, ∗BD -7.35+/−4 vs -4.9+/−1.5 mEq/L, ∗Lactate 6.67+/−7 vs 2.51+/−1.3 mmol/L). Angiography was used 18% (3/17) vs 21% (6/29) of the cases. All early ORIF patients survived and one (3%) of the late ORIF patients died. The trend in shorter hospital LOS was not significant in the early ORIF group (25+/− 24 vs 37+/− 32 days) while the ICU LOS was comparable (12/17 patients with 2.9+/−2.5 days vs 15/26 patients with 3.7+/−3.6 days). Minimally invasive acute ORIF of unstable pelvic ring fractures could be performed even in severely shocked polytrauma patients. The procedure did not lead to increased rates of transfusion, mortality, ICU LOS or overall LOS. Furthermore, all these parameters showed a trend towards benefit compared to a staged approach.
An experimental model was designed to find a theoretical solution to the clinical problem of congenital tibial pseudarthrosis in children. The osteogenic properties of periosteum having been accepted, paired pedicled flaps of periosteum were raised from the subcutaneous surface of the tibia, tubed and anastomosed in a series of young dogs. In the last twenty-four consecutive cases the rate of complete ossification in these tubes rose to one in three. In the later stages of the work, in addition to the construction of periosteal tube grafts, pseudarthroses were induced in the middle third of each canine tibia in order to see if hypertrophy would occur under the stress of weight-bearing. It was found that in each of twenty-four specimens some hypertrophy occurred in the ossified periosteal tube grafts, and in three of the specimens this hypertrophy was associated with complete ossification of the graft that by-passed the pseudarthrosis.
