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F2.4 Is posterior tension band plating for vertically unstable transforaminal sacral fractures safe in terms of soft tissues?
Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13
Results: In the model simulates standing, overall motion at the posterior column was minimum when two columns were plated (0.071 mm). The second best fixation was posterior column plate with anterior column screw (0.077 mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326 mm). The successor was plating two columns (0.0333 mm). In the model that simulates sitting, overall at posterior column motion was minimum when two columns were plated (0.047 mm), and then posterior column plate with an anterior column screw (0.051 mm). Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.019 mm) two columns were plated (0.047 mm), and then plating both columns (0.0203 mm). Conclusion: Posterior column plating combined with anterior column screw has quite comparable results to both column plating in transverse fractures, making two column fixation unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures. F2.2 Male sexual dysfunction after pelvic fracture C. Çopuroglu1 , B. Yilmaz2 , S. Yilmaz2 , M. Özcan1 , M. Çiftdemir1 , E. Çopuroglu1 . 1Trakya University, 2Adiyaman Besni DH, Adiyaman, Turkey Introduction: Pelvic fractures usually result from high-energy trauma. Sexual dysfunction is a significant complication after pelvic fracture. Though anatomical problems can be a reason of sexual disorders, psychological factors following a trauma may also be linked to sexual problems. Materials and Methods: To evaluate the frequency of sexual dysfunction after pelvic and acetabular fractures, and to help pelvic fracture patients with their usually undisclosed sexual problems, through timely referrals to relevant clinics, and offer them support. We retrospectively evaluated a 2-year period, which included 18 male patients with a mean age of 41.8-years (range, 19–61 years), based on our institutional data. All patients were requested to complete the Arizona Sexual Experience Scale (ASEX), which is a 5-item self-evaluation scale. According to the results of the questionnaire, patients who needed supportive treatment were referred to the psychiatry department. Results: Nine patients (50%) scored 10 points or less in the ASEX questionnaire. The remaining 9 patients (50%) had 11 points or more. Two (22.2%) of these 9 patients had a score of 19 points or more. Patients with a score of 19 points, any one item with a score of 5 or 6 points, or any three or more items with a score of 4 points were considered to have a high probability of sexual dysfunction through psychiatric examination. High probability patients were considered as patients with a definite need for psychiatric treatment. Conclusion: The frequency of sexual dysfunction in pelvic fracture patients was tested, and the necessity of orthopedic surgeons need for investigating early history of pelvic fractures in patients with sexual disorders was stressed. This study will attract the attention of orthopedic surgeons to sexual dysfunction in patients with pelvis fractures and the necessity of referring them to related clinics for treatment. F2.3 Epidemiology of pelvic and acetabular fractures in a Ümraniye-Istanbul T. Kurtulmus1 , N. Saglam1 , G. Saka1 , M. Abughalwa1 , C. Avci1 . 1Ümraniye Training and Research Hospital, Istanbul, Turkey Introduction: Pelvic and acetabular fractures are usually caused by high-energy trauma such as traffic accident, fall from height, crush injuries, and may have associated other organ systems damage. These fractures occur in all ages.
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Materials and Methods: We evaluated all the cases of pelvic and acetabular fractures that conservative and underwent surgery over a six year period (from 2006 to 2012) was carried out, retrospectively. Population of Ümraniye city is approximately 800.000 and ten private hospital, one training and research hospital are in Ümraniye. We classified this fracture according to modified Tile AO Muller ¨ classification. We recorded demographic data, injury mechanism and site of injury. Results: We hospitalized 64 acetabular and 139 pelvic fractures, totally 203 patients. We operated 11 pelvic fractures of 139 patients (Group A), 17 acetabular fractures of 64 patients (Group B). Mean age was 49 (13–86) years in group A, 42 (797) years in group B. The etiology of fractures was 73 traffic accident, 23 fall from height, 12 suicide attempt, 10 crush, 19 fall of ground level, 2 sport activities in group A and 37 traffic accident, 12 fall from height, 8 suicide attempt, 6 fall from stairs, 1 gunshot in group B. We recorded accompanying complication with fractures. Conclusion: We found in our study that all age groups were affected by this injury and traffic accident and fall from height occurred in young men and children, simple traumas in elderly patients and suicide in young lady. We operated 29 patients (13.8%) with releated unstable pelvic and acetabular fractures. F2.4 Is posterior tension band plating for vertically unstable transforaminal sacral fractures safe in terms of soft tissues? H. Kinik1 , T. Ahmad2 . 1Ankara University, Dept of Orthopedics & Traumatology, 2Acibadem Ankara Hospital, Dept of Orthopedics & Traumatology, Ankara, Turkey Introduction: In the management of vertically unstable sacral fractures, fixation techniques including transiliac bars, iliosacral screws and reconstruction plates were advocated. Transiliac bars have lower biomechanical properties. Iliosacral screws were shown a high failure rate in transforaminal fractures. Posterior tension band plating was considered as disadvantageous in terms of wound complications. The purpose of this study was to evaluate the complication rate and short-term outcome of vertically unstable transforaminal sacral fractures treated by posterior tension band plate fixation. Materials and Methods: All patients were treated by the same surgeon between years 2005–2010 with a posterior approach using 4.5 mm reconstruction plates and various forms of internal or external anterior pelvic ring fixation. The group had 25 patients (11 male and 14 female) with a mean age of 34.6 years whom were followed for at least 12 months by the same surgeon. The mean follow-up was 18.76 months. One very large soft tissue contusion, 1 subcutaneous laceration and 1 large dermabrasion were identified in three patients. Results: Ten patients had various associated skeletal injuries. Mean surgical incision length was 13.36 cm in the fractured side. Mean healing time of fracture is 7.84 weeks. There was one deep infection in the series that necessitates multiple debridement, irrigation and antibiotic cement bead applications. In one patient with associated transverse acetabular fracture and symphyseal diastasis; Pfannenstiel, triradiate Y and also posterior pelvic approaches were used for fixation. This patient had a local posterior wound necrosis and superficial infection that was treated with debridement and a rotational flap that healed uneventfully. All the fractures united without any implant failure or loss of reduction. Conclusion: Posterior plate fixation of vertically unstable transforaminal sacral fractures is stable enough to prevent loss of reduction, necessitates little radiation exposure and safe in terms of wound problems.
Results: In the model simulates standing, overall motion at the posterior column was minimum when two columns were plated (0.071 mm). The second best fixation was posterior column plate with anterior column screw (0.077 mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326 mm). The successor was plating two columns (0.0333 mm). In the model that simulates sitting, overall at posterior column motion was minimum when two columns were plated (0.047 mm), and then posterior column plate with an anterior column screw (0.051 mm). Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.019 mm) two columns were plated (0.047 mm), and then plating both columns (0.0203 mm). Conclusion: Posterior column plating combined with anterior column screw has quite comparable results to both column plating in transverse fractures, making two column fixation unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures. F2.2 Male sexual dysfunction after pelvic fracture C. Çopuroglu1 , B. Yilmaz2 , S. Yilmaz2 , M. Özcan1 , M. Çiftdemir1 , E. Çopuroglu1 . 1Trakya University, 2Adiyaman Besni DH, Adiyaman, Turkey Introduction: Pelvic fractures usually result from high-energy trauma. Sexual dysfunction is a significant complication after pelvic fracture. Though anatomical problems can be a reason of sexual disorders, psychological factors following a trauma may also be linked to sexual problems. Materials and Methods: To evaluate the frequency of sexual dysfunction after pelvic and acetabular fractures, and to help pelvic fracture patients with their usually undisclosed sexual problems, through timely referrals to relevant clinics, and offer them support. We retrospectively evaluated a 2-year period, which included 18 male patients with a mean age of 41.8-years (range, 19–61 years), based on our institutional data. All patients were requested to complete the Arizona Sexual Experience Scale (ASEX), which is a 5-item self-evaluation scale. According to the results of the questionnaire, patients who needed supportive treatment were referred to the psychiatry department. Results: Nine patients (50%) scored 10 points or less in the ASEX questionnaire. The remaining 9 patients (50%) had 11 points or more. Two (22.2%) of these 9 patients had a score of 19 points or more. Patients with a score of 19 points, any one item with a score of 5 or 6 points, or any three or more items with a score of 4 points were considered to have a high probability of sexual dysfunction through psychiatric examination. High probability patients were considered as patients with a definite need for psychiatric treatment. Conclusion: The frequency of sexual dysfunction in pelvic fracture patients was tested, and the necessity of orthopedic surgeons need for investigating early history of pelvic fractures in patients with sexual disorders was stressed. This study will attract the attention of orthopedic surgeons to sexual dysfunction in patients with pelvis fractures and the necessity of referring them to related clinics for treatment. F2.3 Epidemiology of pelvic and acetabular fractures in a Ümraniye-Istanbul T. Kurtulmus1 , N. Saglam1 , G. Saka1 , M. Abughalwa1 , C. Avci1 . 1Ümraniye Training and Research Hospital, Istanbul, Turkey Introduction: Pelvic and acetabular fractures are usually caused by high-energy trauma such as traffic accident, fall from height, crush injuries, and may have associated other organ systems damage. These fractures occur in all ages.
S9
Materials and Methods: We evaluated all the cases of pelvic and acetabular fractures that conservative and underwent surgery over a six year period (from 2006 to 2012) was carried out, retrospectively. Population of Ümraniye city is approximately 800.000 and ten private hospital, one training and research hospital are in Ümraniye. We classified this fracture according to modified Tile AO Muller ¨ classification. We recorded demographic data, injury mechanism and site of injury. Results: We hospitalized 64 acetabular and 139 pelvic fractures, totally 203 patients. We operated 11 pelvic fractures of 139 patients (Group A), 17 acetabular fractures of 64 patients (Group B). Mean age was 49 (13–86) years in group A, 42 (797) years in group B. The etiology of fractures was 73 traffic accident, 23 fall from height, 12 suicide attempt, 10 crush, 19 fall of ground level, 2 sport activities in group A and 37 traffic accident, 12 fall from height, 8 suicide attempt, 6 fall from stairs, 1 gunshot in group B. We recorded accompanying complication with fractures. Conclusion: We found in our study that all age groups were affected by this injury and traffic accident and fall from height occurred in young men and children, simple traumas in elderly patients and suicide in young lady. We operated 29 patients (13.8%) with releated unstable pelvic and acetabular fractures. F2.4 Is posterior tension band plating for vertically unstable transforaminal sacral fractures safe in terms of soft tissues? H. Kinik1 , T. Ahmad2 . 1Ankara University, Dept of Orthopedics & Traumatology, 2Acibadem Ankara Hospital, Dept of Orthopedics & Traumatology, Ankara, Turkey Introduction: In the management of vertically unstable sacral fractures, fixation techniques including transiliac bars, iliosacral screws and reconstruction plates were advocated. Transiliac bars have lower biomechanical properties. Iliosacral screws were shown a high failure rate in transforaminal fractures. Posterior tension band plating was considered as disadvantageous in terms of wound complications. The purpose of this study was to evaluate the complication rate and short-term outcome of vertically unstable transforaminal sacral fractures treated by posterior tension band plate fixation. Materials and Methods: All patients were treated by the same surgeon between years 2005–2010 with a posterior approach using 4.5 mm reconstruction plates and various forms of internal or external anterior pelvic ring fixation. The group had 25 patients (11 male and 14 female) with a mean age of 34.6 years whom were followed for at least 12 months by the same surgeon. The mean follow-up was 18.76 months. One very large soft tissue contusion, 1 subcutaneous laceration and 1 large dermabrasion were identified in three patients. Results: Ten patients had various associated skeletal injuries. Mean surgical incision length was 13.36 cm in the fractured side. Mean healing time of fracture is 7.84 weeks. There was one deep infection in the series that necessitates multiple debridement, irrigation and antibiotic cement bead applications. In one patient with associated transverse acetabular fracture and symphyseal diastasis; Pfannenstiel, triradiate Y and also posterior pelvic approaches were used for fixation. This patient had a local posterior wound necrosis and superficial infection that was treated with debridement and a rotational flap that healed uneventfully. All the fractures united without any implant failure or loss of reduction. Conclusion: Posterior plate fixation of vertically unstable transforaminal sacral fractures is stable enough to prevent loss of reduction, necessitates little radiation exposure and safe in terms of wound problems.