INFIX is a minimally invasive, biological way of achieving reduction and providing stability in complex fractures of pelvis .Study design- Prospective case series Aims and Objectives: Evaluate complications and functional outcome measures using both disease specific scores and quality of life scores.Methods : A total of 12 out of 112 pelvic fracture patients during one year study duration had complex fracture patterns of anterior pelvic ring and was decided for INFIX by two pelvic surgeons. Reduction criteria was evaluated radiologically using Matta’s criteria, Pelvic deformity Index (PDI) and Pubic symphyseal opening. Results : Fracture reduction was excellent in 10 (83.3%) cases and good in 2 (16.6%) cases. Average PDI in post-operative period and post implant removal was 0.0130 and 0.0170 signifying maintenance of reduction even after INFIX removal. Functional outcomes were excellent in 11 patients (91.6%) and good in 1 patient with mean Majeed score of 92.67±5.8. The average IOWA pelvic score at 6 month post-operative follow up was 93.92±6.201. The average SMFA score at 6 months follow up was 51±4.39 (Function Index and Bother Index within normal population norms) suggestive of excellent outcome. On analyzing SF-12 scores, the average PCS12 score indicating physical wellbeing was 48.493±6.74 (Range 33.68-55.81) and average MCS12 score indicating mental wellbeing was 56.370±4.04 (Range 48.633-63.790). Conclusions : INFIX is a safe, effective and viable option for addressing complex pelvic fractures involving the anterior half of pelvic ring with excellent radiological and functional outcomes and predictable fracture healing.

Introduction:To compare the clinic effects of 3D printing assisted transrectus abdominis lateral incision and traditional ilioinguinal approach in the treatment of pelvic fracture.

Methods:46 patients with pelvic fracture who were treated in orthopaedic department in our hospital were selected as research object, they were randomly divided into the experimental group and the control group, with 23 patients each. The control group was given traditional ilioinguinal approach surgery, while the experimental group was given 3D printing assisted transrectus abdominis lateral incision surgery. The hip function, pain visual analogue score and operation time, postoperative drainage volume, hospital stay, length of incision and complications were compared between the two groups.

Results:  After 6 months' follow-up, the excellent and good rate of hip function in the experimental group was significantly higher than that in the control group, with statistical significance, P＜0.05; the operation time and hospital stay in the experimental group were significantly shorter than those in the control group, the postoperative drainage volume was significantly less than that in the control group, and the length of incision in the experimental group was significantly shorter than that in the control group, with statistical significance all, P＜0.05; the total incidence of complications in the experimental group was significantly lower than that in the control group, P＜0.05.

Conclusion:Compared with the traditional ilioinguinal approach, the 3D printing assisted transrectus abdominis lateral incision approach in the treatment of patients with pelvic fractures can shorten the recovery time of hip function, receive more significant effect.

Introduction Peri-implant (PIFs) and periprosthetic fractures (PPFs) of the femur are commonplace in parallel with rising age of the population. The literature is sparse on post-surgery functional outcomes in these two groups. In this study, we compare the Modified Barthel’s Index (MBI) scores of PIFs and PPFs from premorbid to 12-months after surgery. Charlson Comorbidity Index (CCI), Bone Mineral Density (BMD) and mortality at 24 months were measured.
Methods A sample size of 33 patients with PIFs (n=16) and PPFs (n=17) over 3 years was obtained. MBI at premorbid, 6 and 12 months were collected. Return to function was assessed as return to the same level of independence as premorbid. Student’s t-test was used for statistical significance. CCI, BMD, and mortality at 48 months were measured.
Results PIFs and PPFs patients have similar independence scores from premorbid to the 12-month mark. The MBI scores did not show any statistical significance. 61% of patients were noted to return to their premorbid function with only 3% falling by two levels of independence. Both groups were comparable in terms of frailty, BMD readings and mortality at 48 months.
Conclusion Both PIFs and PPFs have similar functional scores and recovery from the premorbid to 12-month post-surgery. Premorbid function is a stronger predictor of scores at the 12-month mark than age. The groups share common risk factors such as frailty, age, gender and low bone density. PPFs confer a similar mortality to hip fractures.

Level of evidence Grade III, retrospective, cohort study

Abstract:
A 22-year old male, who was injured in trafic accident as passenger, was brought to our hospital with billateral asymetric traumatic hip dislocations, associated with fracture of right acetabulum. After initial clinical examination and full body scan, other injuries were excluded. Neurovascular status on lower extremities initially was good. After completion of diagnostics, closed reduction was performed under general anesthesia. Indication for operative treatment of right acetabulum fracture was based on postreduction radiographs and CT of pelvis. Operative treatment (open reductuon and internal fixation) was performed 3 days after injury. 6 months after operation, we stated that fracture healed in good position and the patient was fully recovered.


Key words: bilateral, dislocation , hip, trauma

Introduction: The management of open fractures of the distal lower extremity is challenging. These injuries are associated with increased complications and bear significant socioeconomic impact. Current literature demonstrates that delayed soft tissue coverage for Gustilo III fractures of extremities have increased complication rates. Meeting the recommended time frame for coverage is however often not possible, and this may lead to poorer patient outcomes. Objective: We aim to (i) determine infection rates (soft tissue infection, osteomyelitis) in patients with delayed coverage, and (ii) measure complications of prolonged recumbency (deep vein thrombosis, pulmonary embolism, pressure injuries, pneumonia). Methods: Retrospective analysis of consecutive patients from January 2018 to December 2021 with Gustilo IIIB and IIIC fractures of distal tibia, ankle, and foot who underwent free-flap coverage procedure was performed. Patients with ≤1 initial debridement, <6 months of follow-up, and locoregional flaps were excluded. Results: 12 patients met the criteria, with mean time-to-free-flap procedure of 15 days. 1 patient had coverage performed <7 days from index injury. Only 1 patient (8%) belonging to the delayed (>7 days) group developed a soft tissue infection. No patient in either group developed osteomyelitis or complications of prolonged recumbency. Conclusion: Contrary to published literature, delayed soft tissue coverage for open fractures of the distal lower limb did not yield significant infection rates. These lower rates may be due to: (i) multiple debridements performed (mean of 4 in our study), (ii) consultant-led debridements (more meticulous and extensive), (iii) use of adjuncts (antibiotic cement beads, local vancomycin powder, gentamicin-collagen sponge).

ABSTRACT BACKGROUND: The initial severity of the condition of victims with vertically unstable pelvic injuries often does not allow for early reconstructive surgery. Thus, the number of long-standing damages is growing. Treatment of patients with chronic injures (after 3 weeks since injury) of the pelvic ring with the vertical displacement (more than 20 mm) causes a separate difficulty. AIM: To analyze the immediate and long-term results of treatment of patients with chronic vertically unstable pelvic ring injuries. MATERIALS AND METHODS: The results of treatment of 31 patients of the Priorov National Medical Research Center with chronic vertically unstable damage to the pelvic ring in the period from 2017 to 2024 were analyzed. To assess the results of treatment, clinical and radiation diagnostic methods and the Majeed questionnaire were used. RESULTS: The long–term follow-up period for patients ranged from 1 to 3 years (on average 2.1 years). Excellent results on Majeed a year after surgery were achieved in 3 (9.7%) patients, good in 25 (80.6%), satisfactory in 3 (9.7%), there were no unsatisfactory results. CONCLUSIONS: The technique of spino-pelvic fixation makes it possible to effectively treat chronic vertically unstable injuries of the pelvic ring and perform simultaneous reposition and stable fixation of the posterior pelvic ring.

Introduction: The important components of soft tissue management for ankle fractures are lower limb elevation
and fracture site distraction. With the available methods for soft tissue management, no single technique is found to be effective in providing simultaneous limb elevation and fracture distraction. Thus, we propose use of Triangular Elevation and Distraction (TED) frame, as a novel design of external fixator for soft tissue
management. Methods: The data of patients admitted with Pilon fracture (AO/OTA-43 B, 43C) from January 2017 to December 2019 were retrospectively collected from the hospital records. A total of 105 patients with pilon fracture (AO/OTA- 43 B, 43C) were admitted; of whom 63 patients fulfilled the inclusion criteria. All these patients were given either TED frame or Bohler Braun Splint along with Calcaneum Pin Traction (BBSCPT) for the initial management.
Results: Thirty patients were managed with TED and 33 with BBSCPT for pre-operative soft tissue resolution. The mean time for swelling subsidence after application of TED was 75.9 + 14.7hrs (Mean + SD) compared to 117.5 + 25.9hrs required in BBSCPT group. Time required for soft tissue resolution in AO/OTA 43-B fractures was significantly less in TED group 68.7 + 13.2hrs, compared to BBSCPT group 102.4 + 15.4hrs. Swelling subsidence was also noted significantly earlier in AO/OTA 43-C fractures managed with TED 84.2 + 12hrs compared to 135.7 + 24.3hrs with BBSCPT.
Conclusion: This novel TED design is an economical, effective, and easy-to-apply solution for the management of soft tissue components in fractures around the ankle.

Background: Pelvic fractures and concomitant injuries remain problems in orthopaedics, especially when the fracture is more than 4 weeks old. Open reduction will increase the number of severe, life-threatening injuries, regardless of the approach is used. The Starr Frame made a revolution in pelvic surgery. The invention made it possible to treat also old pelvic fractures with closed reduction and low invasive surgery. But this frame is bulky and has its own disadvantages. Methods: For unstable pelvic fractures, we established a comprehensive and integrated solution. We made a modification of the Starr Frame, that can be easier used in operating room. Results: The modified Pelvic Frame (MPF) is very helpful for closed reduction and percutaneous fixation in complex pelvic fractures. In this study, a minimally invasive fixation technique in the pelvic fracture was explored. Although the patient had delayed anterior sacral nerve compression problems after trauma we developed a traction system and surgical method using the MPF to achieve a closed reposition after 5 weeks from accident. The patient was relieved of nerve pressure, pain and rehabilitate his leg movement and sensitivity. Conclusions: This treatment method could be an alternative treatment for pelvic fractures and concomitant injuries. The application of this treatment is a safe and feasible option that can be employed to manage early and late nerve repair with sacral fractures when open surgery or conservative treatment is unsuitable. The MPF is more comfortable to use in operating room through its size and possibilities in its accommodation.

Introduction:
Iliosacral rescue screws (ISRSs) may be utilized in trauma patients with unstable pelvic fractures and associated hemodynamic instability. The goal of the current study is to determine the early impact of this measure on cardiopulmonary status.
Methods:
Patients with unstable pelvic ring injuries and hemodynamic instability were extracted from the institutions pelvic trauma registry. Patients treated by ISRSs between 2015 and 2021 were included. The impact of ISRS-placement on pelvic volume (distance between the left and right anterior sup. iliac spine (SPIAS)) was calculated prior to and after rescue screw placement. Moreover, vital parameters and resuscitation requirements was determined.
Results:
A total of 40 patients with a mean age of 46 (std. 18) and an ISS 30 (std. 12) received ISRSs. Systolic blood pressure (SBP) in hemodynamically unstable patients in this cohort was 85 (std. 16) mmHg on admission. After resuscitation and ISRS-placement SBP was significantly higher (107 (std. 14) mmHg, P=0.0003). No statistically significant changes in pulse rate and vasoactive medication requirements were observed. ISRS-placement resulted in a statistically significant volume reduction of the pelvis as the distance between both SPIAS decreased from 232 (std. 17)cm to 222 (std. 23)cm (P=0.015).
Conclusions:
The current study shows that iliosacral rescue screws are an effective tool to reduce pelvic volume and to stabilize the pelvic ring in hemodynamic unstable trauma patients with pelvic ring injury. These findings warrants the implementation of TRSs as a treatment modality in guidelines for unstable pelvic ring injuries.

Introduction:Urinary tract injuries (UTIs) such as bladder, ureter, or urethral lesions occur frequently in patients with pelvic trauma. Especially bladder injuries negatively affect outcome. However it´s exact impact is unclear. This study aimed to investigate the association between urinary tract injuries on outcome of trauma patients with pelvic trauma.
Methods:All adult patients with pelvic trauma and concurrent UTIs have been included from our trauma registry. Two groups were composed and compared.Group BLAD comprised patients with bladder injuries, while Group URET included those with ureter or urethra injuries. Outcome parameters examined included length of hospital stay (HLOS), length of intensive care unit stay (ICU-LOS), complication rates including infections, and mortality.
Results:The study included 43 patients with a mean age of 43 +/- 20. The mean Injury Severity Score (ISS) was 37 +/- 10.Group BLAD (N=33) had a significantly higher incidence of infectious complications compared to Group URET (N=10), respectively 60.1% vs. 20.0%; P=0.03. Gram-negative infections were most common (N=15). Fifteen patients developed sepsis. There were no significant differences in ICU and hospital stays or overall mortality rates between the two groups.
Conclusions:Concurrent traumatic injuries of the urinary tract in patients with pelvic trauma are associated with elevated rates of infectious complications and sepsis. Notably, infection rates are higher in associated bladder injuries compared to ureter or urethra lesions, with gram-negative bacteria being the most frequently implicated pathogens. Given the increasing clinical importance of antibiotic-resistant gram-negative bacteria, co-treatment of urinary tract injuries in pelvic trauma warrants the development of novel international guidelines.

Purpose:To evaluate the complications of acetabulum fractures and the factors affecting the quality of reduction in surgically operated cases Material:116 patients with 120 acetabular fractures were included. Demographic data, mechanisms of injury, fractures morphology, complications and radiological outcomes were recorded. The significance of factors including age, gender, mode of injury, associated injuries, individual fracture patterns and timing of surgery on quality of reduction was assessed.Results:81% of the study population were males, with average age of 39.95± 15.87 years. 70 of these patients were operated with an average time duration from injury to surgery of 8.32 days. Mortality was reported in 5 patients, 4 patients had deep vein thrombosis and sciatic nerve injuries was seen in 12 patients of which 4 were iatrogenic. 8 patients had infection of which 4 required multiple debridements. 4 cases developed heterotopic ossification while 2 cases had a loss of reduction.Quality of reduction was assessed as per Mata’s criteria as anatomical (n=29), congruent (n=31) and incongruent (n=10). The quality of reduction was seen to be associated with timing of surgery and other associated fractures while age, gender, mode of injury or individual fracture patterns had no such effect.Conclusion:
The aim of fixation of acetabulum fractures is to achieve anatomical reduction by early open reduction and internal fixation with management of associated injuries for improved patient outcomes.

Introduction:
Acetabular fractures and pelvic ring fractures are caused by motor vehicle accidents, pre-falls or simple falls and rarely by sports injuries. The aim of the study was to investigate the return to sport after acetabular and pelvic ring fractures

Method: In this retrospective study, hospital records and clinical notes were reviewed in order to collect demographic data, injury mechanism, date of surgery, operating times, type of implants, and surgical approaches.

Results: A total of 35 patients met the inclusions criteria. Twenty patients had acetabular fractures (male/female ratio of 4:1, mean age of 45,3 years); 15 had pelvic ring fractures (male/female ratio of 6,5/1 ratio and mean age of 51,3 years). According to Judet-Letournel classification, the most common fracture pattern includes the posterior and anterior wall , followed by the posterior wall and column and both columns. They have been ranked by the mean of their placement in every item (PCS-12; MCS-12; MAQ total; HOS total; HSAS and TAS).
According to Young-Burges classification, the most common fracture pattern is the antero-posterior compression, followed by the lateral compression and the vertical shear . The results of the comparison between the APC, LC and VS fractures were calculated with ANOVA test

Conclusions: For acetabular fractures the ones of the anterior region have a better outcome compared to the posterior ones, whereas for the pelvic ring fractures APC have a best outcome, followed by the LC and VS ones.