Traumatic dislocation of the hip is an extremely severe injury. Complex hip dislocations (dislocation associated with acteabular or femoral fracture) are more frequent than simple dislocations and are usually associated with a higher incidence of complications.
Early recognition and emergent closed reduction within the first 6 hours constitute the cornerstone of proper treatment of this injury. A post-reduction CT with 3D reconstruction must be performed for all traumatic hip dislocations to rule out associated femoral head and acetabular fractures. If surgical reconstruction of an associated acetabular fracture is indicated, it is done best in the first 10 days after the injury. A few patients in whom nonconcentric reduction, failed closed reduction, or impaired neurologic status occurs after reduction will require early open reduction and internal fixation of the fracture. Complications can be caused by the initial injury or by the treatment.
Avascular necrosis of the femoral head, degenerative osteoarthritis, heterotopic ossification and sciatic nerve lesion are the main complications encountered in patients with unsatisfactory final results. Despite a perfect reduction of the hip dislocation and anatomic reduction of the acetabular fracture, a significant degenerative process of the hip is expected when the patient is assessed at long-term follow-up.
The authors present and discuss the management of a case serie of posterior complex traumatic hip dislocations from our institution in the past 10 years, describing both their diagnosis, initial management, acetabular fracture osteosynthesis, early and late complications and clinical, radiological and functional outcomes.

Acetabular fractures are severe articular injuries that frequently require surgical treatment. The ilioinguinal approach have long been used for reduction and fixation of displaced anterior column fractures. However, alternative approaches have been more frequently used developed to avoid the risk and complications of this classic approach.
The modified Stoppa approach is an anterior intrapelvic extraperitoneal approach which provides direct access to the pubic bones, the posterior surface of the ramus, the quadrilateral surface, the pubic eminence, and the infrapectineal surface. When supplement by a lateral window of the ilioinguinal approach (the so called anterior Combined Endopelvic (ACE) approach) provides additional access to the sciatic buttress, sciatic notch, and iliac crest and anterior sacroiliac joint.
The authors retrospectively analyzed 11 cases of acetabular fractures approached by the ACE in the least 5 years, in a level II Trauma Center. It was evaluated intra-operative blood loss, duration of surgery, intra-operative and post-operative complications, duration of hospital stay, clinical and functional Matta modification of Merle d’Aubinne score, Matta Reduction Criteria and Matta’s Radiological Criteria on follow up.
It was verified that the majory of the patients returned to their daily lifes with satisfatory clinical and radiological results. Non of them required revision osteossynthesis. However, a few ended up, at mid-term, into total hip replacement.
That authors have found that the modified Stoppa approach presents with good to excellent reduction accuracy and clinical scores in majority of cases with complication rates comparable to ilioinguinal approach.

Introduction: At our level 1 Trauma Centre, pelvic surgeons have been using an image intensifier which collects axial CT images intraoperatively, allowing for position checking of metalwork in three dimensions on-table, instead of the routine postoperative CT. We propose that utilising intraoperative CT results in a lower radiation dose to the patient, and eliminates the need for a postoperative CT. Methods: A retrospective analysis of a prospectively collected pelvic trauma database from 09/2018 to 06/2019 identified 5 patients who had fixation of an acetabular fracture using image intensifier and intraoperative CT. As a control group, the same database was analysed between 01/2017 and 01/2019 to identify 34 patients who had fixation of an acetabular fracture using image intensifier and postoperative CT. Combined radiation dose was collected. Results: In the intraoperative CT group, mean effective radiation dose was 2.13 mSv (SD 1.33). In the postoperative CT group, mean effective radiation dose was 11.25 mSv (SD 8.83), p<0.01. No patients in the intraoperative CT group required additional postoperative CT scanning. Conclusions: We demonstrate that intraoperative CT scanning has a significantly lower radiation exposure than separate postoperative CT, and achieves a clinically acceptable level of detail, as additional postoperative imaging was not required. Further research would examine use of the technology for a range of pelvic fractures and undertake an objective assessment of image quality. Other aspects to evaluate would be the health economics offered by reducing the in-patient hospital stay without the need for the post op CT.

Introduction: Current partially-threaded screws used for sacroiliac screw fixation have standardized thread lengths involving a small portion of the screw regardless of its overall length. This study aims to determine if the distance between the lateral cortex of the ilium and medial aspect of the SI joint is consistent can be used to develop novel sacroiliac screws. Methods: Adult patients with computed tomographic (CT) imaging of the uninjured pelvis were identified from our institution’s trauma database between April 2013 and September 2015. Scans were analyzed and measured, and demographic data was collected. Results: 23 male (57.5%) and 17 female (42.5%) patients were included. The mean depth to the lateral sacral cortex at S1 was 24.8 mm (dLSC-S1; range 20 to 30 mm, SD ± 2.3). dLSC-S1 was not significantly correlated with patient age, height, or BMI (all, p>0.05). Mean depth to the lateral sacral cortex at S2 was 22.9 mm (dLSC-S2, range 18 to 19 mm; SD ± 2.7). dLSC-S2 was significantly correlated with patient height (0.386, p = 0.014). Mean distance from the lateral iliac cortex to the midline of the S1 and S2 body was 77.2 mm (dML-S1; range 64 to 88 mm; SD ± 6.3) and 66.7 mm (dML-S2; range 57 to 78 mm; SD ± 5.13), respectively. Conclusion: Using a smooth segment value of 32mm, a significant increase in thread lengths is achievable allowing for a novel sacroiliac screw design to achieve greater purchase in the sacrum.

Introduction: Trochanteric fracture of femur is a major cause of disability in elderly population. Operative fixation is the treatment of choice for early ambulation. Two common implants currently popular are sliding hip screw and proximal femoral nail. This paper makes a comparative analysis of the results of these two procedures. Material & Methods: Between 2001 and 2017 one hundred thirty seven patients of trochanteric fractures of femur, treated by the author, were selected for the study. 87 of them were treated with sliding hip screw (Group A) and 50 with proximal femoral nails (Group B). 107 were female and 30 male; age varied from 30 – 92 years (average 70.2). Follow up of the study ranged from 3 to 20 years. Result: Results were evaluated according to Kyle’s criteria. In Group A, 68 (78%) had good to excellent results and 6 poor. Rest was either lost to follow up or had expired. In Group B, 40 (80%) had good to excellent result and 3 poor. Union occurred at 8 – 12 weeks in both the groups. Both the groups had almost similar complication patterns. Discussion: There was no significant difference in long term outcome between these two procedures as far as union time, operating time, complications and return to pre-injury level lifestyle were concerned. Thus results of this study are comparable to those of other workers.

Introduction: Injuries of both pelvic ring and acetabulum as rare very few articles are available in literature. There are no set protocols in defining the injury let alone defining early and definitive management strategies. This article is an attempt to encompass all available data to give us guidelines in managing these injuries. Methods: An extensive literature review was carried out on Pubmed/google scholar and embase databases were done with the eligibility criteria of 1). Case series with a minimum of 20 cases. 2). The patient’s outcome reported. 3). Full article available. 4). Article in English. 5). Minimum Jadad score of 3. As per PRISMA guidelines the search was done and gradually filtered down to relevant articles which were 8 in number. Results: The incidence of these injuries range from 5 to 16%. The transverse acetabular fracture pattern is the commonest followed by associated both column fractures. The initial management is similar to managing pelvic ring injuries with focus on patient resuscitation, hemodynamic stabilization and temporary stabilization. The injury severity score and the mortality rates are comparable to isolated unstable pelvic ring injuries. Definitve management focuses on fixing the posterior pelvic ring first followed by the acetabular fracture and then the anterior pelvic ring. The re-displacement rates and outcome is worse than isolated acetabular injuries or pelvic injuries. Conclusion: Combined Pelvic and acetabular injuries are complex injuries which needs to be managed initially as we manage pelvic injuries and later as we fix an acetabular fracture meticulously.

Acute Compartment Syndrome (ACS) is a serious clinical emergency in trauma and orthopaedic. The clinical signs and symptoms of the condition and measuring the Intramuscular Pressure (ImP) are the gold standards. However, pressure monitoring has its numerous weaknesses. Can Near Infrared Spectrometry (NIRS) and power of hydrogen/ hydrogen ion concentration (PH) measurements assist in the diagnosis of ACS?. Clinical studies investigating the application of NIRS and PH measurements for the diagnosis of ACS of the lower extremities from different search engines between from inception of data up until November 2020 were included. Eleven articles were included in this review (After application of the inclusion/exclusion criteria) (8 NIRS 3 PH articles). The means of five papers (NIRS) were pooled together in a meta-analysis., There was no heterogeneity between the five studies (I2=79.5%). The pooled effect size was 2.27 (95%CI: -1.02, 3.53) which indicated that there seemed to be considerable change in NIRS and this was statistically significant (p-value<.001). The pooled effect size for PH (effect size=0.724, 95%CI: 0.52 0.92). PH measurement found to be a statistically significant tool (p-value<0.001) in detecting the differences between injured legs with ACS/induced legs with ACS-similar model and the contra-lateral un-injured legs. Conclusion: This systematic review and meta-analysis has demonstrated clinical usefulness of both the near infrared and Intramuscular PH measurement in the diagnosis of ACS in patients with extremity trauma. The differences between injured/uninjured legs were both clinically and statistically significant for both devices

Introduction : Pelvic -acetabular fractures constitute one of the major orthopaedic injuries resulting from high energy trauma .They are one of the most challenging injuries which require special attention and expertise for surgical management in specialized hospitals .The purpose of this study is to analyze the epidemiological characteristics of operated pelvic and acetabular fractures in a tertiary level hospital and compare with same from other centres across the globe. Methods: A retrospective study of trauma data at Khoula Hospital from January 2010 to December 2016 where age , gender , mode of trauma , presence of associated injuries, fracture classification , surgical approach and associated complications were analyzed. Results: A total of 209 patients with pelvis and acetabular fractures were included in this study .Young age group ( mean : 35) and male gender (68%) were predominantly affected . Road traffic accidents were was the leading cause of fractures(96%).There were a total of 179 (86%)acetabular fractures and 30 (14%)pelvic fractures .Posterior wall fractures of the acetabulum was the most most common pattern (39%) followed by transverse fracture (27%). Antero posterior compression type was the most common pelvic fracture (40%). Six patients had postoperative sciatic nerve palsy, five patients had venous thromboembolism and nine patients had wound infection .Conclusion : The study showed that like other centres great majority of our patients were young and male with posterior wall of acetabulum fractures being the most common fracture pattern. However unlike other centres , road traffic accidents accounted for majority of fractures.