Introduction:
Percutaneous sacroiliac screw fixation (SI) of unstable pelvic ring fractures with Rescue Screws is used to immediately stabilize the posterior pelvic ring to regain haemodynamic stability. This intervention is conducted under challenging conditions and might therefore be associated with complications. The aim of our study was to compare Rescue Screws with elective SI-screw fixation.

Methods:
A retrospective study of trauma patients with acute pelvic ring injuries at a level one trauma center was performed. Patients ≥15 years, treated with sacroiliac/transsacral screw fixation were included. Patients were stratified according to treatment strategy (RS: Rescue Screws; EL: Elective screw placement). Outcome: screw breakage, loosening, malpositioning and reoperations.

Results:
252 patients were included between 11/2014 and 08/2021. 48 patients (43±18 years) were treated with Rescue Screws; 204 patients (61±20 years) received EL. The RS-group was more frequently polytraumatized (p<0.001) than the EL-group (89.6% vs. 46.1%) with a higher overall ISS (30±12 vs. 17±10). Unstable pelvic ring fractures were diagnosed more often (p<0.001) in the RS-group (91.7% vs. 48.0%) as well as concomitant shock (37.5% vs. 3.4%). Implant related complications occurred more often in the RS-group (25.0% vs. 10.8%, p=0.018). There was no difference regarding reoperations before (p=0.986) or after (p=0.110) fracture consolidation.

Conclusions:
Despite a higher overall risk of implant complications, Rescue Screws were not associated with elevated revision rates, which might indicate a minor clinical relevance of these findings and supports the usage of Rescue Screws in critical situations. Further studies are needed to compare Rescue Screws to other emergency interventions.

Objective: To compare between single trans-iliac trans-sacral screw versus dual ilio-sacral screws in Management of unstable pelvic ring disruptions after achieving reduction, to facilitate union of the fracture and early mobilization. Methods: In a prospective cohort study that was done in Assiut University hospital trauma unit between May 2018 to September 2020, 30 patients with unstable fracture pelvis were included in the study. Single trans-iliac trans-sacral screws were done in 14 cases while two ilio-sacral screws were done for the rest of cases. Age ranged from 18 to 57 years old, with exclusion of patients with spino-pelvic dissociation, comminuted fractures, chronic uncontrolled co-morbidities, bilateral sacral fractures. Follow up of the patients radiologically using plain X-ray and Computed Tomography scan to identify union of fractures were reported. Functional follow-up using Majeed score and Visual analogue scale were reported with allowance of weight bearing as tolerated. Results: Both groups of patients had insignificant differences regarding Visual Analogue Scale of pain, Majeed Pelvic score at 1.5 month and 6 months, either while standing or stepping. Neurological deficit was noticed in only two patients with trans-sacral screws fixation whom they needed revision surgery which was done after detection of the complication. Earlier full weight bearing was significant in the trans-sacral group when compared to ilio-sacral screws group. Conclusion: Fixation of unstable pelvic fractures posteriorly with single trans-sacral screw has better pain score when compared to fixation with dual ilio-sacral screws fixations, allowing for faster rehabilitation and rapid return to functional life although technical difficulties

Introduction:
Sacroiliac (SI) screw fixation is a feasible treatment option for posterior pelvic ring disruption. During the last decade, navigated screw fixation has been introduced, which provides a three-dimensional vision field for the surgeon. However, this technique requires a more advanced set up. The aim of this study was to compare the outcome of navigated SI-screws with non-navigated SI-screws.

Methods:
A retrospective cohort study of patients with acute traumatic pelvic ring injuries at a level one trauma center was performed. Patients aged ≥15, treated with elective SI screw fixation were included. Patients were stratified according to treatment strategy (Group NV: Navigated screws vs. Group CV: conventional screws). Outcome: implant-related complications: breakage, loosening, intraforaminal/malpositioning of the screws, reoperations.

Results:
A total of 204 (mean age 61±20 years, mean ISS 17±10) patients were included between 11/2014 and 08/2021. 65 patients (64±21 years) underwent navigated screw fixation, whereas 139 patients (59±20 years) received conventional percutaneous screws to the posterior pelvic ring. The groups were comparable at baseline except in terms of comorbidities (ASA; NV: 2.92±0.78 vs. CV: 2.54±0.87, p=0.003). Overall hardware complication rates did not differ significantly (p=0.805). However, screw malpositioning only occurred in the CV-group with 6.5% (vs. NV: 0%). Reoperation/implant removal rates after fracture consolidation were lower in the NV-group (NV: 9.2% vs. CV: 21.6%, p=0.05).

Conclusion:
Navigated screw fixation of the posterior pelvic ring results in optimal accuracy of screw placement in trauma patients. Patients with severe comorbidities as well as difficult osseous corridors might benefit from a navigated intervention.

Purpose: We aimed to report our early experience treating paediatric pelvic fractures (PPF) surgically. Methods: Patients aged 0–15 with PPF treated surgically were included prospectively between 2016 and 2018. Fractures were classified according to AO/OTA classification. Functional evaluation was performed using a modification of the Majeed scoring system. Radiological evaluation of vertical and posterior displacement was performed according to
Matta and Tornetta criteria and the method described by Keshishyan et al. for assessing pelvic rotational asymmetry.
Results: We included 45 patients, with a mean age of 9.53 ± 3.63 and 19.87 ± 8.84 months of mean follow-up. The functional outcome was excellent in 42 (93.3%) patients, good in two (4.4%), and fair in one (2.2%). Radiologically, the vertical displacement improved from 5.91 ± 4.64 to 3.72 ± 2.87 mm (p-value 0.065), the posterior displacement improved from 7.87 ± 8.18 to 5.33 ± 13.4 mm (p-value 0.031), and the symphyseal diastasis improved from 9.88 ± 7.51 mm to 7.68 ± 3.18 mm (p-value 0.071). Residual pelvic asymmetry improved from 1.2 ± 0.61 to 0.8 ± 0.7 (p-value 0.001). Complications occurred in 21 (46.7%) patients, 11 (24.4%) pin tract infection, six (13.3%) limb length discrepancy, two (4.4%) prominent metals, one (2.2%) subcutaneous haematoma, one (2.2%) infected ISS. Conclusions: We achieved acceptable functional and radiological outcomes after surgically treating a group of patients with PPF, which was relatively safe with minimal complications. The proper approach and fracture fixation tool should be tailored according to the fracture classification and the presence of associated injuries.

Background: The management of Acetabular fractures in the elderly is a matter of contention. Acute total hip replacement (THR) obviates the risk of secondary arthritis but carries risk of a bigger procedure, increased surgical time and arthroplasty related complications in this frail patient group. Open reduction and internal fixation (ORIF) in select patients can lead to acceptable outcomes. Methods: All surgically treated acetabular fractures on the electronic database of a UK major trauma Centre between 1/8/2016 and 1/8/2021 were reviewed. All Patients aged above 60 years were identified. Patients with delayed presentation, periprosthetic and pathological fractures were excluded. The main outcome measures was rate of conversion to THR and secondary procedures. Results: A total of 49 patients were identified with minimum follow up of 1 yr. Mean Age, ASA and BMI are presented. 5 patients (10%) with significant femoral head damage or extensive comminution of post wall or column received an acute THR. 44 patients underwent ORIF only. Off those 7 patients were converted to a THR. 2 patients had secondary procedures for infection and 1 for nerve related complications bringing the overall rate of secondary procedures to 22 %. The 1-year mortality was 6%. Conclusion: Open reduction and internal fixation of acetabular fractures in patients above 60 years old yields acceptable outcomes. The risk of arthritis is balanced against the morbidity of an acute total hip replacement. An elective hip replacement using standard implants in an optimized patients can be performed in case 2ry OA develops.

Objectives:The purpose of this study was to investigate the risk factors associated with sciatic nerve injury in patients with acetabulum fractures.
Methods: A retrospective cohort review was conducted on 275 patients with acetabulum fractures who were treated between 2017 and 2019. The medical records and radiographs of these patients were analyzed to determine the incidence of sciatic nerve injury, as well as the potential risk factors associated with this type of injury. The recovery of neurological function was also assessed.
Results:The overall nerve injury rate was 8.4% (23 cases), with 10 cases (3.6%) occurring as a result of the initial injury and 13 cases (12.7%) as post-operation complications. Among those with nerve injuries, 95.7% were males and the average age of the patients was 30.9 years. The most common mode of injury was MVC, and the fracture pattern associated with nerve injury was posterior column and posterior wall fracture. Hip dislocation was found in 17.4% of patients with nerve injury. The Kocher Langenbeck approach was the most common approach used for patients with nerve injury surgery, and the prone position was significantly associated with sciatic nerve injury during the operation. Of the patients with nerve injury, 52.4% had fully recovered, 28.6% had partially recovered, and 19% had no improvement.
Conclusion: This study highlighted the importance of identifying and addressing potential risk factors for sciatic nerve injury in patients with acetabulum fractures. Careful consideration of surgical positioning and approach may also help to reduce the incidence of iatrogenic nerve injury.

Introduction and objectives: Pelvic ring injuries lead to significant patient morbidity and mortality. We evaluated long term (>1 year) functional outcome of these patients using PROMs (Patient reported outcome measures) using both generic health specific (QoL) and disease specific outcome instruments. Materials and methods: Pelvic ring injury patients seen between 2015 to 2020 were called for a follow up visit. Patient’s demographic profile, mode and pattern of injury, associated injuries, management and complications were recorded. Functional outcome assessment was done using two generic health specific QoL scores and three disease specific scores. Results: Of 56 patients, (37 males, 19 females, mean age 32 years), there were 40 Tile B type and 16 Tile C type. Mean follow up duration was 26.8 months. Mean (SD) SF-36 PCS score was 64.01 (22.89) and MCS score was 63.79 (23.31). SMFA dysfunction index and SMFA bother index mean (SD) were 22.41 ± 11.75 and 25.97 ± 14.12 respectively. Mean (SD) of IPS and PDI score were 78.61 (9.40) and 21.70 (16.59) respectively. There was no statistical difference between two types of scores when assessed using Spearman correlation tests. However, on comparison of study population mean SF-36 subset scores with general population norms, no domain of SF-36 could reach norm values. Long term sequelae of trauma were significantly associated with poor quality of life scores. Conclusion: Long-term physical functioning and QoL in patients who had sustained a pelvic ring injury seems fair, although significantly decreased in comparison with their peers from the general population.

Road traffic injuries are a major public health issue in the Philippines, causing significant morbidity and mortality. Data from the Philippine Statistics Authority indicate that there were 11,274 deaths from road crashes in 2016, 65% higher than the 6,916 deaths registered in 2006. The majority of road traffic injuries occur in urban areas, where there is a high density of people and vehicles. The study of Herbosa and Lu (2022) found that road crashes in the country are increasing over the years (5% to 16-17%). The casualties are very young people in their prime working age. Motorcycles are the most common vehicle involved, accounting for over half of all deaths (52-76%). Pedestrians are amongst the most vulnerable road users (7.5-24%). Alcohol, speeding, non-use of helmets and seatbelts were also identified as factors that increase the risk of death and injury. Other risk factors include lack of infrastructure, poor law enforcement, and lack of awareness amongst road users. Overall, there is an increasing trend in the total number of road traffic injuries (21-37% annually). The mean age of casualties is about 30.5 years. Forty three percent have multiple injuries, 60% have external injuries, 40% with injuries to the extremities and 5% with brain injury. This study is an initial actualization of the entire road traffic injury profile of the Philippines. Further studies are warranted to complete the picture.

Aim : To assess the relative influence of individual co morbid factors on - the decision making regarding salvage vs amputation, the prediction of infection among the salvaged limbs. Methods: This was a prospective study conducted from 1st June 2020 to July 31st 2021 at a Level 1 Trauma center. A total of 251 patients above 18 years of age with Type 3 A & Type 3 B open tibia fractures were included with a minimum follow up of 6 months. The co morbid factors assessed include - Age, BMI, Gender, Diabetes Mellitus, Level of Fracture, Albumin, Lactate, ISS, Ganga hospital open injury severity score (GHOISS) and Injury to debridement Interval. Results: Of the 23 hypoalbuminemia patients, 6 patients had amputation with a significant p value of 0.005. Of the 20 amputations, 14 patients had an ISS score more than 18 with a significant p value of 0.013. GHOISS above 17 predicts amputation. In our study out of 6 amputations 3 had a score more than 17 and hence was significant with p value <0.001.Out of patients with 20 segmental tibia fractures, 14 patients developed infection and hence was statistically significant (p-value 0.002). Out of the 25 uncontrolled diabetic patients, 14 developed infection and was significant with a p value of 0.003. Conclusion: The albumin level, ISS and GHOISS play a major role in predetermining the outcome.The location of fracture and Diabetes mellitus were both statistically significant factors in predicting the ooccurrence of infection

BACKGROUND: calcaneus fractures are complex injuries that can be classified using Sanders classification system, with Sanders 3 and 4 fractures being most severe. The optimal management approach for these fractures remains controversial, with both operative and non-operative strategies being employed.

METHODS: we conducted a retrospective study to compare the functional outcomes of operative versus non-operative management for Sanders 3 and 4 calcaneus fractures. We reviewed the medical records of patients who presented with these fractures over a 12-year period at our institution. Patients were divided into two groups based on their management approach: operative or non-operative. Functional outcomes were assessed using various measures, including American Orthopedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) for pain, and return to pre-injury activities.

RESULTS: a total of 119 patients were included in the study from 2008 to 2020, with 33 patients managed operatively and 86 patients managed non-operatively followed-up for 12 months, with a mean age of 34.16 years. The operative group had a higher rate of initial surgical complications, including wound infection and implant-related issues. However, they showed significantly better outcomes in terms of AOFAS scores (p = <0.01), pain scores (p = <0.01), and return to pre-injury activities provided Boehler’s angle was restored to normal range, compared to the non-operative group.

CONCLUSION: our study suggests the overall outcomes of operative management of Sanders 3 and 4 calcaneus fractures may result in more favourable functional outcomes compared to the non-operative management, despite the higher rate of initial surgical complications.