Anthony J. Ward

The use of blood cell salvage in acetabular fracture internal fixation surgery.

Objectives: To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. Design: A retrospective study. Setting: Tertiary pelvic and acetabular reconstructive center. Patients/Participants: Patients undergoing internal fixation for acetabular fractures. Results: Eighty consecutive patients were reviewed, comprising 26 elementary fracture (EF) and 54 associated fracture (AF) types. The mean volume of autologous blood transfused was 484 mL. The mean volume of 561 mL of autologous blood transfused in patients with AF types was significantly greater than the mean volume of 325 mL transfused in the EF group (P = 0.007). Additional allogenic blood transfusion was required in 5 (19%) patients with EFs and 15 (28%) patients with AFs (P = 0.418). The mean cost of the blood cell salvage and additional blood products in our study was

The modified ilioinguinal and anterior intrapelvic approaches for acetabular fracture fixation: indications, quality of reduction, and early outcome.

223 (£135) for all fracture types (

Isolated partial tear and partial avulsion of the medial head of gastrocnemius tendon presenting as posterior medial knee pain

174/£105 for EF and

The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring: a report of technique, indications and complications

246/£149 for AF). When treating AF types, the mean cost of using blood cell salvage was

Gluteal compartment syndrome with sciatic nerve palsy caused by traumatic rupture of the inferior gluteal artery: a successful surgical treatment

246 (£149) as compared with the mean predicted cost of not using blood cell salvage and transfusing the equivalent of 1.7 units of allogenic blood instead, which was

The influence of outside temperature and season on the incidence of hip fractures in patients over the age of 65.

463 (£281). These distributions are significantly different (P = 0.01). Conclusions: The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion. Level of Evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Is Fixation Failure After Plate Fixation of the Symphysis Pubis Clinically Important

Objectives: Traditionally, the anterior surgical approach of choice for acetabular reconstruction was ilioinguinal. There has been an increasing usage of the midline “Stoppa” or “anterior intrapelvic approach.” The aim is to report the techniques, early results (minimum 1 year), and complications of anterior approaches for acetabular reconstruction. Design: Retrospective case-note review. Setting: Pelvic and acetabular tertiary center. Patients: A consecutive series of acetabular fractures treated at 1 tertiary specialist unit were retrospectively reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up), were recorded. Main Outcome Measurements: Postoperative reduction (measured by postoperative plain radiographs and computed tomography). Results: Of 160 consecutive patients who underwent acetabular reconstruction, 56 (mean age, 44 years) underwent reconstruction using only anterior approaches (mean of 7 days after injury). Iatrogenic complications, postoperative infection, arthritis, and avascular necrosis rates are comparable with the literature. Overall, anatomic reduction was seen in 71% of cases and concentric reconstruction of the dome in over 90%. Thirty-six of the 56 patients (64%) were symptom-free at the latest follow-up and 34 (61%) had returned to work. Conclusions: The results reported suggest the use of dual approaches using the lateral 2 windows, and/or a midline anterior intrapelvic approach in anterior acetabular reconstructions has a relatively low complication rate and can lead to anatomic reconstructions in 71%. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

We present a case of medial head of gastrocnemius tendon tear. The type of injury widely reported in the literature is tear of the medial head of gastrocnemius muscle or ‘tennis leg’. We previously reported an isolated partial tear and longitudinal split of the tendon to the medial head of gastrocnemius at its musculotendinous junction. The case we now present has notable differences; the tear was interstitial and at the proximal (femoral attachment) part of the tendon, the patient’s symptoms and clinical examination suggested a medial meniscus tear, and magnetic resonance imaging demonstrated bone oedema at the tendon insertion site indicating a traction injury. Both cases suggest that isolated tear of the medial head of the gastrocnemius tendon may have a variety of presentations and appearances and should be considered in the differential diagnosis of tennis leg as well as medial meniscus tear.

Use of tightrope fixation in ankle syndesmotic injuries

Aims The anterior pelvic internal fixator is increasingly used for the treatment of unstable, or displaced, injuries of the anterior pelvic ring. The evidence for its use, however, is limited. The aim of this paper is to describe the indications for its use, how it is applied and its complications. Patients and Methods We reviewed the case notes and radiographs of 50 patients treated with an anterior pelvic internal fixator between April 2010 and December 2015 at a major trauma centre in the United Kingdom. The median follow‐up time was 38 months (interquartile range 24 to 51). Results Three patients were excluded from the analysis leaving 47 patients with complete follow‐up data. Of the 47 patients, 46 achieved radiological union and one progressed to an asymptomatic nonunion. Of the remaining patients, 45 required supplementary posterior fixation with percutaneous iliosacral screws, 2 of which required sacral plating. The incidence of injury to the lateral femoral cutaneous nerve (LFCN) was 34%. The rate of infection was 2%. There were no other significant complications. Without this treatment, 44 patients (94%) would have needed unilateral or bilateral open reduction and plate fixation extending laterally to the hip joint. Conclusion The anterior pelvic internal fixator reduces the need for extensive open surgery and is a useful addition to the armamentarium for the treatment of anterior pelvic injuries. It is associated with injury to the LFCN in a third of patients.

Fragility fractures of the pelvic ring

Gluteal compartment syndrome is a rare entity, usually caused by direct trauma. This occurrence with sciatic nerve palsy caused by inferior gluteal artery laceration and compressive haematoma has not been reported in the literature. We describe such a case treated successfully by urgent surgical decompression and resolution of the sciatic nerve palsy. A man aged 41 years sustained blunt trauma to the right gluteal region causing a rupture of the inferior gluteal artery, gluteal compartment syndrome and rapidly progressive sciatic nerve palsy. The condition was treated urgently with interventional radiology, open surgical decompression and debridement. Recovery was complicated by recurrent haematoma formation, treated successfully with subsequent complete resolution of the sciatic nerve palsy. A review of the literature of traumatic gluteal compartment syndrome is presented with discussion of the clinical diagnosis, multidisciplinary treatment and recommendations for treatment of this injury.