Minimally invasive surgical treatment using ‘iliac pillar’ screw for isolated iliac wing fractures in geriatric patients: a new challenge

Abstract

Purpose

There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to present a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named ‘iliac pillar screw fixation’.

Materials and methods

We retrospectively reviewed six geriatric patients over 65  years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016.

Results

Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. The visual analog scale score for pain at the last follow-up was quite satisfactory. Union was achieved in all patients at the last follow-up.

Conclusions

Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.

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No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review

Abstract

Purpose

To assess the effect of surveillance on deep vein thrombosis (DVT) and pulmonary embolism (PE) rates, the efficacy of chemoprophylaxis and mechanical prophylaxis, and the relationship between DVT and PE.

Methods

A 23 year, systematic literature review was performed in PubMed. Twenty publications with > 13,000 patients were reviewed. Analyzed traits included: DVT surveillance utilization, the total number of patients included in each study, the number of patients developing DVT and/or PE, chemoprophylaxis and mechanical prophylaxis utilization. When event proportions from individual studies were combined, a weighted mean proportion was computed based on the size of each individual cohort. Combined event proportions were compared with other combined event proportions, according to differences in intervention. Inter-group event proportions were compared using Chi-Square or Fisher’s exact test, as appropriate.

Results

DVT rates increase with surveillance (10.7% vs. 2.5%, p < 0.001). PE rates were similar regardless of surveillance (p = 1.0). Chemoprophylaxis lowered both DVT rates (8.2% vs. 10.7%; p < 0.0001) and PE rates (1.2% vs. 1.9%; p = 0.0050). Mechanical prophylaxis did not decrease DVT rates (10.2% vs. 11.5%; p = 0.2980) or PE rates (1.7% vs. 1.6%; p = 1.0). In patients with neither chemoprophylaxis nor mechanical prophylaxis, DVT rate was 11.5%, PE was 1.6%. When chemoprophylaxis and/or mechanical prophylaxis were given, DVT rate was 8.6% (p < 0.0189) and PE was 1.3% (p = 0.4462). PE proportions were not decreased with mechanical prophylaxis or surveillance. DVT and PE rates were not associated (p = 0.7574).

Conclusions

The results suggest that PE is not associated with lower extremity DVT in adult trauma patients.

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EMS Specialist Projects Supervisor - GAAA

Make A Difference in your community by being a leader of our Emergency Medical Service Team! Galveston County Health District is seeking a new EMS Special Projects Supervisor! The right candidate will be responsible for successfully managing daily operational aspects of non-emergency medical transport and emergency medical services provided by the Galveston County Health District's Galveston Area Ambulance ...

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FT/PT Paramedic - Med-Star Paramedic Ambulance, Inc.

MED-Star Paramedic Ambulance, Inc. located in Brandon, South Dakota is currently hiring full and part time Paramedics. We are a family owned and operated company. We respond to 911 calls in the southeast area of Minnehaha county and provide interfacility transports from area hospitals. We offer flexible scheduling with 12 and 24 hour shifts available and minimal call time. Pay starting at $36,500-$42,000/year ...

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Wash. responders, civilians honored for saving life of retired fire chief

Retired Chehalis Fire Department Chief Bill Nacht went into cardiac arrest while waiting for a friend so they could go on a motorcycle trip

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EMCrit 236 – George Kovacs on EVLI Airway Incrementalization

Approach to steps of laryngoscopy/intubation

EMCrit Project by Scott Weingart.

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EMCrit 236 – George Kovacs on EVLI Airway Incrementalization

Approach to steps of laryngoscopy/intubation

EMCrit Project by Scott Weingart.

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