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Berton R Moed - One of the best experts on this subject based on the ideXlab platform.
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Radiographic Changes of Implant Failure After Plating for Pubic Symphysis Diastasis: An Underappreciated Reality?
Clinical Orthopaedics and Related Research®, 2012Co-Authors: Cory A Collinge, Michael T Archdeacon, Elizabeth Dulaney-cripe, Berton R MoedAbstract:Background Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described. Questions/purposes We therefore determined the incidence and characterized radiographic implant failures in patients undergoing symphyseal plating after disruption of the Pubic Symphysis. Methods We retrospectively reviewed 165 adult patients with Orthopaedic Trauma Association (OTA) 61-B (Tile B) or OTA 61-C (Tile C) pelvic injuries treated with symphyseal plating at two regional Level I and one Level II trauma centers. Immediate postoperative and latest followup anteroposterior radiographs were reviewed for implant loosening or breakage and for recurrent Diastasis of the Pubic Symphysis. The minimum followup was 6 months (average, 12.2 months; range, 6–65 months). Results Failure of fixation, including screw loosening or breakage of the symphyseal fixation, occurred in 95 of the 127 patients (75%), which resulted in widening of the Pubic symphyseal space in 84 of those cases (88%) when compared with the immediate postoperative radiograph. The mean width of the Pubic space measured 4.9 mm (range, 2–10 mm) on immediate postoperative radiographs; however, on the last radiographs, the mean was 8.4 mm (range, 3–21 mm), representing a 71% increase. In seven patients (6%), the Symphysis widened 10 mm or more; however, only one of these patients required revision surgery. Conclusions Failure of fixation with recurrent widening of the Pubic space can be expected after plating of the Pubic Symphysis for traumatic Diastasis. Although widening may represent a benign condition as motion is restored to the Pubic Symphysis, patients should be counseled regarding a high risk of radiographic failure but a small likelihood of revision surgery. Level of Evidence Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
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radiographic changes of implant failure after plating for Pubic Symphysis Diastasis an underappreciated reality
Clinical Orthopaedics and Related Research, 2012Co-Authors: Cory A Collinge, Michael T Archdeacon, Elizabeth Dulaneycripe, Berton R MoedAbstract:Background Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described.
Justi Lim - One of the best experts on this subject based on the ideXlab platform.
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management of Pubic Symphysis Diastasis with locking plates a report of 11 cases
Injury-international Journal of The Care of The Injured, 2013Co-Authors: Abdulkade Hamad, George Pavlou, Jonatha Dwye, Justi LimAbstract:Abstract Introduction The optimal method of fixation of symphyseal disruptions in pelvic ring injuries and post-operative rehabilitation is still debated. Options include two-hole, multi-hole and multiplanar plates. Post-operative rehabilitation can range from non-weight bearing bilaterally to full weight-bearing with crutches. Locking symphyseal plates have recently been introduced. There is a paucity of literature evaluating their use in such injuries. We present the first clinical case series of symphyseal Diastasis managed with locking plates. Methods A retrospective analysis of a single centre case series between August 2008 and December 2011 was conducted. A total of 11 patients; 2 females and 9 males with a mean age of 42 years were included. The mean radiological follow up was 27 weeks. Radiological failure and need for revision were evaluated. Results 4 patients sustained their injury as a result of a motorcycle accident, 3 patients following a car accident, 2 fell from a height and 2 had crush injuries. 9 patients had other concomitant injuries. The mechanism of injury was classified as anterior–posterior compression injury in 6 patients, vertical shear in 4 patients and combined mechanism in 1 patient. 6 patients required posterior pelvic fixation. Patients were mobilised fully or partially weight bearing. One patient had a significant radiological failure. All patients were asymptomatic at last follow-up and none required revision surgery. Conclusion Our series represents the first published clinical series of patients with symphyseal Diastasis managed with locking plates. We have found the use of locking plates across the Pubic Symphysis to be safe with low complication rates despite early weight bearing.
Cory A Collinge - One of the best experts on this subject based on the ideXlab platform.
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Radiographic Changes of Implant Failure After Plating for Pubic Symphysis Diastasis: An Underappreciated Reality?
Clinical Orthopaedics and Related Research®, 2012Co-Authors: Cory A Collinge, Michael T Archdeacon, Elizabeth Dulaney-cripe, Berton R MoedAbstract:Background Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described. Questions/purposes We therefore determined the incidence and characterized radiographic implant failures in patients undergoing symphyseal plating after disruption of the Pubic Symphysis. Methods We retrospectively reviewed 165 adult patients with Orthopaedic Trauma Association (OTA) 61-B (Tile B) or OTA 61-C (Tile C) pelvic injuries treated with symphyseal plating at two regional Level I and one Level II trauma centers. Immediate postoperative and latest followup anteroposterior radiographs were reviewed for implant loosening or breakage and for recurrent Diastasis of the Pubic Symphysis. The minimum followup was 6 months (average, 12.2 months; range, 6–65 months). Results Failure of fixation, including screw loosening or breakage of the symphyseal fixation, occurred in 95 of the 127 patients (75%), which resulted in widening of the Pubic symphyseal space in 84 of those cases (88%) when compared with the immediate postoperative radiograph. The mean width of the Pubic space measured 4.9 mm (range, 2–10 mm) on immediate postoperative radiographs; however, on the last radiographs, the mean was 8.4 mm (range, 3–21 mm), representing a 71% increase. In seven patients (6%), the Symphysis widened 10 mm or more; however, only one of these patients required revision surgery. Conclusions Failure of fixation with recurrent widening of the Pubic space can be expected after plating of the Pubic Symphysis for traumatic Diastasis. Although widening may represent a benign condition as motion is restored to the Pubic Symphysis, patients should be counseled regarding a high risk of radiographic failure but a small likelihood of revision surgery. Level of Evidence Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
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radiographic changes of implant failure after plating for Pubic Symphysis Diastasis an underappreciated reality
Clinical Orthopaedics and Related Research, 2012Co-Authors: Cory A Collinge, Michael T Archdeacon, Elizabeth Dulaneycripe, Berton R MoedAbstract:Background Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described.
Eric J Voiglio - One of the best experts on this subject based on the ideXlab platform.
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Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Floran A Reynard, Alexandros N Flaris, Eric R Simms, Olivier Rouviere, Pascal Roy, Nicolas J Prat, Jean-gabriel Damizet, Jean-louis Caillot, Eric J VoiglioAbstract:Abstract Introduction Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on Pubic Symphysis Diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC. Materials and methods Left-sided “open-book” UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated. Results The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD ( p p Conclusion Our study demonstrated that a TB in combination with the KED on UPFs is an effective way to achieve early reduction. The addition of the TB in combination with the KED could be considered for Pre-Hospital Trauma Life Support (PHTLS) training protocols.
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Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study
Injury, 2016Co-Authors: Floran A Reynard, Alexandros N Flaris, Eric R Simms, Olivier Rouviere, Pascal Roy, Nicolas J Prat, Jean-gabriel Damizet, Jean-louis Caillot, Eric J VoiglioAbstract:INTRODUCTION: Pre-hospital pelvic stabilisation is advised to prevent exsanguination in patients with unstable pelvic fractures (UPFs). Kendrick's extrication device (KED) is commonly used to extricate patients from cars or crevasses. However the KED has not been tested for potential adverse effects in patients with pelvic fractures. The aim of this study was to examine the effect of the KED on Pubic Symphysis Diastasis (SyD) with and without the use of a trochanteric belt (TB) during the extraction process following a MVC. MATERIALS AND METHODS: Left-sided "open-book" UPFs were created in 18 human cadavers that were placed in seven different positions simulating pre-extraction and extraction positions using the KED with and without a TB in two different positions (through and over the thigh straps). The SyD was measured using anteroposterior radiographs. The effects of the KED with and without TB, on the SyD, were evaluated. RESULTS: The KED alone resulted in a non-significant increase of the SyD compared to baseline, whereas the addition of a TB to the KED resulted in a significant reduction of the SyD (p
Mario Giuseppe Meroni - One of the best experts on this subject based on the ideXlab platform.
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is x ray compulsory in Pubic Symphysis Diastasis diagnosis
Acta Obstetricia et Gynecologica Scandinavica, 2014Co-Authors: Alessandro Svelato, Antonio Ragusa, Antonino Perino, Mario Giuseppe MeroniAbstract:SirWe read with great interest your case of postpartum symphy-sis pubis separation (1). We would like to present a case ofPubic Symphysis Diastasis that we diagnosed with a differentapproach.A 36-year-old gravida 1 para 0 at 39.6 weeks’ gestation wasadmitted with the onset of spontaneous contraction. After threehours and 18 min she delivered a 3170 g baby without compli-cations.Three hours after delivery, she complained of severe pain inthe Symphysis Pubic region. On examination, there was localtenderness in that region. We performed an ultrasound exami-nation, which revealed a 15.2-mm gap in the region of the sym-physis pubis (Figure 1), diagnosed as Pubic Symphysis Diastasis.She was given analgesics and advised bed rest. The patient wasdischarged six days after delivery and advised to maintain activeambulation and start physiotherapy. Three months later she wasseen at the outpatient clinic. She was able to walk independentlyand was no longer experiencing any pain.Although the case presented is not particularly impressive inseverity, it still offers the opportunity to inform all cliniciansabout the possibility of diagnosing this condition with the useof the ultrasonography alone. The reported incidence of PubicSymphysis Diastasis varies widely in the literature, from 1 in 300to 1 in 30 000 deliveries (2,3). Generally, it is a rare complica-tion and for this reason it is very difficult to perform random-ized controlled trials to compare different diagnostic tools. Thediagnosis is based primarily on clinical findings. The most con-sistent finding is pain in the symphyseal region that radiates tothe lower back and thighs and is exacerbated by leg movement(4). In addition, many women will have difficulty walking, infact the gait is described as waddling, or potentially be unableto stand or walk due to pain (3). Symptoms may be noted dur-ing labor and up to 48 h postpartum. Often the first diagnostictest used to identify the Pubic Diastasis is antero-posterior radi-ography. However, we think that ultrasound might be a goodchoice as an initial imaging study, rather than x–ray, due toabsence of exposure to ionizing radiation and its ease of opera-tion, and as it presents an optimal assessment of the extent ofSymphysis separation (3–5). We performed ultrasonography inthe following way: we placed the probe in transverse orientationon the Pubic Symphysis (identified by palpation) with an approx-imately 30° caudal scanning plane, with the purpose of measuringthe width of the symphyseal joint at its upper margin.Pubic Symphysis Diastasis is an uncommon injury that shouldbe considered when evaluating patients in the peripartum periodwho are experiencing supraPubic, sacroiliac or thigh pain. In addi-tion we would like to bring to the general attention the usefulnessof ultrasound in the diagnosis and management of this rare condi-tion. The literature is inconsistent on this topic, due to the lack ofrandomized controlled trials, but good suggestions are present (3–5). In our experience, ultrasound is simple, reproducible and with-out side effects, and should be used as an initial imaging studybecause the accuracy is at least as good as that of x-rays for esti-mating the width of the Symphysis pubis Diastasis.Alessandro Svelato
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Is x‐ray compulsory in Pubic Symphysis Diastasis diagnosis?
Acta Obstetricia et Gynecologica Scandinavica, 2013Co-Authors: Alessandro Svelato, Antonio Ragusa, Antonino Perino, Mario Giuseppe MeroniAbstract:SirWe read with great interest your case of postpartum symphy-sis pubis separation (1). We would like to present a case ofPubic Symphysis Diastasis that we diagnosed with a differentapproach.A 36-year-old gravida 1 para 0 at 39.6 weeks’ gestation wasadmitted with the onset of spontaneous contraction. After threehours and 18 min she delivered a 3170 g baby without compli-cations.Three hours after delivery, she complained of severe pain inthe Symphysis Pubic region. On examination, there was localtenderness in that region. We performed an ultrasound exami-nation, which revealed a 15.2-mm gap in the region of the sym-physis pubis (Figure 1), diagnosed as Pubic Symphysis Diastasis.She was given analgesics and advised bed rest. The patient wasdischarged six days after delivery and advised to maintain activeambulation and start physiotherapy. Three months later she wasseen at the outpatient clinic. She was able to walk independentlyand was no longer experiencing any pain.Although the case presented is not particularly impressive inseverity, it still offers the opportunity to inform all cliniciansabout the possibility of diagnosing this condition with the useof the ultrasonography alone. The reported incidence of PubicSymphysis Diastasis varies widely in the literature, from 1 in 300to 1 in 30 000 deliveries (2,3). Generally, it is a rare complica-tion and for this reason it is very difficult to perform random-ized controlled trials to compare different diagnostic tools. Thediagnosis is based primarily on clinical findings. The most con-sistent finding is pain in the symphyseal region that radiates tothe lower back and thighs and is exacerbated by leg movement(4). In addition, many women will have difficulty walking, infact the gait is described as waddling, or potentially be unableto stand or walk due to pain (3). Symptoms may be noted dur-ing labor and up to 48 h postpartum. Often the first diagnostictest used to identify the Pubic Diastasis is antero-posterior radi-ography. However, we think that ultrasound might be a goodchoice as an initial imaging study, rather than x–ray, due toabsence of exposure to ionizing radiation and its ease of opera-tion, and as it presents an optimal assessment of the extent ofSymphysis separation (3–5). We performed ultrasonography inthe following way: we placed the probe in transverse orientationon the Pubic Symphysis (identified by palpation) with an approx-imately 30° caudal scanning plane, with the purpose of measuringthe width of the symphyseal joint at its upper margin.Pubic Symphysis Diastasis is an uncommon injury that shouldbe considered when evaluating patients in the peripartum periodwho are experiencing supraPubic, sacroiliac or thigh pain. In addi-tion we would like to bring to the general attention the usefulnessof ultrasound in the diagnosis and management of this rare condi-tion. The literature is inconsistent on this topic, due to the lack ofrandomized controlled trials, but good suggestions are present (3–5). In our experience, ultrasound is simple, reproducible and with-out side effects, and should be used as an initial imaging studybecause the accuracy is at least as good as that of x-rays for esti-mating the width of the Symphysis pubis Diastasis.Alessandro Svelato