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      A Rare Case of an Iliac Fracture at the Iliac Fossa Immediately after Salter Innominate Osteotomy

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      Case Reports in Orthopedics

      Hindawi

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          Abstract

          This report presents the unusual case of a 5-year-old girl with iliac fracture just after Salter innominate osteotomy for developmental dysplasia of the hip. The iliac fracture was diagnosed two days after Salter innominate osteotomy, and computed tomography (CT) revealed that it was at the extremely thin portion of the iliac wing called the “iliac fossa.” We were able to reduce the fracture by pulling the left leg distally, and after reducing the iliac bone, the ilium was fixed by Kirschner wire from the anteroinferior iliac spine and anterosuperior iliac spine. The patient was in a hip-spica cast for 6 weeks postoperatively and allowed to walk from 3 months after the surgery. At the last follow-up one year after the surgery, bone union was completely obtained, and she had no complications. The cause of the fracture seems to be the stress concentration on the iliac fossa due to the cranked iliac osteotomy line passing through the iliac fossa. The current case indicates the importance of careful evaluation by CT before surgery and ensuring that the osteotomy line does not extend near the iliac fossa.

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          Most cited references 10

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          Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child.

           R Salter (1966)
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            Salter innominate osteotomy for the treatment of developmental dysplasia of the hip in children: results of seventy-three consecutive osteotomies after twenty-six to thirty-five years of follow-up.

            Reorientation of the acetabulum may be necessary in the treatment of an unstable hip in children with developmental dysplasia of the hip. In 1961, Salter described the innominate osteotomy for stabilizing the reduced hip in the position of function by redirection of the acetabulum as one piece. In the present study, we describe our long-term results with this procedure. We reviewed the cases of sixty-one patients who had seventy-three Salter innominate osteotomies. At the time of the operation, the mean age of the patients was 4.1 years (range, 1.3 to 8.8 years). Radiographs made preoperatively, postoperatively, and at the time of the most recent follow-up visit were evaluated. Clinical evaluation was performed with use of the Merle d'Aubigné and Postel system as well as the Harris hip score. The mean duration of follow-up was 30.9 years (range, 26.2 to 35.4 years). There were seven true revisions (one acetabuloplasty, one triple osteotomy, and five total hip arthroplasties). With true revision as the end point, the cumulative survival rate at 35.3 years was 0.90. Fifteen of the seventy-three hips were considered a failure, which was defined as a revision or a Harris hip score of <70 points and/or a Merle d'Aubigné and Postel score of <13 points. The long-term clinical outcome was significantly influenced by the grade of dislocation on the radiographs made at the first examination (p = 0.0388) and on those made immediately preoperatively (p < 0.0001), the postoperative summarized hip factor (the radiographic grade of dysplasia) (p = 0.0002), the preoperative (p = 0.0392) and postoperative (p = 0.0072) grades of avascular necrosis of the femoral head, and the technique of reduction (p < 0.0001). When an acetabulum can be most closely restored to a normal configuration without the development of avascular necrosis, good long-term results (lasting for more than thirty years) can be expected. When open reduction is necessary, it is preferable to perform it separately prior to the Salter innominate osteotomy. The grade of dislocation at the time of the first examination and immediately preoperatively, the grade of avascular necrosis of the femoral head, and the adequacy of surgical correction are important prognostic factors for the long-term clinical result.
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              Simple anterior pelvic external fixation.

              Unstable pelvic ring disruptions are often associated with significant morbidity and mortality, especially in patients with multiple injuries. Early pelvic fixation provides stability and should diminish ongoing hemorrhage. A simple anterior single-pin pelvic external fixator can be applied rapidly and accurately to stabilize pelvic ring injuries as a part of the initial patient resuscitation of such patients. Simple anterior pelvic external fixation (SAPEF) frames can be used as either temporary, definitive, or supplementary fixation depending on the pelvic injury pattern. Over a 32-month period, 41 patients with unstable pelvic ring disruptions were stabilized using a simple anterior pelvic external fixator. Eight patients had open pelvic ring injuries and 13 others had genitourinary system disruptions. Fluoroscopic imaging was used to insert all of the fixation pins into the iliac crest between the iliac cortical tables to a depth of at least 5 cm. Each patient had closed manipulative reduction of the pelvic ring using external methods before SAPEF application. One patient died less than 24 hours after injury because of torrential hemorrhage. Clinical evaluations and serial radiographs, including postoperative computed tomographic scans, were available for the other 40 patients postoperatively. Seventy-five of the 80 (94%) pins were completely contained between the iliac cortical tables, according to the computed tomographic scans. The initial pelvic closed reductions were maintained until the fixators were removed in 37 of 40 patients (93%). Only one deep pin track infection developed, mandating early frame removal and intravenous antibiotic therapy. Simple anterior pelvic external fixation can be applied rapidly using fluoroscopic guidance to direct accurate pin insertion and closed manipulative reduction of the pelvis. Depending on the specific pelvic ring injury pattern and clinical scenario, SAPEF can serve as a resuscitative temporary fixation device, as definitive pelvic treatment, or as a supplement for pelvic internal fixation implants.
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                Author and article information

                Contributors
                Journal
                Case Rep Orthop
                Case Rep Orthop
                CRIOR
                Case Reports in Orthopedics
                Hindawi
                2090-6749
                2090-6757
                2021
                27 January 2021
                : 2021
                Affiliations
                Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
                Author notes

                Academic Editor: Hiroshi Takahashi

                Article
                10.1155/2021/6653726
                7857925
                Copyright © 2021 Masanori Wako et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Orthopedics

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