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      The first use of laparoscopy to treat pelvic ring fractures: A case report

      case-report

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          Highlights

          • The first use of laparoscopy to treat pelvic ring fractures: a case report.

          • We describe the first use of laparoscopy to treat pelvic ring fracture.

          • This “laparoscopic internal fixation” delivered an in situ result as good as that of open surgery.

          • Despite a long operating time, the blood loss was very low.

          • This technique opens a new approach to treatment of pelvic fractures.

          Abstract

          Introduction

          Pelvic ring injuries pose major challenges for the trauma surgeon. Given the complications of open surgeries, percutaneous techniques have become increasingly popular, but laparoscopy has never been employed for internal osteosynthesis of the pelvic ring.

          Presentation of case

          We describe a 34-year-old male with a pelvic ring fracture (grade AO/OTA 61B2.1b). The anterior pelvic arch was successfully plate-fixed using a laparoscopic technique. This is the first report of such an approach to treat pelvic ring fractures.

          Discussion

          Our principal point is that “laparoscopic internal fixation” delivered an in situ result as good as that of open surgery, but we required only four trocar portals.

          Conclusion

          We describe a novel laparoscopic approach to treatment of pelvic ring fractures.

          Related collections

          Most cited references9

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          Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis.

          Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis. Randomized controlled trials (RCTs) comparing LA and OA published between January 1992 and February 2010 were included in this study. Strict literature appraisal and data extraction were carried out independently by two reviewers. A metaanalysis then was performed to evaluate operative time, hospital cost, postoperative complications, length of analgesia, bowel function recovery, day liquid diet began, hospital stay, and return to work and normal activity. The metaanalysis comprised 25 RCTs involving 4,694 patients (2,220 LA and 2,474 OA cases). No significant differences were found between the LA and OA groups in terms of age, gender, body mass index (BMI), or type of appendiceal inflammation. Compared with OA, LA showed advantages of fewer postoperative complications (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55-0.98; p = 0.04), less pain (length of analgesia: weighted mean difference [WMD], -0.53; 95% CI, -0.91 to -0.15; p = 0.007), earlier start of liquid diet (WMD, -0.51; 95% CI, -0.75 to -0.28; p < 0.0001), shorter hospital stay (WMD, -0.68; 95% CI, -1.02 to -0.35; p < 0.0001), and earlier return to work (WMD, -3.09; 95% CI, -5.22 to -0.97; p = 0.004) and normal activity (WMD, -4.73; 95% CI, -6.54 to -2.92; p < 0.00001), but a comparable hospital cost (WMD of LA/OA ratio, 0.11; 95% CI, -0.18 to 0.40; p = 0.47) and a longer operative time (WMD, 10.71; 95% CI, 6.76-14.66; p < 0.00001). Despite the longer operative time, LA results in less postoperative pain, faster postoperative rehabilitation, a shorter hospital stay, and fewer postoperative complications than OA. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis.
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            Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure?

            The purpose of this study is to present the early complications of percutaneous screw fixation of superior pubic ramus fractures and to present a new classification scheme for superior pubic ramus fractures. Retrospective. Level 1 trauma center. One hundred and twelve patients with pelvic fracture between the ages of 14 to 89 years underwent percutaneous screw fixation of 145 pubic ramus fractures. Eighty-one patients with 107 surgically repaired fractures were followed to fracture union. Follow-up averaged 9 months (range 2-52 months). One additional patient who sustained fixation failure 4 days after surgery was included to yield a study group of 82 patients with 108 surgically repaired ramus fractures. Patients underwent percutaneous screw fixation of a superior pubic ramus fracture. Superior pubic ramus fractures were classified according to a new scheme, the Nakatani system, which categorizes superior ramus fractures according to location with respect to the obturator foramen. Patient radiographs were examined for evidence of loss of reduction, defined as any motion at the ramus fracture site or hardware motion, after fracture surgery. Of the 82 patients followed to union or fixation failure, 12 (15%) had loss of reduction on follow-up radiographs. The average age of patients who lost reduction was 55 years. The most common mechanism of reduction loss was a collapse of the pubic ramus over the screw, with recurrence of an internal rotation deformity of the injured hemipelvis. Ten patients who lost reduction were women, and 11 had undergone ramus screw placement in retrograde fashion. No loss of reduction was seen in Zone III ramus fractures (those that involve the bone lateral to the obturator foramen). No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of a superior pubic ramus fracture. The prevalence of loss of reduction after percutaneous screw fixation of pubic ramus fractures is 15%. Loss of reduction is more common in elderly and female patients and in patients whose ramus screws are placed in a retrograde fashion. Also, loss of reduction appears to be more common in fractures medial to the lateral border of the obturator foramen.
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              Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis

              Over the last three decades, laparoscopic appendicectomy (LA) has become the routine treatment for uncomplicated acute appendicitis. The role of laparoscopic surgery for complicated appendicitis (gangrenous and/or perforated) remains controversial due to concerns of an increased incidence of post-operative intra-abdominal abscesses (IAA) in LA compared to open appendicectomy (OA). The aim of this study was to compare the outcomes of LA versus OA for complicated appendicitis.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                25 September 2020
                2020
                25 September 2020
                : 76
                : 60-63
                Affiliations
                [a ]Service de Traumatologie, CHRU de Brest, France
                [b ]Service d’Urologie, CHRU de Brest, France
                Author notes
                [* ]Corresponding author at: Service de Traumatologie, CHRU Brest, Boulevard Tanguy Prigent, 29200, Brest, France. remi.difrancia.pro@ 123456gmail.com
                Article
                S2210-2612(20)30835-X
                10.1016/j.ijscr.2020.09.162
                7530218
                d15b0b12-38a7-4969-b51e-debcfd050539
                © 2020 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 August 2020
                : 22 September 2020
                : 22 September 2020
                Categories
                Case Report

                laparoscopy,pelvic ring fracture,plate fixation
                laparoscopy, pelvic ring fracture, plate fixation

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