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Bäcker HC, Vosseller JT, Deml MC, Cunningham J. Reply to Letter to the Editor: Spinopelvic Dissociation: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg 2023; 31:e175-6. [PMID: 36126157 DOI: 10.5435/JAAOS-D-22-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
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Wu L, Li J, Wang Z, Wang Z, Liu T, Sun J, Ling R, He L, Wang S, Yang L. The risk factors for injuries in parachuting and load exposure in the training of Chinese paratroopers. Work 2023; 75:1467-1476. [PMID: 36565089 DOI: 10.3233/wor-220079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Parachutists are generally recognized as a "high-risk" group among military personnel. However, the findings came mostly from data analysis without soldiers as subjects. OBJECTIVE This study aimed to investigate the injury prevalence in Chinese paratroopers on-site and determine the relationship between injury and risk factors encountered during parachuting and land-based training. METHODS This study consisted of a field study with questionnaire and an experiment on muscle load during the simulated training exercise of platform jumping with surface electromyography (EMG), in which 7230 paratroopers and 38 soldiers were involved respectively. Chi-square test was used for the injury rate analysis, ANOVA and t-test for comparison of EMG data, and logistic regression for the analysis of multiple factors. Taking both intensity and time into consideration, jump-years (J-yrs) was used as a complex indicator for exposure to parachuting. Either injury per 1000 jumps or injured persons per 100 soldiers were calculated as injury prevalence. RESULTS The overall injury rate among Chinese parachutists was found to be 13.9 injuries per 1000 parachute jumps and 24.5% based on personnel. The person-based injury rate increased with the exposure level significantly (χ2 = 142.06, 2-sided, P < 0.05; trend test also significantly). Among the identified risk factors the uneven terrain was ranked as the most important one by logistic analysis. The EMG amplitude in MVE% increased with the platform height of all the 8 measured muscles and even reached 100% in 4 muscles, showing a high impact at landing. In addition, some characteristics of parachuting injury were also revealed by the injury type and site analysis. CONCLUSION A dose-response relationship between parachuting and injury was observed significantly in the survey of Chinese paratroopers. Their injury rate was found to be relatively higher than the reported internationally. Landing impact as a critical point for injury seemed to be proved by the investigation and also the experiment with EMG measurement. It is suggested for future studies, to use the person-based injury rate, landing studied in work physiology and with consideration of different landing skills.
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Affiliation(s)
- Lei Wu
- Department of Occupational and Environmental Health, MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University of Science and Technology, Wuhan, China
- Key Laboratory of Occupational Disease Hazard Identification and Control of Hubei Province, Wuhan University of Science and Technology, Wuhan, China
| | - Jian Li
- Department of Orthopedics, The Airborne Troops Hospital of Chinese PLA, Wuhan, China
| | - Zhenglun Wang
- Department of Occupational and Environmental Health, MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhongren Wang
- Department of Orthopedics, The Airborne Troops Hospital of Chinese PLA, Wuhan, China
| | - Tao Liu
- Department of Orthopedics, The Airborne Troops Hospital of Chinese PLA, Wuhan, China
| | - Jingzhi Sun
- Department of Occupational and Environmental Health, MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruijie Ling
- Department of Occupational and Environmental Health, MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lihua He
- School of Public Health, Peking University, Beijing, China
| | - Sheng Wang
- School of Public Health, Peking University, Beijing, China
| | - Lei Yang
- Department of Occupational and Environmental Health, MOE Key Lab of Environmental and Occupational Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Luo Y, Li Y, He L, Yin E, Gu M, Xu Z, Chen H, Hou Z, Yi C. Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures. Injury 2022; 54 Suppl 2:S8-S14. [PMID: 35180997 DOI: 10.1016/j.injury.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures. METHODS From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up. RESULTS Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort. CONCLUSION LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhe Xu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Chen
- Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Luo Y, Li Y, He L, Yi C. S2-Alar-Iliac Screw Fixation versus Iliac Screw Fixation in the Treatment of Sacral Fractures. J INVEST SURG 2022; 35:1224-1230. [PMID: 34974780 DOI: 10.1080/08941939.2021.2022253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the short-term therapeutic effects of S2-alar-iliac (S2AI) screw fixation and iliac screw fixation techniques in managing sacral fractures. METHODS From September 2015 to May 2020, 42 patients with sacral fractures who underwent lumbopelvic fixation by a single surgeon were analyzed. The patients were divided into the S2AI screw group (19 patients) and the iliac screw group (23 patients). Operative data, reduction quality, postoperative complications, and functional outcomes were evaluated. RESULTS The incidence of unplanned reoperation was significantly different between patients treated with S2AI screws than in those treated with iliac screws (0 versus 6, p = 0.02). The mean intraoperative estimated blood loss was 405.26 ± 229.67 mL in the S2AI screw group and 539.13 ± 246.32 mL in the iliac screw group (P = 0.08). No significant difference was observed in either group regarding the quality of reduction, functional outcome, or low back pain. The reduction quality based on the Matta criteria and excellent/good outcomes were 21/2 in the iliac screw group and 17/2 in the S2AI screw group. The functional outcomes based on the Majeed score and excellent/good/fair outcomes were 17/3/3 in the iliac screw group and 17/1/1 in the S2AI screw group. No complications, including implant breakage, loosening of the implant, or loss of reduction were found in either group during follow-up. CONCLUSION Both S2AI screws and iliac screws were effective in the treatment of sacral fractures. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for surgical site infection, wound dehiscence, and symptoms of screw protrusion than the use of iliac screws.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Petryla G, Bobina R, Uvarovas V, Kurtinaitis J, Sveikata T, Ryliškis S, Kvederas G, Šatkauskas I. Functional outcomes and quality of life after surgical treatment of spinopelvic dissociation: a case series with one-year follow-up. BMC Musculoskelet Disord 2021; 22:795. [PMID: 34525983 PMCID: PMC8444405 DOI: 10.1186/s12891-021-04676-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinopelvic dissociation is a transverse sacral fracture in conjunction with a vertical fracture of the sacrum on both sides, which causes the dissociation of the upper sacrum and spine from the pelvis. The most common causes of these fractures are high energy injuries such as falls from height or motor vehicle accidents. Spinopelvic dissociation is rare and heterogenous with severe associated injuries. The aim of this study was to assess the injury characteristics, changes in the quality of life and functional outcomes in the 1-year period after spinopelvic dissociation. MATERIALS AND METHODS During the period of 4 years (January 2016 and January 2020), 17 patients with spinopelvic dissociation were admitted to our centre and included in this single-centre prospective cohort study. One patient died during the admission; therefore 16 patients were enrolled in the analysis. Patients were followed-up for 12 months. The quality of life changes were evaluated via the SF-36 questionnaire, and the functional outcomes were evaluated using the Majeed pelvic score. Patients completed their questionnaires twice: firstly during hospitalization (regarding their pre-traumatic condition); and once again 1 year after their injury (regarding their current condition). RESULTS The mean age of the patients was 40.2 ± 17.7 years. Mean Majeed, PCS and MCS scores of SF-36 before the injury were 95.81 ± 9.50, 55.87 ± 8.89, and 43.76 ± 12.45, respectively. Mean Majeed, PCS and MCS scores 1 year after the injury were 71.13 ± 20.98, 43.45 ± 9.64, and 43.41 ± 7.56. During the period of 1 year after the injury, Majeed and PCS results reduced statistically significantly (P = 0.001 and P = 0.003, respectively), while MCS results remained similar (P = 0.501). CONCLUSIONS According to the data of our study, for patients with spinopelvic dissociation functional outcomes are significantly reduced and only one-third of the patients achieved pre-traumatic functional outcomes 1 year after the injury.
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Affiliation(s)
- Giedrius Petryla
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rokas Bobina
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Valentinas Uvarovas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jaunius Kurtinaitis
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sigitas Ryliškis
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Kvederas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Igoris Šatkauskas
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
Sacral fractures are a heterogeneous group of fractures occurring in young people following road traffic accidents and falls from height, or in the elderly with osteoporosis following trivial trauma.This heterogeneity, combined with the low incidence of sacral fractures, determines a lack of experience amongst physicians, often leading to misdiagnosis, underestimation and inadequate treatment. The diagnosis should be made by assessing specific features during the clinical presentation, while computed tomography (CT) scan continues to be the choice of investigation.Sacral fractures can be treated non-operatively or surgically. Non-operative treatment is based on rest, pain relief therapy and early mobilization as tolerated. Surgical techniques can be split into two main groups: posterior pelvic fixation techniques and lumbopelvic fixation techniques. Anterior pelvic fixation techniques should be considered when sacral fractures are associated with anterior pelvic ring injuries, in order to increase stability and reduce the risk of posterior implant failure. To improve fracture reduction, different solutions could be adopted, including special positioning of the patient, manipulation techniques and use of specific reduction tools. Patients suffering from spinopelvic dissociation with associated neurologic lesions hardly ever recover completely, with residual lower-limb neurologic sequelae, urinary problems and sexual disfunction.Herein, we present issues, challenges and solutions related to the management of sacral fractures. Cite this article: EFORT Open Rev 2020;5:299-311. DOI: 10.1302/2058-5241.5.190064.
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Affiliation(s)
- Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Italy.,Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK
| | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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