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pain in the posterior and anterior pelvic ring, although the latter is less frequent. There are other symptoms associated with pelvic deformity, such as leg-length discrepancy, aesthetic defects due to bony prominences, posture problems (sitting and
Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK
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NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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minimally invasive or percutaneous techniques 60 , 73 , 86 but rising to up to 50% with open lumbopelvic fixation, and up to 20% if treated with plates); 74 , 95 wound healing problems; 93 , 96 , 97 instrumentation failure (11–17%); 85
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Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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, 2 63% of amputees suffer from one or more skin problems that lead to daily routine activity limitations in one third of these patients. 3 Around 70% of amputees develop phantom limb pain (PLP) or residual limb pain (RLP), 4 14.5% of
School of Medicine, Universidad de La Laguna, Tenerife, Spain
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School of Medicine, Universidad de La Laguna, Tenerife, Spain
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University of Basel, Basel, Switzerland
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School of Medicine, Universidad de Sevilla, Sevilla, Spain
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Osteoporotic ankle fractures result from mechanical forces that would not ordinarily result in fracture, known as ‘low-energy’ trauma, such as those equivalent to a fall from a standing height or less.
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Osteoporotic ankle fractures in frail patients are becoming more and more frequent in daily practice and represent a therapeutic challenge for orthopaedic surgeons.
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The main problems with frail patients are the poor condition of the soft tissues around the ankle, dependence for activities of daily living and high comorbidity.
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The decision to operate on these patients is complex because conservative treatment is poorly tolerated in unstable fractures and conventional open reduction and internal fixation is associated with a high rate of complications.
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The authors conducted a narrative review of the literature on primary tibiotalocalcaneal nailing of ankle fractures in frail patients and categorized the different factors to consider when treatment is indicated for this conditon. Difficulty of ambulation, age over 65 years old, deteriorated baseline state and instability of the fracture were the most frequently considered factors.
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Finally, the authors propose an easy and quick clinical scoring system to help in the decision-making process, although further comparative studies are required to explore its validity.
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NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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morbidity and mortality. 4 Delay of more than 48 hrs to surgery has been found to be related to systemic problems (chest infections, decubitus ulcers, pulmonary oedema, impaired mobility-functional results) leading to prolonged length of stay, morbidity
Department of Orthopaedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.
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radiographic progression of healing for three months. 1 Associated minor criteria include pain, impaired function, delayed rehabilitation resulting in a work and social handicap. A classification is needed to understand the problem and to form the basis
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Brettreichstraße, Würzburg, Germany
Paracelsus Medizinische Privatuniversität, Strubergasse, Salzburg, Austria
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
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Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
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Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), DOUW - Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Grube-Straße, Halle, Germany
BG-Klinikum Bergmannstrost Halle, Halle, Saale, Germany
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primary choice in patients with open physis ( 30 , 31 ). Although a malleolar osteotomy is often the only way to approach the defect, it has the potential for secondary problems and it needs special attention. Bull et al. reported some displacement in a
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known, detrimental, complication of fracture healing. Its impact on functional outcome transcends expected physical limitations. Sufferers may go on to develop psychological problems as a result of chronic intractable pain and subsequent misuse of opiate
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. 22 Therefore, although fixed angle plates have gone some way to improving fixation in the presence of poor bone stock, loss of fixation in the osteoporotic patient remains a problem. 3 Thus, when ORIF is planned in patients over 65 years old
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be avoided as they can cause problems (left). On the right, a correctly placed external fixator (EF) of the pelvis. The clamps should be at least 2 cm from the patient’s abdominal wall in both the lying and sitting positions because of the
