Acetabular fractures often require stabilization. Fractures involving the quadrilateral plate (QP) remain challenging due to complex anatomy and minimal bone stock. Treatment options include orthogonal double plate fixation or anatomically preformed suprapectineal quadrilateral surface (QLS) plates. The purpose of this study was to evaluate a series of buttress plating of acetabular fractures (OTA/AO 62) comparing orthogonal double plate and QLS plate osteosynthesis regarding surgical procedure, complications, and outcome. At one level I trauma center, 109 patients underwent internal fixation either by orthogonal double plate osteosynthesis or by preshaped QLS plate. Surgical approach was performed via the first and third windows of the ilioinguinal approach. Reduction quality and osteosynthesis material were checked using CT. Groups were retrospectively evaluated regarding demographic factors, classification, and trauma mechanism. Clinical outcome was assessed utilizing the modified Harris Hip Score (mHHS). Follow-up was 25 months. Fractures were stabilized using orthogonal double plate osteosynthesis (56

Extensive research regarding instabilities and prevention of kyphotic malalignment in the thoracolumbar spine exists. Keystones of this treatment are posterior instrumentation and anterior vertebral height restoration. Anterior column reduction via a single-stage procedure seems to be advantageous regarding complication, blood loss, and OR-time. Mechanical elevation of the anterior cortex of the vertebra may prevent the necessity of additional anterior stabilization or vertebral body replacement. The purpose of this study was to examine (1) if increased bony reduction in the anterior vertebral cortex could be achieved by utilization of an additional reduction tool, (2) if postoperative loss of vertebral height could be reduced, and (3) if anterior column reduction is related to clinical outcome. From one level I trauma center, 173 patients underwent posterior stabilization for fractures of the thoracolumbar region between 2015 and 2020. Reduction in the vertebral body was performed via intraoperative lordotic positioning or by utilization of an additional reduction tool (Nforce, Medtronic). The reduction tool was mounted onto the pedicle screws and removed after tightening of the locking screws. To assess bony reduction, the sagittal index (SI) and vertebral kyphosis angle (VKA) were measured on X-rays and CT images at different time points ((1) preoperative, (2) postoperative, (3) ≥ 3 months postoperative). Clinical outcome was assessed utilizing the Ostwestry Disability Index (ODI). Bisegmental stabilization of AO/OTA type A3/A4 vertebral fractures was performed in 77 patients. Thereof, reduction was performed in 44 patients (females 34

Background For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics. Methods From one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed. Results During the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m 2 . Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse ( p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted ( p = 0.001) and negatively related to a fall from a horse ( p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity ( p < 0.001). Three of them required an amputation (30%). Conclusion Despite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity.

STUDY DESIGN:Retrospective study. OBJECTIVES:To analyze factors associated with major complications (MC) in patients with ankylosing spondylitis (AS) undergoing surgical management for a spine fracture. METHODS:Included were all persons with spine fractures and AS in a teriary health care center between 2003 and 2019. Clinical data and MC were characterized with descriptive characteristics. Multivariable analyses were used to find factors associated with MC. RESULTS:In total, 174 traumatic fracture incidents in 166 patients with AS were included, with a mean patient age of 70.7 ± 13.1 years. The main reason for spine fracture was minor trauma (79.9%). Spinal cord injuries (SCI) were described in 36.7% of cases. The majority of patients (54.6%) showed more than one fracture of the spine, with cervical fractures being the most common (50.5%). Overall, the incidences of surgical site infection, implant failure, nosocomial pneumonia (NP), and mortality were 17.2%, 9.2%, 31%, and 14.9%, respectively. ICU stay > 48 hours was associated with MC (including death). Posterior approach for spondylodesis, ICU stay > 48 hours and cervical SCI were related to MC (excluding death). Age > 70 years, NP and Charlson comorbidity index > 5 points were associated with in-hospital mortality. CONCLUSIONS:Patients with AS and surgical treatment of spine fractures are at high risk for MC. Therefore, our results might give physicians better insight into the incidence and sequelae of major complications and therefore might improve patient and family expectations.

Abstract Background Bilateral sacral fractures result in traumatic disruption of the posterior pelvic ring. Treatment for unstable posterior pelvic ring fractures should aim for fracture reduction and rigid fixation to facilitate early mobilization. Iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) were recommended for the treatment of these injuries. No algorithm or gold standard exists for surgery of these fractures. Purpose The purpose of this study was to evaluate the differences between ISF and LPF in bilateral sacral fractures regarding intraoperative procedures, complications and postoperative mobilization. The secondary aim was to determine whether demographics influence surgical treatment. Methods Over a 4-year period (2016–2019), 188 consecutive patients with pelvic ring injuries were treated at one academic level 1 trauma center and retrospectively identified. Fractures were classified according to the AO/OTA classification system. Seventy-seven patients were treated with LPF or ISF in combination with internal fixation of pubic rami fractures and could be included in this study. Comparisons were made between demographic and perioperative data. Infection, hematoma and hardware malpositioning were used as complication variables. Mobilization with unrestricted weight bearing was used as outcome variable. Follow-up was at least 6 months postoperatively. Results Operative stabilization of bilateral posterior pelvic ring injuries was performed in 77 patients. Therefore, 29 patients (females 59%) underwent LPF whereas 48 patients (females 83%) had bilateral ISF. The ISF group was older (76 yrs.) compared to the LPF group (62 yrs.) (p = 0.001), but no differences regarding BMI or comorbidities were detected. Time for surgery was reduced for patients who were treated with ISF compared to lumbopelvic fixation (73 min vs. 165 min; respectively, p < 0.001). But this did not result in reduced fluoroscopic time or radiation exposure. Overall complication rate was not different between the groups. Patients with LPF had a greater length of stay (p = 0.008) but were all weight bearing as tolerated when discharged (p < 0.001). Conclusion Bilateral posterior pelvic ring injuries of the sacrum can be sufficiently treated by LPF or ISF. LPF allows immediate weight bearing which may benefit younger patients and patients with an elevated risk for pneumonia or other pulmonary complications. Treatment with ISF reduces operative time, length of stay and postoperative wound infection. Elderly patients may be better suited for treatment with ISF if there is concern that the patient may not tolerate the increased operative time.

Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm 2 ; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

Background The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods Over a 5-year period (2010–2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities ( p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients ( p = 0.01). Conclusion Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32–86 years; 9m/8f) and the follow-up averaged 26.9 months (14–48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in “daily activities” (89.6 vs. 57.1; p = 0.031), “mobility” (84.7 vs. 45.5; p = 0.015) and “function” (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

Abstract Introduction The OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes. Methods From one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years). Results Cephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion. Conclusion Intramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.

Die Spondylodiszitis ist eine seltene, aber komplexe Erkrankung mit steigender Inzidenz. Diagnostische Algorithmen und Behandlungsoptionen werden kontrovers diskutiert. Nationale Leitlinien sind zwar für Mai 2020 geplant, fehlen aber nach wie vor, so dass diagnostische Algorithmen und Behandlungsoptionen weiterhin kontrovers diskutiert werden. Es erfolgen die Präsentation eines Diagnostikalgorithmus und Behandlungsvorschläge mit Fokus auf die antibiotische Therapie. Eine umfassende Literatursuche wurde durchgeführt, um klinische Studien, nationale Leitlinien, Reviewartikel und Expertenmeinungen zu identifizieren, analysieren und diskutieren. Aufgrund der unspezifischen Klinik erfolgt die Diagnosestellung häufig verzögert. Meist kann die korrekte Diagnose nur mithilfe einer Kombination aus klinischen, laborchemischen und radiologischen Befunden gestellt werden. Die antibiotische Therapie ist eine Säule der Spondylodiszitistherapie. Empfohlen wird eine umgehende empirische antibiotische Therapie bis zur Identifikation des Pathogens. Eine konservative Therapie kann in Erwägung gezogen werden, wenn keine neurologischen Defizite, größeren Abszesse, knöchernen Destruktionen, Instabilitäten oder ein septisches Krankheitsbild vorliegen. Eine engmaschige Reevaluation und klinische Kontrollen sind in der poststationären Nachbehandlung essenziell. Die zeitgerechte operative Therapie kann zu einer schnellen Besserung der neurologischen Symptomatik, einer Sicherung der Diagnose durch Probenentnahme, Stabilisierung und Vermeidung von Deformitäten führen. Die Diagnosestellung und Behandlung der Spondylodiszitis stellt eine Herausforderung dar und ist nach wie vor assoziiert mit einer hohen Morbidität und Mortalität. Schlüsselfaktoren einer erfolgreichen Behandlung sind die schnelle und korrekte Diagnosestellung und die adäquate antibiotische Therapie.

Purpose The number of total knee arthroplasties (TKA) increased rapidly. In conjunction with higher implantation rates, periprosthetic femur fractures following TKA are also gradually increasing. Purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic femoral fractures with retained total knee replacement using polyaxial locking plates in regard to quality of life, functional outcome and complications.MethodsThe Study design is a single-center retrospective cohort analysis. Included were patients with periprosthetic supracondylar femoral fractures with a well-fixed knee prosthesis initially treated with NCB plate (Non-contact bridging plate, Zimmer Inc., Warsaw, IN). Primary outcome was measured including quality of life and functional status using the SMFA-D score (German short musculoskeletal function assessment questionnaire), the mortality rate and union rate. Formerly published SMFA-data presenting representative randomly chosen cross-sectional data from general population of the USA and Dutch population was used as historic control group.ResultsIn total, 45 patients with a mean age of 74 years were included (10 males; 35 females). Body mass index averaged 27.4 kg/m(2). Follow-up averaged 52 months. Comparison of the SMFA-D scores showed higher scores according to bother index (41.5 vs. 15.7/13.8) and function index (42.5 vs. 14.5/12.7). Mortality rate was 26.7%. The CCI was directly related to the mortality rate (p=0.033). Union was achieved in 35 of 45 fractures (78%) six months after the index procedure. The ultimate union rate including following procedures at last follow-up was 95.6%.ConclusionBesides already highlighted limitations in range of motion, we quantified patient-related limitations in daily living. A large number of patients after surgery are not self-reliant mobile or on orthopedic aids. A high CCI was directly related to the mortality rate and can be used as a predictive factor for postoperative mortality.

Trotz jahrzehntelanger Erfahrung und einer Fülle an Studien herrscht bis heute keine Einigkeit bezüglich der optimalen Versorgung und des Zugangsweges bei Instabilitäten der Brust und Lendenwirbelsäule. Neben der dorsalen Zuggurtung ist die ventrale Abstützung ein Grundpfeiler der Versorgung in diesem Bereich. Die kombinierte Stabilisierung von ventral und dorsal bietet neben einer exzellenten Übersicht das stabilste biomechanische Konstrukt. Bei einer Versorgung über zwei separate Zugänge werden die Morbidität des Patienten und die möglichen Komplikationen jedoch addiert. Eine ventrale Versorgung über einen dorsalen Zugangsweg scheint daher hinsichtlich der Komplikationen, des Blutverlusts und der Operationsdauer von Vorteil zu sein. Über einen modifizierten Posterior-lumbar-interbody-fusion(PLIF)-/Transforaminal-lumbar-interbody-fusion(TLIF)-Zugang können auf diese Weise ventrale Defekte aufgefüllt werden. Insbesondere im Bereich der Lendenwirbelsäule ist dies jedoch durch die abgehenden Nervenwurzeln anatomisch beschränkt. Häufig sind nur eine Teilkorporektomie und die Auffüllung des verletzten Bandscheibenraumes erforderlich. Durch aufspreizbare Cages gelingt jedoch auch der Ersatz ganzer Wirbelkörper. Patientenfaktoren und der Operateur beeinflussen weiterhin die gewählte Operationstechnik.

Etwa 2–4 % aller Frakturen sind Humerusschaftfrakturen. Bezüglich der Therapie gibt es in der Literatur und in der Praxis keinen Goldstandard. Sowohl die konservative Therapie, die Plattenosteosynthese als auch intramedulläre Osteosyntheseverfahren werden mit großem Erfolg eingesetzt.

Fractures of the humeral shaft occur with an incidence of 2-4% among all fractures in humans. With both non-operative treatment and surgical treatment, such as open reduction, internal fixation or intramedullary osteosynthesis, good results can be achieved; however, a gold standard has not yet been identified in the literature or in practice.The purpose of this article is to summarize the available evidence and to propose an algorithm for the treatment of humeral shaft fractures.Included were a selective literature search in the Medline database and the clinical experience of the authors.Surgical treatment options for humeral shaft fractures with proven high success rates are open reduction with subsequent plate osteosynthesis and intramedullary nail osteosynthesis. Despite a great deal of research on minimally invasive surgical options and optimized design of implants, non-operative treatment is still an option for treatment of fractures of the upper arm.

The number of patients with total hip replacement (THR) is likely to grow. Periprosthetic femoral fractures occur in 0.1–4.5 % of patients with THR. Treatment of periprosthetic fractures in the vicinity of well-fixed implants has focused on lateral plating. The purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic fractures with THR in regard to fracture type, surgical procedure, complications, and outcome.

INTRODUCTION: Tumoral calcinosis (TC) is a rare disorder defined by hyperphosphatemia and ectopic calcifications in various locations. The most common form of TC is associated with disorders such as renal insufficiency, hyperparathyroidism, or hypervitaminosis D. The primary (hereditary) TC is caused by inactivating mutations in either the fibroblast growth factor 23 (FGF23), the GalNAc transferase 3 (GALNT3) or the KLOTHO (KL) gene.PRESENTATION OF CASE: We report here a case of secondary TC in end-stage renal disease. The patient was on regular hemodialysis and presented with severe painful soft-tissue calcifications around her left hip and shoulder that had been increasing over the last two years. Initially, she was treated with dietary phosphate restriction and phosphate binders. Because of high phosphate blood levels, which were not yet managed with dialysis and medical therapy, a subtotal parathyroidectomy (sP) was performed. This approach demonstrated significant response. Three months after surgery a rapid regression of the tumors was observed.DISSCUSION: Regardless of the etiology, the two types of TC do not differ in their radiologic or histopathologic presentations but need to be diagnosed correctly to initiate targeted and effective treatment. Considering the primary TC, primary treatment is early and complete surgical excision. In case of secondary TC surgical excision of the tumoral masses should be avoid because of extensive complications. These patients benefit from sP.CONCLUSION: After initial conservative therapy chronic kidney disease patients with TC might benefit from sP to avoid prolonged suffering and potential mutilations. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Introduction Occipitocervical fusion (OCF) is a safe and reliable method for stabilization of craniocervical instabilities caused by different mechanisms. Especially patients with acute instabilities and unaffected previous range of motion of the cervical spine, may be affected by the fusion procedure. The purpose of this study was to evaluate retrospectively surgical outcome and patient disability after OCF procedure for acute instabilities. Methods Over a 5-year period, 2009–2014, 33 consecutive patients from one academic trauma center were retrospectively identified as having been treated with OCF. Of these, 29 patients were diagnosed with traumatic or pathologic fractures or nonunion after previously failed surgical intervention. Average follow up was 25 months (range 4–55 months). Demographics were assessed. Fixation constructs were delineated. Nonunion, infection, implant failure, neurologic disabilities, and deaths were used as complication variables. Patient disability was addressed by the Neck Disability Index (NDI) and persistent pain (VAS). Results Traumatic and pathologic fractures were the main reason (90%) for an OCF procedure in our study population. Three patients (10%) suffered from a persistent instability after previously failed surgical stabilization. Fracture location was the odontoid process of C2 in 69% of the patients and 31% had a combined injury to C1 and C2. Fusion was performed between the occiput and C4 in 55%, C5 in 28%, and C3 in 17%. Fusion was enhanced by autologous bone in 14 patients (48%). 3 patients (10%) underwent a surgical revision due to screw misplacement (1) and infection (2). Related to the advanced patient age, 15 patients died before the evaluation. One patient died during hospital stay related to his preoperatively existing comorbidities. Fourteen patients were evaluated. Average age was 74.2 years (range 18–95 years). Regarding the clinical outcome, pain averaged 2.5 on the VAS (median 2). 64% of the patients reported no or minimal pain (VAS 0–2), 23% complained of mild pain (VAS 2–4). The NDI averaged 42% (range 16 – 80%). Conclusion OCF is a reliable and safe procedure for the treatment of craniocervical instabilities caused by different injuries and diseases. Overall, pain reduction was effective. Patients reported no or only mild pain (VAS 0–4) in 86% during our evaluation. Functional disability averaged 42% utilizing the NDI, which is rated as “medium disability.” The rate of 52% deceased patients reflects the fact that OCF is performed in our institution especially in elderly and patients with increased rates of comorbidities.

Introduction Management of unstable sacral fractures has evolved from non-operative treatment to relatively rigid internal fixation. Multidirectional instability of the posterior pelvic ring and lumbopelvic junction may be stabilized by lumbopelvic fixation. This technique decreases the load to the sacrum and SI joint and transfers axial loads from the lumbar spine directly onto the ilium, which allows early full weight bearing and therefore reduces prolonged immobilization. One of the keystones for lumbopelvic fixation is the placement of the iliac screws. The iliac screws are directed from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). The optimal osseous corridor for iliac screw placement requires multiple posteroanterior and lateral views with additional obturator outlet and obturator inlet views. Obtaining the correct views results in increased OR times, fluoroscopy times, and radiation exposure of the patients and OR personnel. The purpose of this study was to evaluate if a better intraoperative visualization of bony structures utilizing a 3D-navigation system can reduce operative time, fluoroscopy time, and radiation exposure. Material and Methods From one academic trauma center, 44 consecutive patients were retrospectively identified as having been treated with lumbopelvic fixation between July 2011 and June 2015 (4 years). Of these, 10 patients were excluded because of only a unilateral triangular fixation. 34 patients (61.8% female) met the inclusion criteria. Patients had an average age of 58.9 years (range 18–87 years). Lumbopelvic implants (USS II, DepuySynthes, Germany) were inserted as described by Schildhauer. A passive optoelectronic navigation system (Brainlab, Germany) was utilized for navigated iliac screw placement. Surface registration of L4 was performed for the matching procedure. To compare groups, demographics were assessed, operative time, fluoroscopic time, radiation, and screw malpositioning were delineated. Results During the study period, 24 patients underwent bilateral lumbopelvic fixation utilizing conventional fluoroscopic imaging alone and 10 patients underwent the procedure with 3D navigated iliac screw placement. No differences were found between the two groups regarding age (60.3 versus 55.6 years; p = 0,553), BMI (25.65 versus 25.17 kg/m2; p = 0.808), gender (62.5% versus 60% females; p = 0.891), or length of hospital stay (39 versus 26 days; p = 0.089). Comparing screw length and diameter, the median was 110 mm and 8 mm, respectively in both groups. Utilization of 3D navigation led to a fluoroscopy time reduction of more than 50% (3.47 versus 8.32 minute.; p = 0.004) resulting in a significantly reduced radiation (4980 versus 2665 Gy*cm2; p = 0.032). Operative time was reduced in the navigation group (177 versus 234 minute; p = 0.028) despite the necessity of additional surface referencing. Conclusion Fixation of sacral fractures continues to be challenging due to complex local anatomy. Especially in severe comminuted sacral fractures lumbopelvic fixation provides superior stability and allows immediate weight-bearing. For iliac screws, identifying the correct entry point and angle of implantation in all planes requires detailed anatomic knowledge and multiple radiographic views. In the current study, 3D navigation helped to reduce operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for the patient and OR personnel.