Pelvic ring injuries (PRI) are among the most difficult injuries to deal with in orthopedic trauma. When these injuries are accompanied by hemodynamic instability their management becomes significantly more complex. A methodical assessment and expeditious triage are required for these patients followed by adequate resuscitation. A major triage decision is whether these patients should undergo arterial embolization in the angiography suit or prompt packing and pelvic stabilization in the operating room. Patient characteristics, fracture type and injury characteristics are taken into consideration in the decision-making process. In this review we discuss the acute evaluation, triage and management of PRIs associated with hemodynamic instability. An evidence based and protocol driven approach is necessary in order to achieve optimal outcomes in these patients.

Background: The aim of this study was to investigate the knowledge, attitudes, and practices of the Greek general population toward coronavirus disease 2019 (COVID-19) during the lockdown period in April 2020, to examine factors associated with misperceptions and to determine behavioral patterns that may require interventions. Methods: A cross-sectional study of the general Greek population (N = 1858) was conducted. A geographically stratified cluster sampling was implemented. A questionnaire was composed consisting of 35 questions. Data collection took place from 15 April to 2 May 2020. A random-digit dialing survey was conducted by 29 interviewers. Results: The majority of respondents (62.7%) answered ≥12/17 questions correctly. Participants aged 18–44 years, male gender, specific occupations (freelancer, unemployed, housewife, retiree) and those who sought information about COVID-19 from less than two sources received lower aggregated scores on knowledge questions. Regarding attitudes toward future vaccination, 18.9% declared that were against it, while 81.1% that they may consider or will be vaccinated. About 40% were not using a face mask and only 42% washed their hands appropriately. Conclusion: Adjusting information campaigns targeting especially people below 45 years of age can help to sensitize them and realise their role to control the spread. Further targeted surveys are needed to adjust/design prevention campaigns.

Purpose: Total hip arthroplasty is among the most successful orthopedic procedures; however, approximately 10%–20% of patients require revision surgery within 15–20 years. Potential failure mechanisms at the bone–implant interface include stress shielding and excessive micromotion. This experimental work aims at examining the optimal ratio of femur length and stem length with respect to primary stability and stress shielding effect, employing a validated finite element analysis. Methods: One hundred human femora were reconstructed from computed tomography (CT) scans, and for each femur, 13 personalized cementless stems were designed with varying lengths (70–130 mm, in 5 mm increments), resulting in 1300 finite element models. Each model was analyzed under standardized joint and muscle loading conditions. The model was validated experimentally after cadaveric implantation with digital image correlation (DIC) under static loading. Primary outcomes included micromotion at the bone–implant interface and proximal stress shielding. Optimal stem length was determined as the ratio of stem‐to‐femur length that minimized the combined normalized scores of micromotion and stress shielding. The effect of stem‐to‐femur length ratio was analysed with linear regression. Results: The analysis revealed a correlation between femoral length and stem length. Longer stems provided better initial stability and reduced micromotion. On the other hand, shorter stems demonstrated less proximal stress shielding and a better stress distribution resembling that of the intact femur. The optimal stem length was found to be 18.5% ± 2.7% (mean ± SD) of the femur length in terms of the mean of calculated micromotions and stress shielding, indicating that personalized stem length selection can enhance the bone–implant osseointegration. Conclusion: The selection of a stem length that corresponds proportionally to femoral length can improve primary stability and stress shielding upon implantation, highlighting the importance of enhancing initial fixation in order to extend the lifespan of hip replacements. Level of Evidence: N/A.