Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

Background and Objectives: Lateral compression injuries of the pelvic ring are most common among young and elderly patients. Of all pelvic ring fracture injuries, the B2.1 type—involving lateral compression of the pelvic ring—is the most common. Despite this, we still have no high-level evidence to consult when choosing between the surgical and non-operative approaches. The purpose of this research was to compare the short-term functional and quality of life outcomes between operatively and non-operatively treated young patients after a B2.1 type pelvic fracture. Materials and Methods: Patients aged 18 to 65 years with pelvic B2.1 type fractures—according to AO/Tile classification—that were hospitalized in a single trauma center between 2016 November and 2019 September were included in the research. Patients were retrospectively divided into two groups regarding their treatment: non-operative and operative. Functional outcomes were evaluated using Majeed score, and SF-36 was used for the evaluation of quality of life. Patients completed these questionnaires twice: first during hospitalization, regarding their pre-traumatic condition (timepoint I); and again 10 weeks after the injury, regarding their current condition (timepoint II). Results: A total of 55 patients (70.6% of whom were female) with type B2.1 pelvic fractures were included in the analysis, with an average age of 37.24 ± 13.78 years. There were 21 (38.18%) patients with high injury severity, and 37 (67.3%) patients were treated operatively versus 18 (32.7%) non-operatively. Between the two timepoints, Majeed score reduced by 34.08 ± 18.95 for operatively and 31.44 ± 14.41 for non-operatively treated patients. For operatively and non-operatively treated patients, the physical component summary (PCS) of the SF-36 questionnaire reduced by 19.45 ± 9.95 and 19.36 ± 7.88, respectively, while the mental component summary (MCS) reduced by 6.38 ± 11.04 and 7.23 ± 10.86, respectively. Conclusions: We observed that operative treatment of B2.1 type pelvic fractures for young patients is not superior to non-operative in the short-term, because the functional outcomes and quality of life are similar in both groups.

With the increase of high energy injuries, acetabular and pelvic ring fractures tend to be a more common part of polytrauma patients. Despite growing incidence, management of these injuries remains one of the most difficult challenges in orthopedic surgery. As these patients are usually multiply injured, it is not only life-threatening trauma in acute settings but also crippling in long time. We present a case of a 40-year-old male who suffered from a dreadful traffic accident following the fractures of pelvic ring and both acetabulum, open fracture of tibia, urinary bladder rupture, and crush syndrome. We discuss the factors which dictated the timing of definitive management of pelvic and associated injuries and compare it with this study. Furthermore, we present patients' final outcomes and management of long-term complications.

Background and Objectives: There are no valid patient-based pelvic ring function assessment tools in Lithuania. The most widely used instrument is the Majeed Pelvic Score (MPS), which is proven to be an effective tool for assessing pelvic function after pelvic injuries. The aims of our study were: (1) the translation and cross-cultural adaptation of the MPS for the Lithuanian-speaking population, (2) to test the psychometric properties of the Lithuanian version of the MPS (MPS-LT) at follow-up two-time points after pelvic fractures. Materials and Methods: The MPS was translated and culturally adapted. Psychometric properties of the MPS-LT were determined in one patient group (n = 40) at two time-points during follow-up examination from 1.5 to 3 months (mean 2 months) and from 11 to 20 months (mean 12 months). Results: At the mean time of 2 months after trauma, Cronbach’s α of the MPS-LT was 0.65. Correlation of the MPS-LT with the Iowa Pelvic Score (IPS) was r = 0.84 (p < 0.001), and with the Lithuanian SF-36, PCS was r = 0.53 (p < 0.001). At the mean time follow-up of 12 months, Cronbach’s α was 0.86, correlation with the IPS was r = 0.92 (p < 0.001), and with the Lithuanian SF-36, PCS – r = 0.82 (p < 0.001). At the 2-month follow-up, neither floor nor ceiling effects were reached, but at 12 months, 27.5% of patients reached the ceiling effect, while none reached the floor effect. The effect size of the MPS-LT was 1.66. Conclusions: The MPS-LT has limited ability to measure functional outcomes at 2 months after pelvic fracture. In contrast, at the 12-month follow-up examination, the MPS-LT had a good ability to assess pelvic function, and it was sensitive to health changes. The MPS-LT can be used as a pelvic function assessment tool after pelvic fractures for the Lithuanian-speaking population.

Intramedullary nailing is the preferred treatment method in tibial, femoral shaft, and sub- or intertrochanteric fractures. Despite good results, a number of complications have been well-characterized. Joint perforation by bone fragment during nail insertion is one such complication. We report an eventful case of a 63-year-old female patient who presented with an intertrochanteric fracture. Osteosynthesis with a short proximal femoral nail was complicated by a well-known and recognized on-time complication - an iatrogenic fracture of the femoral shaft. However, it was further complicated by knee arthrodesis by a bone fragment when a long nail was inserted. The bone fragment not only “closed” the knee joint, but fractured the medial tibial condyle and protruded into the medial soft tissues of the joint. This misfortune was not recognized intraoperatively and led to revision surgery in the short term and joint post-traumatic arthrosis with resultant total knee replacement in the long term.

Introduction: Despite relatively low incidence, dislocation remains one of the main reasons for total hip arthroplasty (THA) revision. It is a devastating complication for a patient and a surgeon, and has high burden on the healthcare system. The aim of the present study was to assess and compare the risk factors for revision after early and delayed THA dislocations. Methods: Some 3403 THA through posterior approach for primary osteoarthritis were retrospectively studied in the Lithuanian Arthroplasty Register from 2011 to 2018. Three months after THA was the splitting time between the first event of early and delayed dislocations. Revision was set as outcome measure. Gender, affected side, number of dislocations, femoral head and neck size, and prosthesis fixation type were tested as risk factors for revision after early and delayed THA dislocations. Results: Dislocation occurred in 108 patients (3.2%), and 26 cases (0.8%) required revision. Men had statistically significant higher risk for revision due to early dislocation [hazard ratio (HR) 4.7; 1.3-17.7 confidence interval (CI)] and considerably lower risk for revision due to delayed dislocation (HR 0.5; 0.1-1.7 CI). The left side THA had twice the risk as compared to the right in the early settings (HR 2.1; 0.6-6.9 CI) which equalized after three months (HR 1.1; 0.4-3.1 CI). Some 32 mm femoral head had significantly lower risk in the early group as compared to 28 mm head (HR 0.3; 0.1-0.5 CI). Short head was associated with increased risk for revision after early dislocation, although, not statistically significant. Prosthesis fixation type was not a risk factor for revision surgery neither after early nor after delayed dislocation. Conclusion: The unique finding of gender separation was found -- men tend for revision after early dislocation and women after delayed dislocation. In early stage, additional precautions should be considered when 28 mm short metal heads are used.