ABSTRACT BOOK Free Papers Date: 2019-12-05 Session: Trauma Free Papers 1 Time: 08:00 - 10:00 Room: Auditorium Abstract no.: 54714 POLYTRAUMA - ARE BINDERS BEING UTILISED APPROPRIATELY? Christopher O'DOWD-BOOTH1, Thomas GEYTON2, Jay WATSON2, Christopher THORNHILL2, Enis GURYEL2, David CRONE2 1Brighton and Sussex University Hospitals, Farnborough (UNITED KINGDOM), 2Brighton and Sussex University Hospitals, Brighton (UNITED KINGDOM) Introduction: Polytauma is an increasing burden upon modern healthcare, and a current focus for improvement. Pelvic trauma carries a significant morbidity and mortality. The development of pelvic binders and their utilization has reduced this risk by reducing intra- pelvic volume, encourage clot formation and reducing blood loss. However, are these devices being used effectively and is sufficient investigation being performed? Methods: A retrospective review of electronic records from November 2018 – February 2019 was conducted within the major trauma centre, with two independent reviewers. Exclusion criteria included: insufficient imaging and paediatric trauma. Analysis of binder position and post-removal imaging was performed. Results: 177 cases were included for review. Analysis revealed 44% of cases demonstrated inappropriate positioning of pelvic binder. 76% were sited above the optimum level of the mid-trochanteric point. There was a mean distance of 58.8mm from the optimum position, with a range from 22m to 128mm. Of these patients 9% had appropriate complete trauma imaging in the form of whole body trauma CT scanogram, with 3.2% of those without a pelvic fracture undergoing a post-binder removal plain pelvic radiograph. Conclusion: Binder position is essential in effective haemorrhage control. This study demonstrates within the major trauma setter only half are positioned optimally. Further education into correct positioning is essential to reduce morbidity and mortality. Ligamentous injury is easily missed and hence post binder removal imaging is essential, but often forgotten. Further education and research is vital to improving trauma practice and improving patient outcomes in regard to pelvic trauma. Date: 2019-12-05 Session: Trauma Free Papers 1 Time: 08:00 - 10:00 Room: Auditorium Abstract no.: 54797 BIOMECHANICAL EVALUATION OF OSSEOUS FIXATION PATHWAYS IN AN ASSOCIATED BOTH COLUMN ACETABULUM FRACTURE Samuel HAILU1, Richard JENKINSON2, Markku NOUSIAINEN2, David STEPHEN2, Hans KREDER2, Stewart MCLACHLIN2, Carin WHYNE2 1Black Lion University Hospital, Addis Ababa (ETHIOPIA), 2Sunnybrook Health Science Centre, Toronto (CANADA) Anatomic reduction and stable fixation of acetabulum fractures plays the key role for successful long term outcome. Their fixation is often challenging and poses a large number of possible instrumentation strategies. There is limited biomechanical data that identifies the ideal construct for fixation of associated both column (ABC) acetabulum. This study examined the relative differences between ABC fracture fixation techniques based on acetabulum displacement under simulated weight bearing loads. Six composite right hemi-pelvises, with a fused right sacroiliac joint, were used in this study. Standardized high variety ABC fractures with each column in a single fragment (AO/OTA 62-C1.1) were created. Fractures were initially reduced and stabilized using 3.5mm screws, then 12-hole J-plate was added. This fully-fixed construct was then tested in a single-leg stance model under six cycles of independent axial load tests of 150, 400, and 800N (representing 25, 50, and 100% weight bearing loads). The final cycle for each load was held for 60 seconds to record the acetabular fracture gap displacement. Changes in acetabular stability were then compared between the (1) fully-fixed configuration and following sequential removal of the (2) plate, (3) lateral compression type II (LS) screw, and (4) retro-acetabular screws (RAS). ABC acetabulum fracture pattern was effectively stabilized at the articular fracture site by all fixation configurations tested in quasi-static loading. Fracture stability identified at simulated 100% body weight loads may suggest patients with an inferiority directed supracetabular screw could withstand earlier weight bearing. Date: 2019-12-05 Session: Trauma Free Papers 1 Time: 08:00 - 10:00 Room: Auditorium Abstract no.: 54727 MANAGEMENT OF UNSTABLE PELVIC RING FRACTURES – IS POSTERIOR FIXATION THE SOLUTION? AN ANALYSIS OF 73 CASES Kumar R J BHARAT, Raju SIVAKUMAR, Kumar V N SUDEEP Preethi Institute of Medical Sciences & Research, MADURAI (INDIA) Introduction: Unstable pelvic ring disruptions result from high-energy trauma and are often associated with multiple concomitant injuries. Internal fixation has become the preferred treatment for unstable posterior pelvic ring injuries. Several methods of fixation of pelvic injuries have been described, including anterior symphysis plating, posterior sacroiliac plating, lumbopelvic fixation and percutaneous fixation with iliosacral screws. Aim: The aim of this study was to report on the functional, clinical and radiological results of internal fixation of unstable pelvic injuries in a tertiary care centre. Materials and methods: This study involved 73 patients with pelvic injuries who had stabilisation in our centre from JAN 2012 to DEC 2017. 28 patients had Tile B, 38 had Tile C & 7 had Tile A injuries. 62 patients had a posterior fixation in the form of iliosacral screw or plate fixation, 9 patients had anterior & posterior fixation and 4 patients had lumbopelvic fixations .The mean duration of postoperative follow-up was 25.29 (13–48) months. The clinical outcome was assessed with postoperative Majeed’s score and the rate of postoperative complications assessed. Results: The mean postoperative Majeed score was 76.57. There was a significant improvement in postoperative vertical displacement .2 patients with lumbopelvic fixation had superficial infection and had implant exit after one year. Conclusion: Treatment of unstable pelvic injuries is individualised according to mode of injury. Selective posterior fixation of unstable pelvic fractures with percutaneous iliosacral screws or posterior ilium plating achieves good functional results with minimal soft tissue trauma. Date: 2019-12-05 Session: Trauma Free Papers 1 Time: 08:00 - 10:00 Room: Auditorium Abstract no.: 54401 DOES TIMING OF SURGERY AFFECT PERIOPERATIVE FACTORS AND SHORT-TERM OUTCOMES AFTER SURGICAL TREATMENT OF ACETABULAR FRACTURES? Kareem SHAATH, Philip LIM, Reid ANDREWS, Elizabeth GAUSDEN, Phillip MITCHELL, Milton "Chip" ROUTT University of Texas Health Sciences Center, Houston (UNITED STATES) Introduction: The purpose of this study was to determine whether the timing of open reduction and internal fixation for acetabular fractures has an influence on perioperative factors and short-term medical and surgical outcomes. Materials and Methods: Patients with operatively treated acetabular fractures over a 5-year period were reviewed and stratified based on time to surgery after admission: <2 days versus >2 days, <5 days versus >5 days, <7 days versus >7 days. Patients were then separated based on approach (Kocher-Langenbeck or ilioinguinal) and re-analysed with the time points discussed previously. Outcomes included operative time, estimated intraoperative blood loss, length of stay, and early medical and surgical complications. Results: We identified 204 patients. When comparing blood loss and operative time amongst various timepoints, there were no statistically significant differences. This held true after the cohort was re- assessed based on approach. At every time point analysed, the latter group had a statistically significant increase in hospital stay. This held true after the cohort was re- assessed based on approach as well. There were no statistically significant differences in early surgical or medical complications observed amongst the time points. Discussion: We found that there was no advantage in terms of blood loss or operative time for early versus late fixation of acetabular fractures. However, at every time point analysed, the later cohort had a statistically significant increase in hospital stay. We, therefore, recommend treating these patients as soon as they are medically optimized to limit their hospital stay. Date: 2019-12-05 Session: Trauma Free Papers 1 Time: 08:00 - 10:00 Room: Auditorium Abstract no.: 54866 FUNCTIONAL OUTCOME OF ACUTE PRIMARY TOTAL HIP REPLACEMENT AFTER COMPLEX ACETABULAR FRACTURES Faizan IQBAL Liaquat National Hospital, Karachi (PAKISTAN) PURPOSE: To assess the functional outcome of acute primary total hip replacement in the management of complex acetabular fractures. MATERIAL AND METHODS: This prospective observational study was conducted in orthopaedic department of Liaquat National Hospital and Medical College, Karachi. The study was approved by the Ethics review committee of hospital (0190-2016). Patients encountered between January 2010 to January 2016 were entered. 54 patients with acetabular fractures with certain indications (marginal impaction or significant comminution (>3 fragments) of the articular surface of the acetabulum, full-thickness articular injury to the femoral head, an associated femur neck fracture, or pre-existing symptomatic osteoarthritis) were treated with primary total hip replacement. Patients were followed at regular intervals to assess the radiological union of fractures and complications. Functional outcome was evaluated after 2 years by applying Harris Hip Score.