Introduction There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently available... Show moreIntroduction There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently available literature regarding the indications and methods for surgical fixation of fragility fractures of the pelvic ring in elderly patients after low-energy trauma. Materials and methods The Pubmed and Embase databases were searched using the key words pelvic fractures, geriatric, fragility, osteoporosis, and surgical fixation, and their synonyms. Extracted data including the indication, method of operative fixation, and post-operative outcomes (pain levels, mobility, complications and mortality) were analyzed using descriptive statistics. The studies were too heterogeneous to perform a meta-analysis. Results Eleven cohort studies (3 comparative and 8 noncomparative) were included. The methodological quality was poor to moderate; the studies were heterogeneous regarding study design and reported outcomes. In all included studies operative treatment for all fracture types was preceded by a period of conservative treatment comprising physiotherapy-guided full weight-bearing. Time to surgery differed widely. For posterior ring fixation, the majority of the included studies used minimally invasive surgery with trans-iliosacral screws. Five studies described a form of additional fixation of the anterior pelvic ring but did not report the indications. Conclusions Fixation of low-energy pelvic ring fractures in elderly is commonly performed after a period of conservative treatment, with persistent pain as the most frequent indication for fixation. Fracture classification based on stability seems to be of secondary importance. Timing for surgical fixation of the pelvic ring fracture in elderly patients remains diverse. Large well-designed comparative prospective studies and randomized controlled trials are needed to provide clearly substantiated guidelines. Show less
In this thesis first we show that patients after total hip replacement are more satisfied than patients after total knee replacement (TKR). The indication to perform TKR is important. We studied... Show moreIn this thesis first we show that patients after total hip replacement are more satisfied than patients after total knee replacement (TKR). The indication to perform TKR is important. We studied the reason for orthopedic surgeons to recommend TKR. It seemed that the radiological osteoarthritis and age were most important. We compared Dutch orthopedic surgeons with those from other countries. Also we studied how well the oldest old patients (85+) perform with or without total joint replacement. In part 2 of the thesis more technical issues are addressed. A RCT studying the effect of fibrin sealant on postoperative knee function. No beneficial effect could be shown for the fibrin sealant. A Cochrane review and meta-analysis studying whether to sacrifice or retain the posterior cruciate ligament in TKR. It seemed there was no clinical difference between the two. Finally a RCT studying two different kinds of warming blankets applied during total joint replacement showed no evident difference between the two. Show less
