Posterior wall acetabular fracture in a 13-year-old boy treated by open reduction and mini-plate internal fixation: long-term follow-up of 17 years

Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis

BACKGROUND

Treatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator.

METHODS

A patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis.

RESULTS

Under the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3-13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases.

CONCLUSIONS

The acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.

Acetabular Labral Tear with a Missed Posterior Wall Fracture in an Adolescent Athlete: A Case Report

CASE

We present an adolescent contact-sport athlete presenting with hip pain after a traumatic in-play event. After delayed clinical improvement, a magnetic resonance arthrogram (MRA) revealed a posterior acetabular labral tear and the patient was referred for arthroscopic repair. However, subsequent critical interpretation of the MRA demonstrated a missed concomitant posterior acetabular wall fracture, which was later confirmed with computed tomography.

CONCLUSION

Despite the low incidence of acetabular fractures in adolescents, this case report highlights the importance of maintaining clinical suspicion in young athletes after a traumatic injury, recognizing the association with labral tears, and acknowledging the limitations of certain imaging modalities.