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Wagner M, Schaller L, Endstrasser F, Vavron P, Braito M, Schmaranzer E, Schmaranzer F, Brunner A. Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2024; 106-B:775-782. [PMID: 39084659 DOI: 10.1302/0301-620x.106b8.bjj-2023-1478.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.
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Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Tyrol, Austria
| | | | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Petr Vavron
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Matthias Braito
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Ehrenfried Schmaranzer
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional, and Paediatric Radiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
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Lee AK, Collinge CA. Assessment of Force Applied During Examination Under Anesthesia Used to Determine Stability in Posterior Wall Acetabular Fractures. J Am Acad Orthop Surg 2024:00124635-990000000-01034. [PMID: 38996345 DOI: 10.5435/jaaos-d-21-00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVES Determination of hip instability associated with posterior wall acetabular fractures may be difficult. Thus, dynamic stress examination under anesthesia (EUA) was developed as a tool for guiding treatment. EUA uses positioning of the hip and application of force across the hip to detect instability. While aspects of the EUA technique seems consistently described in the literature and practiced by surgeons, some components are ill-defined. The goal of this study was to assess standardization of applied force during EUA among experienced acetabular surgeons. METHODS Fellowship-trained orthopaedic trauma surgeons with experience in acetabular fracture treatment performed EUA for posterior wall instability on an intact, fresh human cadaver. All surgeons used a similar method, and each expert performed EUA multiple times separated by a brief hiatus. The maximum force applied along the femur's vector in Newtons (N) was measured using a hand-held digital dynamometer. RESULTS The EUAs of 19 surgeons were evaluated. Five surgeons had been practicing for <5 years, six for 6 to 10 years, five for 11 to 20 years, and three for >20 years. The mean force applied during EUA was 173N, with a notable variability between surgeons (range, 77-368N). Notable variability was also observed between sequential measures of individual surgeons with six surgeons (31.6%) having a >50N range on repeat trials. CONCLUSION This is the first study to report force applied during an EUA to assess for posterior wall acetabular fracture stability. Notable variability was observed among surgeons performing the examination and in repeated examinations by the same surgeon, suggesting that results of EUA may be surgeon-dependent. Further study is needed to determine what optimal applied force should be used to assess hip stability after a posterior wall acetabular fracture. LEVEL OF EVIDENCE Level V. An assessment of a diagnostic tool.
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Affiliation(s)
- Adam Keith Lee
- From the Dignity Health Medical Group - St. Joseph's Hospital and Medical Center, Phoenix, AZ (Lee), Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX (Collinge)
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Agrawal RR, Barber HF, Barnard ER, Miller AN. Acetabular dysplasia and posterior wall fractures: The missing link? Injury 2024; 55:111601. [PMID: 38810571 DOI: 10.1016/j.injury.2024.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Traumatologists are unable to predict hip instability based on CT scans and standard radiographs in posterior wall (PW) fractures comprising <50-60 % of the wall, necessitating an examination under anesthesia (EUA). Risk factors for instability have not been clarified, but acetabular dysplasia has been theorized as a potential etiology. Unfortunately, dysplasia is difficult to evaluate in the traumatic setting. The purpose of this study was to compare acetabular morphology between unstable and stable fractures with a novel method to detect dysplasia. METHODS Patients ≥ 18 years old with a PW fracture that underwent an EUA from 2013 to 2023 were retrospectively identified. For our experimental measurements, the axial distances on CT between the acetabular dome, lateral acetabular opening, and femoral head vertex were recorded. Acetabular geometry was quantified at these levels. Conventional dysplasia metrics (e.g., Tonnis angle) were obtained. Variables were compared between stable and unstable fractures. RESULTS 58 patients met inclusion criteria with 42 stable versus 16 unstable fractures. Unstable fractures had higher distances between the acetabular dome and femoral head vertex (p > 0.05). They had more cranial fracture exit points (p = 0.0015), lower femoral head coverage (p = 0.0102), and lower posterior acetabular sector angles (p = 0.0281). No other differences in acetabular geometry, demographics, injury characteristics, or other markers of dysplasia were identified. CONCLUSIONS Unstable hips demonstrated a more recessed acetabular dome when compared to stable hips. Posterior acetabular femoral head coverage and cranial fracture exit point may be related to hip instability. A larger sample size is needed to validate these findings.
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Affiliation(s)
- Ravi R Agrawal
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
| | - Helena F Barber
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
| | - Eric R Barnard
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO 63110, USA
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO 63110, USA.
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Jaeblon T, Demyanovich H, Bauer B, Beer R, Kufera J. A New Computed Tomography-Based Measure that Provides Insight Into Hip Stability in Patients With Posterior Wall Acetabular Fractures. J Orthop Trauma 2024; 38:306-312. [PMID: 38442184 DOI: 10.1097/bot.0000000000002792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To describe the technique and results of a new sagittal plane computed tomography (CT)-based angular measure for predicting stability after posterior wall acetabular fractures (PWF). METHODS DESIGN Retrospective review. SETTING Academic Level II trauma center. PATIENT SELECTION CRITERIA Fifty-eight consecutive patients with PWF (AO/OTA class 62A.1), 98% were high-energy injuries. INTERVENTION A new sagittal CT measure of PWF based on the angle subtending the joint center, cranial and caudal fracture exits. OUTCOME MEASURES AND COMPARISONS Hip incongruity or dislocation demonstrated using gold standard test, examination under anesthesia (EUA), or instability on static images. Prediction of hip instability using a sagittal CT angular measure based on cranial and caudal fracture exits was compared with previous axial CT measures suggestive of increased risk for instability including posterior wall size >50%, and those with cranial exit within 5.0 mm of the acetabular dome. RESULTS There were 32 operative and 26 nonoperatively treated fractures. Thirty fractures were determined to be unstable, and 28 were stable after EUA. Measurements of >70 degrees using the sagittal CT angular measure predicted instability in 28 of 28 patients, and ≤70 degrees predicted stability in 30 of 30 patients (sensitivity 100% and specificity 100%). Prevalence of EUA confirmed instability for subgroups with PWF based on prior axial CT measures were as follows: ≥50% wall involvement (11/16; sensitivity 67% and specificity 60%; 95% CI, 45%-89%/45%-75%), fracture within 5.0 mm of dome (5/18; sensitivity 86% and specificity 73%; 95% CI, 71%-100%/59%-87%), fracture within 5.0 mm of dome and ≥50% involvement (1/9; sensitivity 89% and specificity 56%; 95% CI, 69%-100%/24%-88%). CONCLUSIONS In a sample of 58 mostly high energy posterior wall fractures all having had an EUA, a new sagittal angular CT measurement of ≤70 degrees predicted hip stability and >70 degrees predicted instability with 100% sensitivity and specificity. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Todd Jaeblon
- Department of Orthopaedic Traumatology, University of Maryland Capital Region Medical Center, Largo, MD
- Department of Orthopaedics, University of Maryland, Baltimore, School of Medicine, Baltimore, MD; and
| | - Haley Demyanovich
- Department of Orthopaedic Traumatology, University of Maryland Capital Region Medical Center, Largo, MD
- Department of Orthopaedics, University of Maryland, Baltimore, School of Medicine, Baltimore, MD; and
| | - Brent Bauer
- Department of Orthopaedic Traumatology, University of Maryland Capital Region Medical Center, Largo, MD
- Department of Orthopaedics, University of Maryland, Baltimore, School of Medicine, Baltimore, MD; and
| | - Robert Beer
- Department of Orthopaedic Traumatology, University of Maryland Capital Region Medical Center, Largo, MD
- Department of Orthopaedics, University of Maryland, Baltimore, School of Medicine, Baltimore, MD; and
| | - Joseph Kufera
- National Study Center for Trauma and EMS, University of Maryland, Baltimore, Baltimore, MD
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Li J, Jin L, Chen C, Zhai J, Li L, Hou Z. Predictors for post-traumatic hip osteoarthritis in patients with transverse acetabular fractures following open reduction internal fixation: a minimum of 2 years' follow-up multicenter study. BMC Musculoskelet Disord 2023; 24:811. [PMID: 37833696 PMCID: PMC10571302 DOI: 10.1186/s12891-023-06945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The predictors of post-traumatic osteoarthritis (PTOA) in patients with transverse acetabular fractures (TAFs) following open reduction internal fixation (ORIF) remain unclear. This study aimed to investigate the risk factors for PTOA in TAFs after ORIF. METHODS Data of TAF patients receiving ORIF were collected from January 2012 and February 2021. Patients suffered PTOA were classified as the osteoarthritis group (OG), while those without PTOA were classified as the non- osteoarthritis group (NG) with a minimum follow-up of 2 years. PTOA was diagnosed according to Tönnis OA classification during the period of follow-up. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate demographics, injury-related characteristics, perioperative and post-discharge information. RESULTS Three hundred and eleven TAF patients were analyzed in this study, including 261 males and 50 females, with a mean age of 40.4 years (range 18 to 64 years). The incidence of PTOA was 29.6% (92 of 311) during the mean follow-up of 36.8 months (range 24 to 70 months). Several factors of PTOA were found using univariate analysis, including transverse fracture associated with posterior wall acetabular fracture (TPW-AF, p = 0.002), acetabular roof fracture (ARF, p = 0.001), femoral head lesion (FHL, p = 0.016), longer time from injury to surgery (TIS, p<0.001) and physical work after surgery (PWAS, p<0.001). Logistic regression analysis showed that TPW-AF (p = 0.007, OR = 2.610, 95%CI: 1.302-5.232), ARF (p = 0.001, OR = 2.887, 95%CI: 1.512-5.512), FHL (p = 0.005, OR = 2.302, 95%CI: 1.283-4.131), TIS (p<0.0001, OR = 1.294, 95%CI: 1.192-1.405) and PWAS (p<0.0001, 3.198, 95%CI: 1.765-5.797) were independent risk factors of PTOA. Furthermore, ROC curve analysis indicated 11.5 days as the cut-off values to predict PTOA. CONCLUSIONS Our findings identified that TPW-AF, ARF, FHL, TIS and PWAS were independent risk factors for PTOA in patients with TAFs following ORIF. It can help orthopedic surgeons to take early individualized interventions to reduce its incidence.
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Affiliation(s)
- Junran Li
- Department of Orthopedic Surgery, Second Hospital of Tangshan, Tangshan, 063000, Hebei, P.R. China
- Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan, 063000, Hebei, P.R. China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China
| | - Chuanjie Chen
- Department of Orthopedic Surgery, Chengde Central Hospital, Chengde, 067000, Hebei, P.R. China
| | - Jingxiu Zhai
- Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan, 063000, Hebei, P.R. China
| | - Ligeng Li
- Department of Orthopedic Surgery, Second Hospital of Tangshan, Tangshan, 063000, Hebei, P.R. China.
- Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan, 063000, Hebei, P.R. China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
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Chen J, Zheng Y, Zhou W, Qian S, Chen Y, Cheng Y, Wang G, Cai X, Liu X. Three-Dimensional Printed Plate Template Versus Hemipelvis Model in Patient-Specific Plate Preparation for Posterior Wall Acetabular Fractures. Orthop Surg 2023; 15:2383-2392. [PMID: 37525356 PMCID: PMC10475674 DOI: 10.1111/os.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The application of three-dimensional (3D) printing technology in the management of posterior wall acetabular fractures can greatly reduce surgical invasiveness and operative time and simplify the procedure of reconstruction plate contouring, but the cost and time of patient-specific plate preparation on the basis of traditional 3D-printed pelvis model should not be neglected. We described a new method for patient-specific plate preparation by using 3D-printed plate template. The study aimed to assess the effectiveness and feasibility of the 3D-printed plate template in patient-specific plate preparation for posterior wall acetabular fractures. METHODS A total of 65 cases of posterior wall acetabular fractures with surgical treatment from December 2012 to December 2020 were chosen. According to the different plate contouring methods, the 65 cases were divided into three groups, which were group A (21 cases), group B (20 cases), and group C (24 cases). In group A, the 3D-printed plate template was used to contour the patient-specific reconstruction plate before surgery, whereas the 3D-printed hemipelvis model was adopted for group B. In group C, the reconstruction plate was contoured intraoperatively. Among the three groups, the instrumentation time, surgical time, blood loss, patient-specific plate preparation time, complications, reduction quality, and hip function were compared. The Kruskal-Wallis test was used to analyze the reduction quality and hip function among three groups. RESULTS In comparison with group C, patients in groups A and B were featured by obviously shorter instrumentation time (-22, -23 min), shorter surgical time (-46, -44 min), and less intraoperative blood loss (-110, -122 mL). Compared to the hemipelvis model in group B (2.29 ± 0.56 vs. 12.70 ± 3.79 days), the 3D printing time for plate templates in group A was significantly shorter. The reduction quality and hip function had no obvious statistical difference among the three groups. The complication rate within group A (3/21) and group B (3/20) were both slightly lower than group C (5/24), with no obvious difference. CONCLUSIONS Both the patient-specific pre-contoured plate fixation methods based on the 3D-printed hemipelvis model and plate template can achieve satisfactory clinical efficacy, with the advantage of shorter instrumentation and surgical time, and less intraoperative blood loss. However, 3D printing of plate template is easier and less time-consuming, considering the shorter time and less cost for 3D printing of physical model.
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Affiliation(s)
- Jianan Chen
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Yifan Zheng
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Wei Zhou
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Shenglong Qian
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Yu Chen
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Yipeng Cheng
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Guodong Wang
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Xianhua Cai
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
| | - Ximing Liu
- Department of Orthopeadics SurgeryGeneral Hospital of Central Theater CommandWuhanChina
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Wan Y, Xue P, Chen K, Yan D, Yu K, Huang G, Guo X. Both-column Acetabular Fractures with Posterior Wall Involved can be Managed through Single Anterior Approach by Evaluation of Computer-assisted Virtual Surgery Technique. Orthop Surg 2023; 15:2400-2409. [PMID: 37435882 PMCID: PMC10475672 DOI: 10.1111/os.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE Posterior wall (PW) fractures were sometimes associated in both-column acetabular fractures. How to evaluate pre-operatively the necessity for the performance of the posterior approach was an issue to be solved. In order to solve this issue, the computer-assisted virtual surgery technique was used to evaluate if the involved PW in both-column acetabular fractures (BACF) should be managed through posterior approach and verify the feasibility of this method. METHODS Data of a consecutive cohort of 72 patients with both-acetabular fractures from January 2012 to January 2020 was collected for retrospective study, of which 44 patients had concomitant acetabular PW fractures, and patients without PW fractures were labeled as the BCAF group. Computer-assisted virtual surgery technique was performed pre-operatively to evaluate the necessity for performance of posterior approach in 44 patients, and posterior approach was required if more than 3 mm of displacement was still present in the reduced 3D model. The 23 patients without treatment through posterior approach were labeled as the BCAF-PW- group, and the 21 patients with treatment through posterior approach were labeled as the BCAF-PW+ group. Operation-related and post-operative parameters were recorded. The quality of reduction and functional outcomes were assessed by the Matta scoring system and modified Merle d'Aubigné and Postel scoring system. The measurement data were analyzed using the t-test of independent samples and rank-sum test of ranked data between every two groups. Also, the one-way analysis of variance (ANOVA) was used to analyze data between the three groups. RESULTS Comparing operation-related and post-operative parameters in the three groups, some PW fractures in both-column acetabular fractures could be ignored, and which could be evaluated pre-operatively for necessity of an additional posterior approach. Operative time (271.2 ± 32.8 mins) and intra-operative blood loss (1176.7 ± 211.1 mL) were significantly higher in the BCAF-PW+ group. The excellent/good of reduction (25/28 of the BCAF group, 21/23 of the BCAF-PW- group, 19/21 of the BCAF-PW+ group) and functional outcomes (24/28 of the BCAF group, 18/23 of the BCAF-PW- group, 18/21 of the BCAF-PW+ group) of three groups were similar. The incidence of complications, such as deep vein thrombosis (4/28 of the BCAF group >3/23 of the BCAF-PW- group >1/21 of the BCAF-PW+ group) and injury of lateral femoral cutaneous nerve (3/23 of the BCAF-PW- group >2/28 of the BCAF group >0/21 of the BCAF-PW+ group), was no significant difference. CONCLUSION The partial both-column acetabular fractures with PW involvement could be managed through a single anterior approach without another posterior approach by evaluation of computer-assisted virtual surgery technique.
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Affiliation(s)
- Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Peiran Xue
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Dong Yan
- Wuhan Asia General HospitalWuhanChina
| | - Keda Yu
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Guixiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
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Chen J, Zheng Y, Fang Z, Zhou W, Xu D, Wang G, Cai X, Liu X. One-stop computerized virtual planning system for the surgical management of posterior wall acetabular fractures. J Orthop Surg Res 2022; 17:439. [PMID: 36195909 PMCID: PMC9531475 DOI: 10.1186/s13018-022-03333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Posterior wall acetabular fractures remain one of the most difficult fracture injuries to treat. Accurate assessment of fracture characteristics and appropriate preoperative surgical strategies are essential for excellent reduction. This paper evaluates the feasibility and effectiveness of a one-stop computerized virtual planning system for the surgical management of posterior wall acetabular fractures.
Methods 52 cases of posterior wall acetabular fractures treated surgically were selected in our department between January 2015 and December 2020 for retrospective analysis. 52 cases were classified into group A (25 patients) and group B (27 patients) according to whether computerized virtual planning procedures were performed preoperatively. In group A, virtual surgical simulation was conducted using a one-stop computerized planning system preoperatively. In group B, traditional surgery was employed. Reduction quality, surgical time, blood loss, hip function, complications, and instrumentation time were compared between the two groups. Results The actual surgery for all patients in group A was essentially the same as the virtual surgery before the operation. Compared to group B, patients in group A had markedly shorter surgical time (−43 min), shorter instrumentation time (−20 min), and less intraoperative blood loss (−130 ml). However, no significant statistical difference was observed in reduction quality and hip function. The complication rate was slightly lower in group A (4/25) than in group B (7/27), without a significant difference. Conclusion The one-stop computerized virtual planning system is a highly effective, user-friendly and educational tool for allowing the cost-efficient surgical simulation of posterior wall acetabular fractures and providing a more individualized therapeutic schedule. The one-stop computerized planning system is feasible to treat posterior wall acetabular fractures, which is an effective method than the conventional treatment of posterior wall acetabular fractures. Trial registration: retrospective registration.
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Affiliation(s)
- Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Yifan Zheng
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Zhixun Fang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Dan Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Xianhua Cai
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.
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Li J, Zhai J, Yin Y, Tian S, Wang Z, Li L, Hou Z, Zhang Y. Three-dimensional mapping study of pure transverse acetabular fractures. J Orthop Surg Res 2022; 17:264. [PMID: 35562736 PMCID: PMC9107150 DOI: 10.1186/s13018-022-03148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe and analyze the morphological characteristics, location and frequency of pure transverse acetabular fracture lines through fracture mapping and quantitative measurements. METHODS Transverse fractures were retrospectively reviewed and analyzed. All computed tomography (CT) data were used for reconstruction and manual reduction. The reductive fracture fragments were graphically overlaid onto a three-dimensional (3D) right hemipelvis template. Then, the fracture lines were accurately depicted onto the surface of the 3D template. The fracture lines were overlapped onto the model to create the 3D fracture map and heatmap. All cases were subdivided into infratectal (62-B1.1), juxtatectal (62-B1.2), and transtectal (62-B1.3) types based on the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification. Some anatomic parameters of the transverse fractures were also analyzed in these 3 groups. RESULTS Our study included forty-nine transverse fractures from 32 male and 17 female patients (mean age, 42 years; range 21-74 years) and included 19 type 62-B1.1, 17 type 62-B1.2, and 13 type 62-B1.3 fractures. The average anterior rim fracture angle was 70.0° (± 11.6°), and the posterior rim fracture angle was 92.4° (± 28.5°). The anterior rim fracture angles in 40 cases (40/49, 81.6%) fell within a wide range between 63° and 80°. On the heatmap, the hot zones were located on the highest position of the cotyloid fossa and the narrowed region, and the cold zone was on the inferior third of the articular surface. For type 62-B1.3 fractures, the hot zone was located on the posterior of the acetabular dome. There were no significant differences in anterior rim fracture angle and anterior height among the three patterns (P = 0.071, P = 0.072). Post hoc tests of the posterior rim fracture angle and the posterior height revealed significant differences among fracture subtypes (P < 0.01). The posterior intra-articular fracture line was significantly longer than the anterior intra-articular fracture line in type 62-B1.1 and type 62-B1.2 fractures (P < 0.01). CONCLUSION The fracture lines of transverse fractures through the anterior rim were concentrated on the narrowed zone, and the posterior fracture lines were diffusely distributed. The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. The recurrent fracture lines involving the weight-bearing dome mainly converged on the posterior region of the roof.
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Affiliation(s)
- Junran Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jingxiu Zhai
- Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Siyu Tian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Ligeng Li
- Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei Province, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei Province, China
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10
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Tian S, Zhang R, Liang S, Yin Y, Ma L, Liu G, Guo X, Hou Z, Zhang Y. Is Plating Fixation Through the
Kocher–Langenbeck
Approach for Associated Posterior Wall Fragment Indispensable in Both‐Column Acetabular Fractures? Orthop Surg 2022; 14:513-521. [PMID: 35098686 PMCID: PMC8926991 DOI: 10.1111/os.13215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Siyu Tian
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
| | - Shaobo Liang
- Department of Pelvic and Acetabular Surgery Honghui Hospital, Xi'an Jiaotong University Xi'an China
| | - Yingchao Yin
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
| | - Lijie Ma
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
| | - Guodong Liu
- Eighth Department, State Key Laboratory of Trauma, Burns and Combined Injuries, Research Institute of Surgery, Daping Hospital Army Medical University Chongqing China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment Shijiazhuang China
| | - Yingze Zhang
- Department of Orthopaedic Surgery Third Hospital of Hebei Medical University Shijiazhuang China
- Key Laboratory of Biomechanics of Hebei Province Shijiazhuang China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment Shijiazhuang China
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11
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Evaluation and Management of Posterior Wall Acetabulum Fractures. J Am Acad Orthop Surg 2021; 29:e1057-e1067. [PMID: 34323866 DOI: 10.5435/jaaos-d-20-01301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.
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12
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Modified lateralized head sign: An accurate marker in diagnosing adult hip dysplasia. J Orthop Sci 2020; 25:460-465. [PMID: 31202493 DOI: 10.1016/j.jos.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although lateralized head sign (LHS) is considered indicative of structural instability, it lacks reproducibility, and its usefulness in diagnosing adult hip dysplasia is unknown. In this study, we proposed a modified LHS and aimed to determine its reliability and accuracy in diagnosing adult hip dysplasia. METHODS We reviewed anteroposterior pelvic radiographs of 94 patients (134 hips) with hip dysplasia. As controls, 133 normal hips were evaluated. We defined the modified lateralization distance (LD) as the horizontal distance between the medial aspect of the femoral head to the acetabular fossa. The sensitivity, specificity, and cutoff value of modified LD in diagnosing hip dysplasia were calculated using receiver operating characteristic curve analysis. RESULTS The sensitivity and specificity of the modified LD (79% and 87%, respectively) were higher than those of the conventional LD (63% and 80%, respectively). Diagnostic accuracy was further improved when patients were divided on the basis of sex. The sensitivity and specificity of the modified LD in men were 89% and 97%, respectively, with a cutoff value of 12 mm, while in women, they were 80% and 96%, respectively, with a cutoff value of 9.7 mm. Therefore, we defined the modified LHS as presentation with a modified LD ≥ 12 mm in men and ≥10 mm in women. Between three observers, the kappa value for intraobserver reliability was ≥0.9, while that for interobserver reliability was >0.8. The mean sensitivity and specificity of the modified LHS in diagnosing hip dysplasia were 85% and 99%, respectively. CONCLUSIONS Modified LHS-a horizontal distance between the medial aspect of the femoral head and the acetabular fossa ≥12 mm in men and ≥10 mm in women-is a clinically useful marker in detecting lateral femoral head subluxation indicative of hip dysplasia or structural hip instability.
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13
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Christian RA, Butler BA, Weber TG, Stover MD. Novel Treatment for Recurrent Posttraumatic Hip Instability: A Case Report. JBJS Case Connect 2019; 9:e0272. [PMID: 31609750 DOI: 10.2106/jbjs.cc.18.00272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 26-year-old woman sustained a traumatic right hip dislocation with posterior wall component in a motor vehicle collision. Initial treatment consisted of open reduction internal fixation of her posterior wall fracture. Six years later, she developed low-energy recurrent hip instability. Imaging demonstrated posterior capsular insufficiency and femoral retrotorsion. The patient underwent intertrochanteric femoral rotational osteotomy. Nine years postoperatively, the patient has returned to activity without restriction or subsequent dislocations. CONCLUSIONS Recurrent posttraumatic hip instability requires careful identification of the etiology of instability. This case provides long-term follow-up after successful treatment with intertrochanteric femoral rotational osteotomy.
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Affiliation(s)
- Robert A Christian
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy G Weber
- OrthoIndy Trauma, St. Vincent Trauma Center, St. Vincent Orthopedics and Spine Center, Indianapolis, Indiana
| | - Michael D Stover
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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14
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Chu L, He Z, Qu X, Liu X, Zhang W, Zhang S, Han X, Yan M, Xu Q, Zhang S, Shang X, Yu Z. Different subchondral trabecular bone microstructure and biomechanical properties between developmental dysplasia of the hip and primary osteoarthritis. J Orthop Translat 2019; 22:50-57. [PMID: 32440499 PMCID: PMC7231963 DOI: 10.1016/j.jot.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Developmental dysplasia of the hip (DDH) is recognized as a frequent cause of secondary osteoarthritis (OA). The purpose in this study was to compare structural and biomechanical properties of subchondral trabecular bone and its relationship with cartilage damage between patients with DDH and patients with primary hip OA. Methods Forty-three femoral head specimens obtained from patients who underwent total hip arthroplasty [DDH, n = 17; primary OA, n = 16; and normal control (NC), n = 10] were scanned by microcomputed tomography and analyzed by individual trabecula segmentation to obtain the microstructural types of subchondral trabecular bone. The biomechanical properties were analyzed by micro-finite element analysis, and cartilage damage was evaluated by histology. The linear regression analysis was used to indicate the association between microstructures, biomechanical property, and articular cartilage. Results The DDH group showed the lowest total bone volume fractions (BV/TV) and plate BV/TV in the three groups (p < 0.05). There were also different discrepancies between the three groups in plate/rod trabecular number, plate/rod trabecular thickness, trabecular plate surface area/trabecular rod length, and junction density with different modes (plate-plate, rod-rod, and plate-rod junction density). The micro-finite element analysis, histology, and linear regression revealed that the subchondral trabecular bone in the DDH group had inferior biomechanical properties and cartilage damage of patients with DDH was more serious with different subchondral trabecular bone microstructures. Conclusion Our findings detected deteriorating subchondral trabecular bone microstructures in patients with DDH. The mass and type of subchondral trabecular bone play a key role in mechanical properties in DDH, which might be related to cartilage damage. The translational potential of this article Our findings suggested that changes of subchondral trabecular bone play a critical role in DDH progression and that the improvement on subchondral trabecular bone may be a sensitive and promising way in treatment of DDH.
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Affiliation(s)
- Linyang Chu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zihao He
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, PR China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, PR China
| | - Weituo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Shuo Zhang
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xuequan Han
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qi Xu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shuhong Zhang
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xifu Shang
- Department of Orthopedics, The Affiliated Provincial Hospital of China Science and Technology University, Hefei, 230001, Anhui Province, PR China
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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