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Chen CH, Lien FC. Subcutaneous anterior pelvic bridge — an innovative technique for fixation of selective acetabular fracture: a case series and literature review. INTERNATIONAL ORTHOPAEDICS 2022; 46:1863-1872. [PMID: 35674913 PMCID: PMC9174027 DOI: 10.1007/s00264-022-05460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
Introduction The aim of the study was to introduce an innovative technique involving the use of a subcutaneous anterior pelvic bridge (SAPB) in the treatment of selective acetabular fractures. Methods We performed a retrospective study of 21 patients with acetabular fracture who were treated with SAPB between January 2016 and March 2021. The patients’ data were retrieved from electronic charts. Radiological results were evaluated according to the Matta system to assess the quality of the reduction and time of union. Functional outcomes were assessed in line with the d’Aubigné and Postel scoring system. Post-operative complications were also recorded. Results SAPB required around 60 minutes, with minimal blood loss and short learning curve. Matta score revealed excellent radiological outcomes in seventeen displaced fractures with seven excellent outcomes and nine good outcomes. Functional outcomes were excellent in twelve hips, good in seven hips, and fair in two hips. Six patients had transient lateral femoral cutaneous nerve palsy. Discussion The innovative SAPB method for the treatment of selective acetabular fracture is proven to be a feasible method with promising outcomes. SAPB is a minimally invasive technique and strengthens the stability of fixation, with less blood loss and fewer intra-operative/post-operative complications.
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Affiliation(s)
- Chien Han Chen
- Present Address: Department of Neurosurgery, Chung Shan Medical University Hospital, 402 Taichung, Taiwan
| | - Fang Chieh Lien
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 600 Chiayi, Taiwan
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Cavalié G, Boudissa M, Kerschbaumer G, Seurat O, Ruatti S, Tonetti J. Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum. Orthop Traumatol Surg Res 2022; 108:103288. [PMID: 35470116 DOI: 10.1016/j.otsr.2022.103288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Antegrade posterior column screw fixation (APCS) provides stable fixation while reducing the complications related to dual acetabular approaches. The objective of this study was to present the radiological and clinical outcomes of fixation of the posterior column of the acetabulum through a single anterior approach. HYPOTHESIS APCS will produce better clinical and radiological outcomes relative to not placing any screws in the posterior column. PATIENTS AND METHODS This was a retrospective single-center study of 69 patients operated through a single anterior approach for a both-column fracture of the acetabulum between 2014 and 2018. Patients were divided into two groups (APCS+, n=24 and APCS-, n=45) depending on whether the posterior column was fixed with an antegrade lag screw or not. The radiological outcomes were defined by the quality of the reduction according to Matta. The clinical outcomes were evaluated using the Harris Hip score and Merle Postel D'Aubigné (MDP) score at the final assessment. A sequential hierarchical analysis was done with a Chi2 test for the radiological criterion and Student's t test for the clinical outcomes. RESULTS In the APCS+ group, the reduction was anatomical in 71% (17/24) of patients, imperfect in 12% (3/24) and poor in 17% (4/24). In the APCS- group, the reduction was anatomical in 33% (15/45) of patients, imperfect in 31% (14/45) and poor in 35% (16/45). This difference between groups was statistically significant (p=.012). The differences between groups in the Harris (p=.201) and MDP (p>.05) scores were not significant. Mean irradiation in the APCS+ group was significantly higher (114.8 cGy.cm-2) relative to the APCS- group (39.8 cGy.cm-2) (p<.001). None of the patients in the APCS+ group underwent a subsequent total hip arthroplasty, while 8 patients from the APCS- group did (p=.031). The differences in the postoperative complications were not statistically significant. DISCUSSION APCS yields satisfactory radiological and clinical outcomes without increasing the complication rate; this must be balanced out against the additional irradiation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guillaume Cavalié
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire d'Anatomie des Alpes Françaises (LADAF), Faculté de médecine, Domaine de la Merci, 38700 La Tronche, France.
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire TIMC-IMAG, CNRS UMR 5525, 38000 Grenoble, France
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Christ AB, Hansen DG, Healey JH, Fabbri N. Computer-Assisted Surgical Navigation for Primary and Metastatic Bone Malignancy of the Pelvis: Current Evidence and Future Directions. HSS J 2021; 17:344-350. [PMID: 34539276 PMCID: PMC8436340 DOI: 10.1177/15563316211028137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Computer-assisted navigation and robotic surgery have gained popularity in the treatment of pelvic bone malignancies, given the complexity of the bony pelvis, the proximity of numerous vital structures, and the historical challenges of pelvic bone tumor surgery. Initial interest was on enhancing the accuracy in sarcoma resection by improving the quality of surgical margins and decreasing the incidence of local recurrences. Several studies have shown an association between intraoperative navigation and increased incidence of negative margin bone resection, but long-term outcomes of navigation in pelvic bone tumor resection have yet to be established. Historically, mechanical stabilization of pelvic bone metastases has been limited to Harrington-type total hip arthroplasty for disabling periacetabular disease, but more recently, computer-assisted surgery has been employed for minimally invasive percutaneous fixation and stabilization; although still in its incipient stages, this procedure is potentially appealing for treating patients with bone metastases to the pelvis. The authors review the literature on navigation for the treatment of primary and metastatic tumors of the pelvic bone and discuss the best practices and limitations of these techniques.
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Affiliation(s)
- Alexander B. Christ
- Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA USA
| | - Derek G. Hansen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John H. Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicola Fabbri
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Davila-Parrilla AD, Iguina-González E. Successful Arthroscopic Fixation of a Posterior Wall Acetabular Fracture Nonunion on a Patient With Femoroacetabular Impingement: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00009. [PMID: 33826557 DOI: 10.2106/jbjs.cc.20.00389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE This report presents the results of a hip arthroscopic technique that was used to treat an unusual posterior wall acetabular fracture nonunion. A 30-year-old man presented with 1 year of persistent left-sided buttock and groin pain with associated feeling of instability when climbing stairs. Magnetic resonance imaging demonstrated a small left acetabular posterior wall fracture nonunion. We describe outpatient treatment with reduction and cannulated screw fixation using arthroscopic techniques that permitted immediate partial weight bearing and achieved excellent outcomes at 1 year. CONCLUSION Arthroscopic fixation of an acetabular posterior wall fracture nonunion may be a feasible treatment option in select cases.
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Affiliation(s)
- Ariel D Davila-Parrilla
- Department of Surgery, Orthopedics Section, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Filippiadis DK, Tselikas L, Bazzocchi A, Efthymiou E, Kelekis A, Yevich S. Percutaneous Management of Cancer Pain. Curr Oncol Rep 2020; 22:43. [DOI: 10.1007/s11912-020-00906-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gürpınar T, Polat B, Kanay E, Polat A, Öztürkmen Y. Arthroscopic Fixation of a Posterior Acetabular Wall Fracture: A Case Report. Cureus 2019; 11:e6264. [PMID: 31893189 PMCID: PMC6937468 DOI: 10.7759/cureus.6264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to present the results of an unusual surgical technique for the treatment of posterior wall acetabular fractures. A 49-year-old man presented to the emergency department after a fall from three meters. His X-rays revealed a right acetabular posterior wall fracture. He was treated with arthroscopic reduction and fixation using a cannulated screw through arthroscopic portals. The patient was allowed partial weight-bearing immediately and had a satisfactory outcome. In selected cases, arthroscopic reduction and fixation in acetabular posterior wall fractures could be a good surgical option with the advantages of simultaneous labral treatments and loose body removal.
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Affiliation(s)
- Tahsin Gürpınar
- Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, TUR
| | - Barış Polat
- Orthopaedics and Traumatology, University of Kyrenia, Kyrenia, CYP
| | - Enes Kanay
- Orthopaedics and Traumatology, Beykoz State Hospital, Istanbul, TUR
| | - Ayşe Polat
- Orthopaedics and Traumatology, Dr. Akçiçek State Hospital, Kyrenia, CYP
| | - Yusuf Öztürkmen
- Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, TUR
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Dekimpe C, Andreani O, De Dompsure RB, Lemmex DB, Layet V, Foti P, Amoretti N. CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome. Eur Radiol 2019; 30:961-970. [PMID: 31628504 DOI: 10.1007/s00330-019-06439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. MATERIALS AND METHODS Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. RESULTS Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. CONCLUSION This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. KEY POINTS • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.
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Affiliation(s)
- Chloé Dekimpe
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France.
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Groupe Arnaud Tzank, Saint Laurent du Var, France
| | - Regis Bernard De Dompsure
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Devin Byron Lemmex
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Vivien Layet
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Pauline Foti
- Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France
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Lea WB, Neilson JC, King DM, Tutton SM. Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Technique. Semin Intervent Radiol 2019; 36:229-240. [PMID: 31435131 DOI: 10.1055/s-0039-1693982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Metastatic disease involving the pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions for unstable pelvic metastatic disease have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. While it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity.
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Affiliation(s)
- William B Lea
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John C Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Tutton
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Roux C, Tselikas L, Yevich S, Sandes Solha R, Hakime A, Teriitehau C, Gravel G, de Baere T, Deschamps F. Fluoroscopy and Cone-Beam CT-guided Fixation by Internal Cemented Screw for Pathologic Pelvic Fractures. Radiology 2018; 290:418-425. [PMID: 30422090 DOI: 10.1148/radiol.2018181105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the safety and efficacy of palliative treatment of patients with pathologic pelvic by using fluoroscopy and cone-beam CT needle guidance software to perform percutaneous fixation by internal cemented screw (FICS). Materials and Methods This single-center study involved retrospective analysis of 100 consecutive patients with cancer with pathologic pelvic fractures managed with percutaneous FICS. Image guidance was performed with fluoroscopy and cone-beam CT needle guidance software. Pain palliative outcomes and opioid use after FICS were compared by means of paired-sample t test. Results A total of 107 percutaneous FICS procedures were performed from 2010 to 2017 to palliate 141 pathologic fractures in 100 patients (mean age, 65.0 years ± 17.6 [standard deviation; female age, 66.3 years ± 18.0; mean, 63.7 years ± 17.2]). Of 107 procedures, 104 (97.2%) were technically successful, with mean postprocedure hospitalization of 2 days ± 3. Complications occurred in 14 patients: focal pain at procedure site for longer than 48 hours (n = 5), hematoma (n = 3), progressive fracture despite fixation (n = 2), infection (n = 1), tumor track seeding (n = 1), and screw displacement (n = 2). In the 88 patients who completed early follow-up, mean numeric rating scale pain score was significantly improved at 6 weeks from 6.1 ± 2.5 to 2.1 ± 3.0 (P < .001). Opioid use was reduced at 6 weeks (preprocedure vs postprocedure, 91.3 g ± 121 vs 64.6 g ± 124, respectively; P = .04). Conclusion Fluoroscopy and cone-beam CT-guided percutaneous fixation of pathologic pelvis fractures by internal cemented screw is a safe and effective approach that can reduce pain and opioid use. © RSNA, 2018.
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Affiliation(s)
- Charles Roux
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Raphael Sandes Solha
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Antoine Hakime
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Christophe Teriitehau
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Guillaume Gravel
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baere
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frederic Deschamps
- From the Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France (C.R., L.T., S.Y., R.S.S., A.H., C.T., G.G., T.d.B., F.D.); and Université Paris-Sud, Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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Deschamps F, Yevich S, Gravel G, Roux C, Hakime A, de Baère T, Tselikas L. Percutaneous Fixation by Internal Cemented Screw for the Treatment of Unstable Osseous Disease in Cancer Patients. Semin Intervent Radiol 2018; 35:238-247. [PMID: 30402006 DOI: 10.1055/s-0038-1673359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Interventional radiology expertise in image guidance has expanded the treatment options for cancer patients with unstable osseous disease. Percutaneous fixation by internal cemented screw (FICS) describes the technique by which the interventional radiologist stabilizes a fracture or impending fracture with the percutaneous placement of a cannulated screw that is locked in position by polymethyl methacrylate cement. The durable metallic screws provide added resistance to torque and tension stresses that complement the axial compression resistance of cement. Compared with cementoplasty alone, the procedure has been advanced as a more durable and precise technique for stabilization of osseous disease for certain disease presentations in cancer patients. The application of advanced image guidance techniques improves upon existing percutaneous surgical techniques to facilitate approaches that would otherwise prove quite challenging, particularly with stabilization of the pelvic flat bones. This article examines the applications of percutaneous FICS procedures for the treatment of unstable osseous disease in cancer patients. Indications, techniques, and follow-up care are reviewed. Case examples in which FICS can be performed in unstable pathology are detailed.
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Affiliation(s)
- Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guillaume Gravel
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Antoine Hakime
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France
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Chen X, Chen X, Zhang G, Lin H, Yu Z, Wu C, Li X, Lin Y, Huang W. Accurate fixation of plates and screws for the treatment of acetabular fractures using 3D-printed guiding templates: An experimental study. Injury 2017; 48:1147-1154. [PMID: 28325671 DOI: 10.1016/j.injury.2017.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/28/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the feasibility of the use of 3D-printed guiding templates for accurate placement of plates and screws for internal fixation of acetabular fractures. METHODS 3D models of the pelvises of 14 adult cadavers were reconstructed using computed tomography (CT). Twenty-eight acetabular fractures were simulated and placement positions for plates and screw trajectories were designed. Bending module was obtained by 3D cutting; guiding template was manufactured using 3D printing, and the plate was pre-bent according to the bending module. Plates and screws were placed in cadaveric pelvises using the guiding template, and 3D model was reconstructed using CT. The designed and real trajectories were matched using 3D registration including the coordinates (entry and exit points) of designed trajectory. The number of qualified points with different accuracy levels was compared using Chi-squared test. RESULTS Sixty-four plates and 339 screws were placed with no cortical breach. The absolute difference of the X, Y, and Z coordinates between the designed and real entry points were 0.52±0.45, 0.43±0.36, and 0.53±0.44mm, respectively. The corresponding values for the exit points were 0.83±0.67, 1.22±0.87, and 1.26±0.83mm, respectively. With an accuracy degree ≥1.9mm for the entry points and ≥3.8mm for the exit points, there was no significant difference between the designed and the real trajectories. CONCLUSION The 3D-printed guiding template helped achieve accurate placement of plates and screws in the pelvis of adult cadavers.
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Affiliation(s)
- Xu Chen
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Xuanhuang Chen
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Guodong Zhang
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China; Department of Human Anatomy, Southern Medical University, School of Basic Medical Sciences, Guangzhou 510515, China
| | - Haibin Lin
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
| | - Zhengxi Yu
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Changfu Wu
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Xing Li
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Yijun Lin
- Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China
| | - Wenhua Huang
- Department of Human Anatomy, Southern Medical University, School of Basic Medical Sciences, Guangzhou 510515, China.
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Scheinfeld MH, Dym AA, Spektor M, Avery LL, Dym RJ, Amanatullah DF. Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics 2016; 35:555-77. [PMID: 25763739 DOI: 10.1148/rg.352140098] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.
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Affiliation(s)
- Meir H Scheinfeld
- From the Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467 (M.H.S., R.J.D.); Albert Einstein College of Medicine, Bronx, NY (A.A.D.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S.); Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (L.L.A.); and Department of Orthopedic Surgery, Stanford University, Palo Alto, Calif (D.F.A.)
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Wu ES, Jauregui JJ, Banerjee S, Cherian JJ, Mont MA. Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture. Expert Rev Med Devices 2015; 12:297-306. [PMID: 25850558 DOI: 10.1586/17434440.2015.1026327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-traumatic arthritis of the hip can develop in 12-57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed.
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Affiliation(s)
- Eddie S Wu
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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14
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Dodré E, Lefebvre G, Cockenpot E, Chastanet P, Cotten A. Interventional MSK procedures: the hip. Br J Radiol 2015; 89:20150408. [PMID: 26317896 DOI: 10.1259/bjr.20150408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures.
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Affiliation(s)
- Emilie Dodré
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France
| | - Guillaume Lefebvre
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France
| | - Eric Cockenpot
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France
| | - Patrick Chastanet
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Lille, France
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15
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Percutaneous osteosynthesis in the pelvis in cancer patients. Eur Radiol 2015; 26:1631-9. [DOI: 10.1007/s00330-015-3971-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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16
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Wang ZF, Hong ZH, Wang MZ, Ruan JW, Wang W, Pan WB. A reduction clamp for an aiming component in associated acetabular fractures. Indian J Orthop 2015; 49:101-4. [PMID: 25593360 PMCID: PMC4292320 DOI: 10.4103/0019-5413.143916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. MATERIALS AND METHODS In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. RESULTS This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. CONCLUSION This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.
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Affiliation(s)
- Zhang-Fu Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Zheng-Hua Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Mei-Zhen Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Jian-Wei Ruan
- Department of Orthopedics, Taizhou Municipal Hospital Affiliated to Taizhou University, Medical School, Taizhou, 318000, China
| | - Wei Wang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, 317000, China
| | - Wei-Bo Pan
- Department of Orthopedics, Taizhou Municipal Hospital Affiliated to Taizhou University, Medical School, Taizhou, 318000, China
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CT scan-guided percutaneous osteosynthesis of a complex, multifocal fracture of the pelvic girdle in a 14-year-old adolescent. Skeletal Radiol 2014; 43:1165-8. [PMID: 24647555 DOI: 10.1007/s00256-014-1855-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/05/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient's parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient.
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