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Buddhist H, Sinha S, Maurya R, Ansari MW, Kumar K, Panda A, Nayak SR, Rai R, Rao V, Poddar SG. Correlation Between Radiological and Functional Outcomes Following Operative and Nonoperative Management of Acetabular Fractures: A Prospective Observational Study. Cureus 2024; 16:e58146. [PMID: 38741859 PMCID: PMC11088990 DOI: 10.7759/cureus.58146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The management of acetabular fractures is a complicated orthopedic procedure that has been advancing with time. Newer radiological tools like CT scans help surgeons to identify and manage these fractures more attentively. The study was conducted to evaluate the clinical and radiographic outcomes in patients with acetabular fractures managed either conservatively or by open reduction and internal fixation. MATERIALS AND METHOD The study was done on 35 patients aged 18-60 years, with acetabular fractures treated either surgically or conservatively. Clinical scorings and radiological scoring were only taken and noted at three- and six-month intervals using Matta's radiographic scoring and modified Merle d'Aubigne and Postel clinical hip scoring. Clinico-radiological variables and complications were compared between the two groups. The data obtained was subjected to statistical analyses using IBM Statistical Package of Social Sciences (SPSS) 2.0 version software (Chicago, IL, USA) at a level of significance being p<0.05. RESULTS Out of a total of 35 patients, 19 were treated surgically and 16 conservatively. In patients belonging to the surgical treatment group, a maximum of 57.9% were aged 40-50 years, whereas the maximum patients (50%) of the conservative treatment group were aged <40 years, with male predominance in both groups. The type of fracture was recorded according to Judet and Letournel in both groups. Merle d'Aubigne's scoring and Matta's hip score were recorded at three and six months in both groups. A positive correlation was seen between radiological and functional outcomes at three and six months, which means that the higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort. CONCLUSION Our study revealed that surgically managed patients had better functional and radiological outcomes than the patients who were conservatively managed at six months of follow-up. However, this is associated with more complications depending on fracture complexity and initial presentation of hip dislocation. The higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort.
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Affiliation(s)
- Harshvardhan Buddhist
- Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shivam Sinha
- Orthopaedics and Traumatology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ravikant Maurya
- Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | | | - Krishan Kumar
- Orthopaedics, Sardar Patel Medical College, Bikaner, Delhi, IND
| | - Amrit Panda
- Orthopaedics, SCB (Srirama Chandra Bhanja) Medical College and Hospital, Cuttack, IND
| | - Soumya Ranjan Nayak
- Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Rai
- Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vikas Rao
- Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Sushil Gandhi Poddar
- Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Aprato A, Caruso R, Reboli M, Giachino M, Massè A. Surgical Technique: Arthroscopic Reduction and Fixation of Partial Posterior Wall Acetabular Fractures. Arthrosc Tech 2024; 13:102932. [PMID: 38690352 PMCID: PMC11056782 DOI: 10.1016/j.eats.2024.102932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Partial posterior wall fractures are usually fixed with open reduction-internal fixation through an open posterolateral approach, but when the fragment may be fixed without a plate (with screws only), reduction and fixation may also be achieved via hip arthroscopy with the patient in the prone position. This article presents all the surgical steps to perform this procedure.
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Kim YJ, Lencioni AM, Tucker NJ, Strage KE, Parry JA, Mauffrey C. Postoperative Computed Tomography Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery. J Orthop Trauma 2024; 38:78-82. [PMID: 38031286 DOI: 10.1097/bot.0000000000002727] [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: 11/14/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To investigate the utility of postoperative computed tomography (CT) scans in identifying indications for revision surgery after surgical fixation of acetabular fractures. METHODS DESIGN Retrospective cohort study. SETTING Urban level 1 trauma center. PATIENT SELECTION CRITERIA Patients with surgically treated acetabular fractures with surgical fixation (open reduction and internal fixation or percutaneous fixation) with routine postoperative CT scans. OUTCOME MEASURES AND COMPARISONS Primary outcome-revision surgery based on postoperative imaging, including intra-articular osteochondral fragments, implant complications, and malreductions. Secondary outcome-quality of reduction on radiographs versus CT scans. RESULTS One hundred forty-eight patients were included. The revision surgery rate was 15.5% (23/148); indications included malpositioned implants (6.7%, n = 10), malreductions (5.4%, n = 8), and intra-articular loose bodies (3.4%, n = 5). Only 8.7% (2/23) of the indications for revision surgery were identified on postoperative radiographs, with the remainder being identified on CT scans. Revision surgeries were found to be associated with male gender (proportional difference: 19.6%, 95% confidence interval [CI]: 3.4%-29.4%; P = 0.04) and T-type fractures (PD 28.7%; CI, 9.0%-48.9%; P = 0.001). Revision surgery was not found to be associated with age, body mass index, posterior wall fractures, concurrent pelvic ring fractures, or surgical approach. On radiographs, 51.3% (n = 76/148) had anatomic reductions (<2 mm) compared with only 10.2% (n = 15/148) on CT scans. CONCLUSIONS Indications for revision of acetabular fixation surgeries and poor reductions were frequently missed on plain radiography and identified on postoperative CT scans. This suggests that the use of advanced imaging such as intraoperative 3D imaging or postoperative CT scans may be beneficial. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ye J Kim
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
| | - Alex M Lencioni
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
| | - Nicholas J Tucker
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
| | - Katya E Strage
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
| | - Joshua A Parry
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopedics, University of Colorado, Aurora, CO
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Qoreishy M, Sajedi A, Gholipour M, Gorji M, Maleki A. Clinical results of acetabular fracture treatment with hybrid fixation by anterior and posterior approach : A minimally invasive technique. Wien Klin Wochenschr 2023:10.1007/s00508-023-02277-2. [PMID: 37815673 DOI: 10.1007/s00508-023-02277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/27/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Open reduction and internal fixation have been described as the gold standard for the treatment of acetabular fractures, but the high complications of these surgeries have led surgeons to seek less invasive procedures. In recent years, minimally invasive treatment, such as fixation through the skin have been proposed. The aim was to assess acetabular fracture outcomes of combination of posterior approach (Kocher-Langenbeck [KL]) with anterior percutaneous screw fixation (APSF) with minimally invasive surgery (MIS). METHODS Between February 2017 and July 2019, 155 patients with acetabular fractures underwent fixation with the KL + APSF approach. For 1 year functional outcomes, radiographic findings, and postoperative complications were evaluated. RESULTS Of 155 patients with a mean age of 40.16 ± 10.32 years, 82 patients were male and 73 were female. The most common pattern of fracture was both columns (32.9%). The average blood loss was approximately 527 ml. The average operation time was 85 min. The mean length of surgical incision was 113.3 mm. Harris' hip score was excellent in 75.5% of cases. The mean VAS score was approximately 4 and 91.6% of patients returned to pre-trauma activity. In 74.8% of cases, the reduction was anatomical. Complications after surgery were very insignificant and included the following: 2 patients had foot drop within 5 months both patients recovered, 2 patients had femoral nerve palsy and 3 cases of deep vein thrombosis and 1 case of pulmonary thromboembolism were treated. There were four patients with surgical site infections, all of whom recovered and two of the seven patients with osteoarthritis underwent total hip arthroplasty. CONCLUSION Combining posterior approach with minimally invasive anterior method in fixation and treatment of acetabular fractures is a safe and reliable method and showed significant functional results with minimal complications.
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Affiliation(s)
- Mohammad Qoreishy
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran
| | - Abdoreza Sajedi
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran
| | | | - Mona Gorji
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Maleki
- orthopedic surgery of medical science, Shahid Beheshti University of Medical Sciences, Akhtar hospital, Tehran, Iran.
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van den Broek M, Govaers K. Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly. Hip Pelvis 2023; 35:54-61. [PMID: 36937212 PMCID: PMC10020729 DOI: 10.5371/hp.2023.35.1.54] [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: 09/18/2022] [Revised: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.
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Affiliation(s)
| | - Kris Govaers
- Department of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium
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Krishna A, Arora S, Goyal R, Kumar M, Naik N, Kumar M. Preventable iatrogenic cause of foot-drop in knee injuries with literature review. Chin J Traumatol 2022; 25:224-231. [PMID: 34330596 PMCID: PMC9252936 DOI: 10.1016/j.cjtee.2021.06.005] [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: 07/15/2020] [Revised: 10/03/2020] [Accepted: 06/30/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment. METHODS We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital. RESULTS In addition to fibular neck fracture, the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion. common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases. Other 6 such cases remained neurologically intact as traction was not applied to them. CONCLUSION Such iatrogenic complication could have been prevented if the injury pattern of "concomitant medial and lateral columns" of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.
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Affiliation(s)
- Anant Krishna
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India,Corresponding author.
| | - Rakesh Goyal
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Manish Kumar
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Nirup Naik
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Manoj Kumar
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
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Villacres Mori B, Young JR, Lakra A, Chisena E. Team Approach: Management of Geriatric Acetabular Fractures. JBJS Rev 2022; 10:01874474-202205000-00009. [PMID: 35613307 DOI: 10.2106/jbjs.rvw.22.00017] [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
» Geriatric acetabular fractures are defined as fractures sustained by patients who are ≥60 years old. With the rapidly aging American populace and its increasingly active lifestyle, the prevalence of these injuries will continue to increase. » An interdisciplinary approach is necessary to ensure successful outcomes. This begins in the emergency department with hemodynamic stabilization, diagnosis of the fracture, identification of comorbidities and concomitant injuries, as well as early consultation with the orthopaedic surgery service. This multifaceted approach is continued when patients are admitted, and trauma surgery, geriatrics, and cardiology teams are consulted. These teams are responsible for the optimization of complex medical conditions and risk stratification prior to operative intervention. » Treatment varies depending on a patient's preinjury functional status, the characteristics of the fracture, and the patient's ability to withstand surgery. Nonoperative management is recommended for patients with minimally displaced fractures who cannot tolerate the physiologic stress of surgery. Percutaneous fixation is a treatment option most suited for patients with minimally displaced fractures who are at risk for displacing the fracture or are having difficulty mobilizing because of pain. Open reduction and internal fixation is recommended for patients with displaced acetabular fractures who are medically fit for surgery and have a displaced fracture pattern that would do poorly without operative intervention. Fixation in combination with arthroplasty can be done acutely or in delayed fashion. Acute fixation combined with arthroplasty benefits patients who have poorer bone quality and fracture characteristics that make healing unlikely. Delayed arthroplasty is recommended for patients who have had failure of nonoperative management, have a fracture pattern that is not favorable to primary total hip arthroplasty, or have developed posttraumatic arthritis.
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Selek O, Tosun B, Sarlak AY. A new method for reduction quality assessment in acetabular fractures: acetabular congruency measurement. Hip Int 2021; 31:435-439. [PMID: 31587564 DOI: 10.1177/1120700019881620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The determination of adequate reduction is difficult perioperatively due to inadequate radiographic scanning and objective measurement methods. The purpose of the present study is to evaluate an objective measurement of the weight bearing acetabular dome congruency. The sensitivity and specificity of 2 measurement methods after acetabular fracture fixation are compared. PATIENTS AND METHODS Postoperative acetabular reduction was assessed based on postoperative anteroposterior radiographs according to hip joint congruency and Matta's classification in 55 patients. For hip joint congruency measurements, one circle was drawn as superior femoral head border and another one was drawn as weight-bearing acetabular dome border. The difference between the centres of the circles was measured in millimetres. Comparative studies were performed between groups according to reduction quality and clinical and radiological results. RESULTS The threshold value for the difference between the 2 circle centres was found as 4.4 mm according to the clinical outcomes; 3.8 mm according to radiological outcomes in joint congruency method. The sensitivity of this method was found as 90.2% and 92.7%, and specificity as 64.3% and 57.1% considering the clinical and radiological results, respectively. In the assessment of joint congruency, false positive rate was lower than assessing reduction quality using the method defined by Matta. CONCLUSIONS Joint congruency assessment based on a postoperative anteroposterior radiograph in patients treated with open reduction internal fixation for acetabular fractures is a suitable method for assessing the adequacy of reduction. This method can be used intraoperatively using fluoroscopy imaging during surgery.
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Affiliation(s)
- Ozgur Selek
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Turkey
| | - Bilgehan Tosun
- Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Turkey
| | - Ahmet Y Sarlak
- Department of Orthopaedics and Traumatology, Akademi Hospital, Kocaeli, Turkey
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Walls A, McAdam A, McMahon SE, Diamond OJ. The management of osteoporotic acetabular fractures: Current methods and future developments. Surgeon 2021; 19:e289-e297. [PMID: 33597085 DOI: 10.1016/j.surge.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/11/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
Acetabular fractures in the elderly are challenging. Management is complicated by patients' poor physiological status and osteoporotic bone. Analysis of the management of these patients must be separated from the treatment of younger patients. Conservative management continues to have a role in patients who sustain fractures that are non-displaced and are considered stable with weight bearing mobilisation, and in those patients considered too medically frail to undergo surgical intervention. The mainstay of current surgical intervention is open reduction and internal fixation (ORIF) and variations of ORIF and total hip arthroplasty (THA), or fix and replace. Fix and replace is being increasingly favoured in those patients who display poor prognostic factors for long term joint survival after ORIF. Percutaneous fixation has the theoretical benefits of minimally invasive surgery and the potential to make any subsequent THA less complicated. However, it requires specialised fluoroscopic skills and is not suitable for all fracture patterns. There are a number of developments being reported. The use of a reinforcement ring and THA in has been reported in a number of centres, as has the use of trabecular metal acetabular implants. A coned hemi pelvic prosthesis and THA has been described in our centre, with promising early results. The potential for 3D printing to improve preoperative planning and reduce intra-operative time is also being explored. The aim of this review is to provide a summary of the literature supporting current and future treatment methods, tips on reduction techniques and an overview of the treatment algorithm of these patients in our unit.
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Affiliation(s)
- Andrew Walls
- Specialist Registrar Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | - Andrew McAdam
- Core Surgical Trainee, Royal Victoria Hospital, Belfast, UK.
| | - Samuel E McMahon
- Specialist Registrar Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK
| | - Owen J Diamond
- Consultant Trauma and Orthopaedic Surgeon, Royal Victoria Hospital Belfast, Belfast, UK
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Debuka E, Kumar G, Dalal N, Kalra S. Fracture characteristics and outcomes of acetabular fracture management with minimally invasive approach and percutaneous fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1363-1368. [PMID: 33512590 DOI: 10.1007/s00590-021-02886-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to assess acetabular fracture outcomes of percutaneous fixation (PF) with or without minimally invasive surgery (MIS). METHODS Between July 2011 and October 2016, acetabular fractures fixed with PF with or without MIS were included. Data collected are demographics, mechanism of injury, associated injuries, time to surgery, American Society of Anesthesiologists grade, fracture characteristics, surgical techniques, fracture reduction, secondary osteoarthritis (OA), revision surgery, patient survival and complications. RESULTS Of 26 patients with a mean age of 56 years (19-86) (22 males and 4 females), 11 were < 50 years age (U50) and 15 were > 50 years (A50). Most common pattern was anterior column with posterior hemi-transverse. Three out of 11 U50 were minimally displaced and had PF only; the rest had MIS and PF. All had good fracture reduction, but 2 had secondary OA at follow-up but no further surgery. Eight out of 26 had secondary OA but only 3 needed surgery. Three (A50 with PF) with fair/poor reduction (deemed unfit for open reduction) had secondary OA but no further intervention. Three more (A50 with MIS + PF) had secondary OA treated with primary total hip replacement (THR). Complications were as follows: one foot drop recovered after immediate repositioning of screw, one cardiac event and one pulmonary embolism. CONCLUSION Fracture mal-reduction predicts secondary OA, but good fracture reduction does not prevent secondary OA. MIS and PF in elderly are useful even with suboptimal reduction as it sets the bed for a non-complex THR. Despite MIS surgery, medical complications are potentially significant.
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Affiliation(s)
- Ekansh Debuka
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | | | - Neel Dalal
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sanjay Kalra
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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11
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Aprato A, Sallam A, Di Benedetto P, Giaretta S, Masse A. Arthroscopic reduction and fixation of partial posterior wall acetabular fractures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021551. [PMID: 35604270 PMCID: PMC9437670 DOI: 10.23750/abm.v92is3.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Reduction and fixation of partial posterior wall fracture is usually performed with an open posterolateral approach. When the fragment may be fixed without a plate (with screws only), reduction and fixation may be also achieved via hip arthroscopy. To our knowledge no study described this technique. Aim of our study is to describe the surgical technique and to present the achieved outcomes and the occurred complications. METHODS Six cases of arthroscopic fixation of partial posterior wall fracture have been reviewed for the purpose of this study. Patients were treated arthroscopically if the fragment was not bigger than 25% of the posterior wall. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score. RESULTS Fracture reduction was classified as anatomic on post-operative x-rays in all patients. The mean clinical score was 98 points at one year follow-up. No patient developed symptomatic femoral head AVN, none had heterotopic ossification. In one patients a screw breakage occurred without clinical complications. CONCLUSIONS Arthroscopic reduction and fixation of partial posterior wall fracture is an effective treatment and showed good outcomes if a careful patients' selection is done.
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12
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Shah N, Gill IP, Hosahalli Kempanna VK, Iqbal MR. Management of acetabular fractures in elderly patients. J Clin Orthop Trauma 2020; 11:1061-1071. [PMID: 33192010 PMCID: PMC7656530 DOI: 10.1016/j.jcot.2020.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023] Open
Abstract
Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.
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Affiliation(s)
- Nikhil Shah
- The North West Pelvic and Acetabular Surgery Service, Wrightington Hospital, Salford Royal Hospital, Manchester Royal Infirmary, United Kingdom
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13
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Baker G, McMahon SE, Warnock M, Johnston A, Cusick LA. Outcomes of conservatively managed complex acetabular fractures in the frail and elderly one year post injury. Injury 2020; 51:347-351. [PMID: 31843199 DOI: 10.1016/j.injury.2019.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 11/12/2019] [Accepted: 12/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Despite advances in operative techniques, there remains a cohort of elderly, extremely frail patients with comminuted fractures who are considered unfit for surgery and are treated conservatively. We aim to assess mortality, mobility and radiological outcomes one-year post injury in this challenging cohort. METHODS We performed a review of the regional Fracture Outcome and Research Database for patients over 65 with associated type acetabular fractures which were treated conservatively. We collected data on demographics, fracture classification, pre-injury mobility and habitation, and length of acute hospital stay. Mobility status, habitation, radiographic result and mortality were also recorded at one-year post injury. RESULTS There were 49 patients with a mean age of 80 years. The mean estimated American Society of Anaesthesiologist (ASA) score was 3.1. 92% sustained a low energy injury, and the most common fracture pattern was anterior posterior hemi-transverse (84%). Mean acute hospital stay was 20 days and mortality was 24% at one year. 56% of patients maintained habitation in their own home and 35% returned to their premorbid level of mobility. Of the surviving patients, 30% had an 'excellent/good' reduction on x-ray at one year, 70% had a 'fair/poor' reduction. There was no correlation between fracture reduction and either one year mobility status or maintenance of mobility. CONCLUSIONS The data confirms that conservatively managed complex acetabular fractures in the elderly, frail patient are associated with a significant reduction in mobility and living independence, a high level of mortality and poor radiological outcomes. IMPLICATIONS Conservative management of this cohort is associated with poor outcomes and current operative solutions are unsuitable for this frail cohort of patients. Future developments should focus on minimising surgical insult and allowing weight bearing mobilisation to maximise the rehabilitation potential in this frail cohort.
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Affiliation(s)
- Gavin Baker
- Trauma and orthopaedics, Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6 BA, Northern Ireland.
| | - Samuel E McMahon
- Trauma and orthopaedics, Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6 BA, Northern Ireland
| | - Michael Warnock
- Trauma and orthopaedics, Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6 BA, Northern Ireland
| | - Andrew Johnston
- Trauma and orthopaedics, Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6 BA, Northern Ireland
| | - Laurence A Cusick
- Trauma and orthopaedics, Fracture Clinic, Level 2, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6 BA, Northern Ireland
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Obey MR, Berkes MB, McAndrew CM, Miller AN. Lower-Extremity Skeletal Traction Following Orthopaedic Trauma. JBJS Rev 2019; 7:e4. [DOI: 10.2106/jbjs.rvw.19.00032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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3D surgical printing for preoperative planning of trabecular augments in acetabular fracture sequel. Injury 2018; 49 Suppl 2:S36-S43. [PMID: 30219146 DOI: 10.1016/j.injury.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
We describe the methodical and possibilities of 3D surgical printing in preoperative planning for a total hip arthroplasty in acetabular deformity after acetabular fractures, showing a case of a 43-year-old with posttraumatic arthritis after both column fracture of the left acetabulum that was treated non operatively, supporting the do it yourself mode.
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Xiao X, Chen J, Wang C, Liu H, Li T, Wang H, Fan S. Central dislocation of femoral head without involvement of acetabular anterior and posterior columns. J Int Med Res 2018; 46:3388-3393. [PMID: 29962248 PMCID: PMC6134659 DOI: 10.1177/0300060518761786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was performed to explore the treatment of central dislocation of the femoral head without involvement of the acetabular columns. Methods Preoperatively, a three-dimensionally printed model of the patient's pelvis was manufactured according to the patient's computed tomography data. An all-locking anatomical plate was designed based on the mirror of the ipsilesional semi-pelvis. The fracture was reduced using reduction forceps and femoral traction via the lateral rectus approach. The customized plate was used as a template for reduction of the quadrilateral plate fracture. Results Reduction and fixation of this patient's fracture was achieved with a customized all-locking anatomical plate with a propeller shape via the lateral rectus approach. Conclusions This report describes an isolated quadrilateral plate fracture with central dislocation of the femoral head without involvement of the columns, which is a rare injury that has not yet been classified. It was effectively treated using a customized all-locking anatomical plate with propeller shape via the lateral rectus approach.
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Affiliation(s)
- Xingling Xiao
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jiahui Chen
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Canbin Wang
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Han Liu
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Tao Li
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hua Wang
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shicai Fan
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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May C, Egloff M, Butscher A, Keel MJB, Aebi T, Siebenrock KA, Bastian JD. Comparison of Fixation Techniques for Acetabular Fractures Involving the Anterior Column with Disruption of the Quadrilateral Plate: A Biomechanical Study. J Bone Joint Surg Am 2018; 100:1047-1054. [PMID: 29916932 DOI: 10.2106/jbjs.17.00295] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In elderly patients who have sustained an acetabular fracture involving disruption of the quadrilateral plate (QLP), postoperative loading of the joint beyond the level of partial weight-bearing can result in medial redisplacement of the QLP. The purpose of this biomechanical study was to compare the performances of 4 different fixation constructs intended to prevent medial redisplacement of the QLP. METHODS Anterior column posterior hemitransverse (ACPHT) fractures with disruption of the QLP were created on synthetic hemipelves (fourth-generation Sawbones models) and subsequently stabilized with (1) a 12-hole plate bridging the QLP (Group 1), (2) the plate with added periarticular screws along the QLP (Group 2), (3) the plate combined with an infrapectineal buttress plate (Group 3), or (4) the plate with the added periarticular screws as well as the buttress plate (Group 4). The point of load application on the acetabulum was defined to be the same as the point of application of maximum vertical hip contact force during normal walking. Loads were applied to simulate either partial weight-bearing (20 cycles, from 35 to 350 N) or inadvertent supraphysiologic loads (linearly increasing loads until the onset of failure, defined as fragment displacement of >3 mm). A universal testing machine was synchronized with a digital image correlation system to optically track redisplacement at the QLP. The level of significance was set at p < 0.05. RESULTS During experimental simulation of partial weight-bearing, maximum fracture step openings never exceeded 2 mm. During simulation of inadvertent supraphysiologic load, the median load to failure was higher (p < 0.05) in Group 2 (962 N; range, 798 to 1,000 N) and Group 4 (985 N; range, 887 to 1,000 N) compared with Group 1 (445 N; range, 377 to 583 N) and Group 3 (671 N; range, 447 to 720 N). CONCLUSIONS All 4 fixation constructs performed in an acceptable manner on testing with simulated partial weight-bearing. Only additional periarticular screws along the QLP increased the fixation strength. CLINICAL RELEVANCE Redisplacement of the QLP resulting in an incongruency of the hip joint has been associated with poor long-term outcomes. Within the constraints of this study, periarticular long screws were superior to infrapectineal buttress plates in preventing medial redisplacement of the QLP.
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Affiliation(s)
| | - Mike Egloff
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | | | | | - This Aebi
- DePuy Synthes Trauma, Zuchwil, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
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Mesbahi SAR, Ghaemmaghami A, Ghaemmaghami S, Farhadi P. Outcome after Surgical Management of Acetabular Fractures: A 7-Year Experience. Bull Emerg Trauma 2018; 6:37-44. [PMID: 29379808 DOI: 10.29252/beat-060106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To determine the functional and radiologic results of surgical treatment in patients with acetabular fractures. Methods This was a retrospective cross-sectional study. We retrospectively reviewed medical records of patients operatively treated acute acetabular fractures at a level I trauma center (Shahid Rajaee) and an orthopedic center (Shahid Chamran) both in southern Iran (Shiraz) with minimally 1 year follow up over a period of 7 years from April 2009 to March 2016. Functional and radiographic outcomes, and complication were considered as main outcomes. Results A total number of 79 patients completed the study. Fifty-five patients were operated through Kocher-Langenbeck approach, and 18 were operated through the standard ilioinguinal approach, and 6 patients were operated through the standard ilioinguinal approach combined with Kocher-Langenbeck approach. The mean follow-up of patients was 45.6 months. The average operative time was 162.4±78.5 min, and the median blood loss was 500 ml. Functional results were excellent in 41 patients (51.9%), good in 12 (15.2%), fair in 13 (16.5%), and poor in 13 patients (16.5%). Radiologic results were excellent in 27 cases (34.2%), good in 17 cases (21.5%), fair in 18 cases (22.8%), and poor in 16 (16.5%). Osteoarthritis of hip (60.8%) and AVN of head of femur (22.8%) were two most common complications. In addition, there wasn't any significant difference between surgical approaches regarding clinical and radiographic outcomes. Conclusion The operative treatment for acetabular fractures gives universally satisfactory results. Thereafter, this study provides evidence that ilioinguinal approach is a good choice for anterior fractures, Kocher-Langenbeck is a good choice for posteriors fractures, and combined approach may be a good choice in the management of acetabular fractures involving two columns.
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Affiliation(s)
- Seyed Amir Reza Mesbahi
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ghaemmaghami
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Ghaemmaghami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouya Farhadi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Iqbal F, Taufiq I, Najjad MKR, Khan N, Zia OB. Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital. Hip Pelvis 2016; 28:217-224. [PMID: 28097111 PMCID: PMC5240317 DOI: 10.5371/hp.2016.28.4.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. MATERIALS AND METHODS Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. RESULTS There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. CONCLUSION Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome.
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Affiliation(s)
- Faizan Iqbal
- Department of Orthopedic Surgery, Liaquat National Hospital, Karachi, Pakistan
| | - Intikhab Taufiq
- Department of Orthopedic Surgery, Liaquat National Hospital, Karachi, Pakistan
| | | | - Naveed Khan
- Department of Orthopedic Surgery, Liaquat National Hospital, Karachi, Pakistan
| | - Osama Bin Zia
- Department of Orthopedic Surgery, Liaquat National Hospital, Karachi, Pakistan
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An Effective and Feasible Method, "Hammering Technique," for Percutaneous Fixation of Anterior Column Acetabular Fracture. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7151950. [PMID: 27493962 PMCID: PMC4963568 DOI: 10.1155/2016/7151950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022]
Abstract
Objective. The objective of this study was to evaluate the effectiveness and advantages of percutaneous fixation of anterior column acetabular fracture with “hammering technique.” Materials and Methods. We retrospectively reviewed 16 patients with percutaneous fixation of anterior column acetabular fracture with “hammering technique.” There were 11 males and 5 females with an average age of 38.88 years (range: 24–54 years) in our study. Our study included 7 nondisplaced fractures, 6 mild displaced fractures (<2 mm), and 5 displaced fractures (>2 mm). The mean time from injury to surgery was 4.5 days (range: 2–7 days). Results. The average of operation time was 27.56 minutes (range: 15–45 minutes), and the mean blood loss was 55.28 mL (range: 15–100 mL). The mean fluoroscopic time was 54.78 seconds (range: 40–77 seconds). The first pass of the guide wire was acceptable without cortical perforation or intra-articular perforation in 88.89% (16/18) of the procedures, and the second attempt was in 11.11% (2/18). Conclusion. Our study suggested that percutaneous fixation of anterior column acetabular fracture with “hammering technique” acquired satisfying surgical and clinical outcomes. It may be an alternative satisfying treatment for percutaneous fixation of anterior column acetabular fracture by 2D fluoroscopy using a C-arm with less fluoroscopic time.
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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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23
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Harnroongroj T, Wattanakaewsripetch M, Sudjai N, Harnroongroj T. Acetabular roof arc angles and anatomic biomechanical superior acetabular weight bearing area. Indian J Orthop 2014; 48:484-7. [PMID: 25298555 PMCID: PMC4175862 DOI: 10.4103/0019-5413.139858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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 Acetabular fracture involves whether superior articular weight bearing area and stability of the hip are assessed by acetabular roof arc angles comprising medial, anterior and posterior. Many previous studies, based on clinical, biomechanics and anatomic superior articular surface of acetabulum showed different degrees of the angles. Anatomic biomechanical superior acetabular weight bearing area (ABSAWBA) of the femoral head can be identified as radiographic subchondral bone density at superior acetabular dome. The fracture passes through ABSAWBA creating traumatic hip arthritis. Therefore, acetabular roof arc angles of ABSAWBA were studied in order to find out that the most appropriate degrees of recommended acetabular roof arc angles in the previous studies had no ABSAWBA involvement. MATERIALS AND METHODS ABSAWBA of femoral head was identified 68 acetabular fractures and 13 isolated pelvic fractures without unstable pelvic ring injury were enrolled. Acetabular roof arc angle was measured on anteroposterior, obturator and iliac oblique view radiographs of normal contralateral acetabulum using programmatic automation controller digital system and measurement tools. RESULTS Average medial, anterior and posterior acetabular roof arc angles of the ABSAWBA of 94 normal acetabulum were 39.09 (7.41), 42.49 (8.15) and 55.26 (10.08) degrees, respectively. CONCLUSIONS Less than 39°, 42° and 55° of medial, anterior and posterior acetabular roof arc angles involve ABSAWBA of the femoral head. Application of the study results showed that 45°, 45° and 62° from the previous studies are the most appropriate medial, anterior and posterior acetabular roof arc angles without involvement of the ABSAWBA respectively.
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Affiliation(s)
- Thossart Harnroongroj
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand,Address for correspondence: Dr. Thossart Harnroongroj, Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. E-mail:
| | - Montri Wattanakaewsripetch
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Sudjai
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thos Harnroongroj
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sandlin MI, Morshed S, Routt CML. Acetabular Refracture Through Posterior Wall Malunion Treated with Sciatic Neuroplasty and Open Reduction and Internal Fixation. JBJS Case Connect 2013; 3:e34-e7. [PMID: 29252489 DOI: 10.2106/jbjs.cc.l.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Isiah Sandlin
- Department of Orthopaedic Surgery, University of California, Los Angeles 10833 Le Conte Avenue, Room 76-143 CHS, Los Angeles, CA 90095
| | - Saam Morshed
- Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110. E-mail address:
| | - Chip M L Routt
- Department of Orthopaedic Surgery, University of Texas Medical School, 6400 Fannin Street, Suite 1700, Houston, Texas 77030
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Lichte P, Sellei RM, Kobbe P, Dombroski DG, Gänsslen A, Pape HC. Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study. Patient Saf Surg 2013; 7:9. [PMID: 23510122 PMCID: PMC3606597 DOI: 10.1186/1754-9493-7-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/13/2013] [Indexed: 01/05/2023] Open
Abstract
Background and Purpose Acetabular fractures are often combined with associated injuries to the hip joint. Some of these associated injuries seem to be responsible for poor long-term results and these injuries seem to affect the outcome independent of the quality of the acetabular reduction. The aim of our study was to analyze the outcome of both column acetabular fractures and the influence of osseous cofactors such as initial fracture displacement, hip dislocation, femoral head lesions and injuries of the acetabular joint surface. Methods A retrospective cohort study in patients with both column acetabular fractures treated over a 30 year period was performed. Patients with a follow-up of more than two years were invited for a clinical and radiological examination. Displacement was analyzed on initial and postoperative radiographs. Contusion and impaction of the femoral head was grouped. Injuries of the acetabular joint surface consisting of impaction, contusion and comminution were recorded. The Merle d’Aubigné Score was documented and radiographs were analysed for arthritis (Helfet classification), femoral head avascular necrosis (Ficat/Arlet classification) and heterotopic ossifications (Brooker classification). Results 115 patients were included in the follow up examination. Anatomic reduction (malreduction ≤ 1mm) was associated with a significantly better clinical outcome than nonanatomical reduction (p = 0.001). Initial displacement of more than 10mm (p = 0.031) and initial intraarticular fragments (p = 0.041) were associated with worse outcome. Other associated injuries, such as the presence of a femoral head dislocation, femoral head injuries and injuries to the acetabular joint surface showed no significant difference in outcome individually, but in fractures with more than two associated local injuries the risk for joint degeneration was significant higher (p < 0.001) than in cases with less than two of them. In the subgroup of anatomically reconstructed fractures no significant influence of the analyzed cofactors could be observed. Conclusion Anatomical reduction appears to be an important parameter for a good clinical outcome in patients with both column acetabular fractures. Additional fracture characteristics such as the initial displacement and intraarticular fragments seem to influence the results. Patients should also be advised that both column acetabular fractures with more than two additional associated factors have a significantly higher risk of joint degeneration.
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedic Trauma Surgery, Medical School of the RWTH Aachen, Aachen, Germany.
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Abstract
Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century.
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