Open Reduction and Internal Fixation of Acetabular
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Open reduction and internal fixation was performed on 50 displaced acetabular fractures in 49 patients by nine different attending surgeons over a 10-year period. At an average follow-up of 38 months, poor results were noted clinically in 38% and radiographically in 40%. The incidence of short- and long-term complications was greater than in other studies. Particularly distressing was the 58% incidence of heterotopic ossification (HO). Twenty-four percent had grade III or IV; five hips were autofused and the remainder had 40-60% loss of motion. There was no correlation of HO with age, sex, fracture type, degree of comminution, associated femoral head fracture or dislocation, delay to surgery, or operative time. However, 26 of 28 patients who had a trochanteric osteotomy as part of the operative exposure developed HO. Other complications included wound infection (12%), avascular necrosis of the femoral head (10%), nerve palsy (8%), and deep vein thrombosis/pulmonary embolism (8%). The data suggest formulation of specific treatment protocols, an awareness of surgical risks, and that staff specialization may reduce complications and improve outcome. Avoiding a trochanteric osteotomy at surgery and using prophylactic postoperative irradiation or indomethacin are suggested to reduce HO.Keywords:
Avascular Necrosis
Acetabular fracture
Acetabular fracture
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Avascular Necrosis
Osteosynthesis
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Avascular Necrosis
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Surgical treatment of acetabular fracture is very challenging because the acetabular geometry is complex. As anterior and posterior columns are the main support structures of the acetabulum, anatomical reduction and strong internal fixation of the two acetabular columns can achieve the best prognosis for patients with acetabular fracture. Constant study of the complex anatomy around the acetabulum reveals an infra-acetabular screw channel that can pass through both columns. Biomechanical studies show that use of an additional infra-acetabular screw can greatly strengthen the internal fixation of acetabular fracture. Biomor-phological studies prove that an infra-acetabular screw channel of 5 mm in diameter is available in more than 90% of people which allows insertion of a 3.5 mm screw. Imaging studies demonstrate that one in-fra-acetabular screw can be safely placed under the guidance of C-arm roentgenography. In surgery of acetabular fracture, surgeons have used infra-acetabular screws, the clinical value of which has been confirmed by good functional recovery of the patients after surgery. This paper presents an overview of the progress in research on infra-acetabular screwing for acetabular fracture.
Key words:
Acetabulum; Fractures, bone; Bone nails; Fracture fixation, internal
Acetabular fracture
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The purpose of this study was to estimate the efficacy and safety of percutaneous periacetabular screw (PPS) insertion assisted by screw view model of navigation (SVMN) to treat fracture of acetabulum.A 61-year-old male patient was injured in a motorcycle accident, which caused pain, swelling, deformity and limited mobility on his right hip.He was diagnosed with fracture of acetabulum.We used PPS insertion assisted by SVMN to treat fracture of acetabulum in this patient.The follow up lasted 24 months. Totally 2 screws were inserted into anterior and posterior column of acetabulum respectively and both of them displayed grade 0. Compared with the preoperative gap and step of fracture displacement, the postoperative ones were significantly reduced. It took 11.7 minutes for designing the screws, 6.7 minutes for implanting the guide wire, and 45.5 minutes for placing the screws. Intraoperative blood loss was 29 mL and total fluoroscopic time was 4.1 minutes. No clinical complications such as nerve vascular injury, infection and screw loosening were found after the operation.The study indicated that SVMN is favorable to the PPS insertion for acetabular fracture. Our lesson is that the relative position between the acetabular and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.
Acetabular fracture
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Objective:To analyze the clinical effect of Guxintai in treating fracture,fracture nonunion,osteoporosis,avascular necrosis of femoral head.Methods:246 patients suffered from fracture,fracture nonunion,osteoporosis,avascular necrosis of femoral head were randomly divided into two groups,the treating group(106 cases)and control group(146 cases).Guxintai was used in the treating group.Results:246 cases had been followed up for 5～24 months.The excellent and good rate in treating group of fracture,fracture nonunion,osteoporosis were 87.5%,73.7% and 91.4% respectively higher than that in control group (P0.05).There was no obvious difference in treating and control group of avascular necrosis of femoral head.Conclusion:Guxintai has satisfactory effect in treating fracture,fracture nonunion,osteoporosis and avascular necrosis of femoral head.
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Currently, conventional diagnosis of acetabular fractures is often supplemented and even replaced by CT examination, as this can provide a more detailed image of the extent of fracture and its morphology.Supported by developmental anatomy, Harris et al. proposed a new classification for acetabular fractures in which the pubic bone component of the acetabulum is shown to coincide with the anterior column of the acetabulum.There is no need to abandon the generally accepted and much used Letournel-Judet classification, but changes in the algorithm of acetabular fracture examination will certainly require that the CT classification of acetabular fractures is included.The Harris classification, based on evaluation of simple and unambiguous axial CT scans, is readily understood by both radiologists and orthopedic trauma surgeons and thus the use of it will foster greater interdisciplinary cooperation resulting in a better care for patients with acetabular fractures.
Acetabular fracture
Posterior column
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Introduction: Heterotopic ossification (HO) is a well-recognized complication following operative fixation of acetabular fractures with a range of severity and clinical consequences. The purpose of this review was to: (1) report the incidence of heterotopic ossification (HO) formation following operative fixation of acetabular fractures; (2) determine the effectiveness of prophylactic treatments for HO; and (3) assess the radiographic severity of HO with and without prophylactic treatment. Materials and Methods: A literature search for peer-reviewed articles was conducted utilizing a variety of research databases. PRISMA guidelines were followed and included in this review were full-length, English language manuscripts published before September 2019, using the following search criteria: “heterotopic ossification AND acetabulum OR acetabular.” Studies that reported HO as one of the reported outcomes were included. Articles were excluded if radiographic HO was not reported and if it was evaluated in surgeries other than those involved in acetabular fractures. Extracted data included, but was not limited to: type of prophylaxis; incidence of HO; severity of HO based on the Brooker classification; and statistical significance. A methodologic quality appraisal of the included studies was also conducted. A total of 54 full-text studies with 5,890 patients with operatively fixed acetabular fractures met inclusion criteria. There were four level I studies, four level II study, 26 level III studies, and 20 level IV studies. Results: The overall incidence of HO after acetabular fracture surgery was 28.4%. The rate of HO formation was: 34.9% without prophylaxis, 28.3% with non-steroidal anti-inflammatory drugs (NSAID) prophylaxis, and 21.2% with radiation therapy (RT). Patients receiving a combination of both RT and NSAIDs developed HO 21.8% of the time. The rate of radiographic severe HO was 13.9% (range, 0–75%) in patients without prophylaxis, 9.4% (range, 0–50%) with NSAID prophylaxis, 5.7% (range, 0–12.8%) with RT prophylaxis, and 11.7% (range, 0–18.5%) with the combination of RT and NSAIDs. Conclusion: With the current literature collected in this systematic review, there was a lower incidence and severity of heterotopic bone formation following acetabular fracture fixation using radiation prophylaxis compared to NSAIDs or no treatment. The available literature is heterogeneous in fracture characteristics, surgical approaches, and prophylactic regimens with a general lack of randomized control trials. Further prospective studies are required to make definitive claims on the optimal prophylactic strategy to prevent heterotopic ossification.
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Objective To analysis the results of treating the both-column fractures of acetabulum via ilioinguinal approach.Methods 10 patients with both-column fracthre of acetabulum treated surgically via the single ilioinguinal approach from January 1999 to January 2003 were reviewed.According to AO classification,type C1 5 cases,type C2 4 cases and type C3 1 case.After reduction and fixation of the fracture fragments of anterior column,the posterior fracture fragments of column were reduced using the quadrilateral surface and were fixed with two retrograde lag screws.Results The patients were followed up for an average of 18.4 months(range 11～36 months).Fracture reduction were graded as anatomic(0～1 mm displacement)in 7 cases,imperfect(2～3 mm displacement) in 3 cases,as determined by plain radiography.According to the modified Merled′AubignePostel hip score system,clinical outcome was graded as excellent in 7 patients,good in 2 and fair in one.Conclusion Treating the both-column fractures of acetabulum via ilioinguinal can obtain satisfactory clinical results.The key techniques are fixation of posterior column with retrograde interfragmentary lag screws.
Acetabular fracture
Posterior column
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Objective To explore the prophylaxis and treatment of heterotopic ossification by analyzing the genesis, development, and outcomes of this disorder after acetabular surgery. Methods We retrospectively analyzed the outcomes of acetabular surgery on 56 patients (46 receiving acetabular fracture surgery and another 10 receiving total hip arthoplasty) from January 2000 to March 2007. Results The incidence rate of heterotopic ossification was 60% in patients undergoing acetabular fracture surgery and 43% in those receiving hip replacement, approximate 8% of whom required a secondary surgery to remove the ossified tissues. Conclusions Early radiotherapy or medical treatment should be performed for the prophylaxis of heterotopic ossification following hip replacement or acetabular fracture surgery and nonsteroid anti-inflammatory drugs (NSAIDs) are the most effective medications. Surgical resection is the only treatment for those with severe hip joint dysfunction due to heterotopic ossification.
Acetabular fracture
Heterotopic bone
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