ABSTRACT
The epidemic spectrum of acetabular fractures is changing with the changing population structure in China which has resulted in an increased proportion of the elderly patients. As acetabular fractures are intra-articular in nature, their management should follow the principles for intra-articular ones. However, it is still a great challenge for orthopedists to choose an appropriate treatment to deal with the fracture because of the pathophysiological changes in the elderly patients and the particular characteristics of acetabular fractures. Technical advances may offer a diversity of treatment options for geriatric acetabular fractures and demands for individualized management are increasing. In order to deepen the knowledge of geriatric acetabular fractures for orthopedists, this review expounds on the current achievements in the management and research concerning the fractures.
ABSTRACT
Objectives To put forward the modified Letournel classification of acetabular fractures,and evaluate the guiding role of the modified Letournel classification in clinical work.Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed.Among them 129 cases were males and 41 were females.The average age was 40.2±14.2 years (range,14-82 years).According to the Letournel classification,unclassifiable/atypical acetabular fractures were found out with plain Ⅹ-ray and plain CT scan and three-dimensional CT,and then their unclassifiable reasons were analyzed.Based on anatomical landmarks,clear boundaries of acetabular walls were defined on the 3D printed pelvic model.The structure of each column is a trihedron.The wall's fracture and column's fracture were distinguished using a theory that the wall's fracture involved two surfaces of column with interruption of continuity and column's fracture involved three.When column's fracture associated with wall's fracture,lowercase a,p and q were used representing comminuted areas of corresponding anterior and posterior wall,quadrilateral plate respectively.When column's fracture didn't associates with wall's fracture,it is marked with number 0.Finally,all fractures were classified according to the modified Letournel classification.The relationship between fracture type and surgical approach was analyzed.Results There was 51.7％ (92 sides) of acetabular fractures that couldn't be classified by the Letournel classification.Incomplete fracture lines (49 sides,53.3％),comminuted fractures (28 sides,30.4％),both of them (15 sides,16.3％) were their unclassifiable reasons.There were 8 types in the modified Letournel classification,including posterior wall fracture,posterior column fracture,anterior wall fracture,anterior column fracture,transverse fracture,T-shaped fracture,anterior column+posterior hemitransverse fracture,and both columns fracture.Posterior column+posterior wall fracture,transverse+posterior wall fracture had respectively become a form of posterior column fracture and of transverse fracture.According to the modified Letournel classification,the reclassification rate of 178 side fractures was 100％,which was significantly higher than 48.3％ (86/178) of the traditional Letournel classification,and the difference was statistically significant (x2=124.06,P＜ 0.001).100％ of posterior wall fracture and 80.00％ of posterior column fracture were treated by posterior approach.100％ of anterior column fracture and 73.68％ of both columns fracture were treated by anterior approach.Conclusion All acetabular fractures can be classified by the modified Letournel classification.The orientation of the comminuted walls reflects in part severity of the injury,better helps orthopaedic surgeons understand the morphology of acetabular fractures and select appropriate surgical approach.
ABSTRACT
Objective To summarize the complications and their incidences following Anterior Subcutaneous Internal Pelvic Fixation(ASIPF).Methods A comprehensive search was conducted of PubMed Library,Cochrane Library,Web of Science,SinoMed,Wanfang Data and China National Knowledge Internet for all articles addressing the postoperative complications of ASIPF published in English and Chinese from January 2009 to November 2018.A proportion Meta-analysis across the studies was performed for the complications after ASIPF (lateral femoral cutaneous nerve irritation,femoral nerve palsy,heterotopic ossification,infection and implant failure) using R software.Results This meta-analysis included 29 clinical studies involving a total of 825 patients.The complications following ASIPF were lateral femoral cutaneous nerve irritation,femoral nerve palsy,heterotopic ossification,infection and implant failure;their incidences were respectively 12％ (95％ CI:from 7％ to 19％),3％ (95％ CI:from 2％ to 4％),30％ (95％ CI:from 22％ to 39％),4％ (95％ CI:from 3％ to 6％) and 4％ (95％ CI:from 3％ to 6％).Conclusions Lateral femoral cutaneous nerve irritation and heterotopic ossification are common complications following minimally invasive internal fixation for anterior pelvic ring injury.High-quality clinical research is needed into the factors leading to the complications and into their preventive countermeasures.