Assessment of interobserver reliability for the letournel and judet classification / Avaliação da confiabilidade interobservadores para a classificação de letournel e judet

ABSTRACT Introduction: The Judet and Letournel classification is the most widely used classification system for acetabular fractures. Some complex fractures couldn't be classified according to this classification. The main purpose of this study was to evaluate the reliability of the Letournel and Judet classification system for acetabular fractures. Material and methods: 10 acetabular fractures were analyzed among 17 orthopedic surgeons. The surgeons were asked to classify the fractures according to the Judet and Letournel classification. Their experience, the number of surgeries, and the incision type that the surgeon uses for the anterior part of the acetabulum were recorded. Results: The overall interobserver agreement for the Letournel classification was found to be poor, with a Kappa value of 0.287. The Kappa value for interobserver agreement was 0.224 for plain radiographs, 0.293 for 2D-CT, and 0.321 for 3D-CT scans. There was no significant difference between the incision types used by the surgeons. The highest reliability was determined among the surgeons who operate on 10-20 acetabular fractures per year, with a Kappa value of 0.309. Conclusion: This results revealed that the Judet and Letournel Judet classification is not sufficient to classify acetabular fractures because of unclassified fractures and the complex algorithm of the system. Level of Evidence III; Comparative Retrospective Study.

RESUMO Introdução: A classificação de Judet e Letournel é o sistema de classificação mais amplamente utilizado para fraturas acetabulares. Algumas fraturas complexas, porém, não puderam ser classificadas de acordo com esta classificação. O principal objetivo deste estudo foi avaliar a confiabilidade do sistema de classificação de Judet e Letournel para fraturas acetabulares. Material e métodos: Foram selecionadas aleatoriamente 10 fraturas acetabulares de um banco de dados. Participaram do estudo 17 cirurgiões ortopédicos. Foi solicitado aos cirurgiões que classificassem as fraturas de acordo com a classificação de Judet e Letournel. Suas experiências, o número de cirurgias e o tipo de incisão que o cirurgião utiliza para a parte anterior do acetábulo foram registrados. Resultados: A concordância interobservadores geral para a classificação de Judet e Letournel foi considerada fraca, com um valor de Kappa de 0,287. O valor de Kappa para a concordância interobservadores foi de 0,224 para radiografias simples, 0,293 para tomografias computadorizadas em 2D e 0,321 para tomografias computadorizadas em 3D. Não houve diferença significativa entre os tipos de incisão utilizados pelos cirurgiões. A maior confiabilidade foi determinada entre os cirurgiões que operam de 10 a 20 fraturas acetabulares por ano, com um valor de Kappa de 0,309. Conclusão: Os resultados revelaram que a classificação de Judet e Letournel não é suficiente para classificar fraturas acetabulares devido a fraturas não classificadas e ao algoritmo complexo do sistema. Nível de Evidência III; Estudo Comparativo Retorpectivo.

Refixation of the Excised Acetabular Labrum can Affect the Structural Changes of Cartilage Surface in the Hip Joint / La Refijación del Labrum Acetabular Extirpado Puede Afectar los Cambios Estructurales de la Superficie del Cartílago en la Articulación Coxal

SUMMARY: Refixation of the damaged acetabular labrum is a method of surgical treatment of the hip joint that can promote the repair of joint function after injury and prevent premature osteoarthritis. We sought to determine the condition of the hip joint in rabbits 4 months after excision of the acetabular labrum and the condition of the joint after labral refixation. The articular cartilage of the femoral head and acetabulum was examined by histological methods, multipoint measurement of cartilage thickness, and the ratio between cartilage matrix and chondrocytes lacunae, and the condition of cartilage according to the OARSI grading scale was carried out. On this model, a correlation analysis was performed between the results of the OARSI grading scale and the data of linear morphometry. All these parameters made it possible to better assess changes in articular cartilage. The ratio between matrix and chondrocyte lacunae turned out to be a method that allows establishing early cartilage damage when erosion, fibrosis or deformation did not occur. We found significant differences between the condition of the cartilage after exicion of acetabular labrum and after labral refixation, which give hope to confirm that this surgical technique can delay or prevent progressive changes in the cartilage of the damaged hip joint.

La refijación del labrum acetabular dañado es un método de tratamiento quirúrgico de la articulación coxal, que puede promover la reparación de la función articular después de una lesión y prevenir la osteoartritis prematura. Intentamos determinar el estado de la articulación coxal en conejos de 4 meses después de la escisión del labrum acetabular y observar el estado de la articulación después de la refijación del labrum. El cartílago articular de la cabeza femoral y el acetábulo se examinó por métodos histológicos, se midió a través de multipunto el grosor del cartílago y se realizó la relación entre la matriz del cartílago y las lagunas de condrocitos, y se llevó a cabo la condición del cartílago según la escala de clasificación OARSI. Sobre este modelo se realizó un análisis de correlación entre los resultados de la escala de calificación OARSI y los datos de la morfometría lineal. Todos estos parámetros permitieron evaluar mejor los cambios en el cartílago articular. La relación entre la matriz y las lagunas de condrocitos resultó ser un método que permite establecer temprano el daño del cartílago cuando no se presentó erosión, fibrosis o deformación. Encontramos diferencias significativas entre la condición del cartílago después de la extirpación del labrum acetabular y después de la refijación del labrum, lo que da la esperanza de confirmar que esta técnica quirúrgica puede retrasar o prevenir cambios progresivos en el cartílago de la articulación coxal dañada.

Does Acetabulum Remodel Following Varus Derotation Osteotomy for Perthes' Disease? / O acetábulo sofre remodelamento após a osteotomia derrotatória varizante em pacientes com doença de Perthes?

Abstract Objective We investigated the effect of disease stage, patient's age and final contour of femoral head on acetabulum contour following varus derotation osteotomy of proximal femur (VDRO) in unilateral Perthes's disease. Methods The study is a retrospective analysis of case records of 23 children aged ≥6 years with unilateral Perthes' disease who underwent primary VDRO procedure for containment. Acetabular index (AI) and center edge angle (CEA) were calculated bilaterally in preoperative and follow-up radiographs and compared statistically. Results There were 15 boys and 8 girls. Six hips were in Ib, 8 in IIa and 9 in IIb modified Waldenström stage while undergoing VDRO. The mean age at surgical intervention was 8.7 years. The mean follow-up duration was 3.5 years. All femoral heads were healed at final follow-up and the final Stulberg grades were I = 3, II = 8, III = 7, IV = 5. A significant acetabular dysplasia on the affected side was present preoperatively. At follow-up, the patients operated had significantly raised AI and reduced CEA. There was no significant acetabular remodeling of the affected hips at follow-up even in children operated at younger age (< 8 years) or early stages (stage Ib or IIa). The acetabulum remodeling did not correspond to the final Stulberg grade as well. Conclusion Acetabulum was found involved in early stages of Perthes' disease. Varus derotation femoral osteotomy for the diseased hip showed no significant improvement in acetabular dysplasia even when operated in early disease stages or younger age group. Residual acetabular changes were also noted even with favorable Stulberg grades.

Resumo Objetivo Investigamos o efeito do estágio da doença, idade do paciente e contorno final da cabeça femoral no contorno do acetábulo após a osteotomia derrotatória varizante (VDRO) do fêmur proximal na doença de Perthes unilateral. Métodos O estudo é uma análise retrospectiva de prontuários de 23 crianças com idade ≥ 6 anos com doença de Perthes unilateral que foram submetidas ao procedimento primário de VDRO para contenção. O índice acetabular (AI) e o ângulo da borda central (CEA) foram calculados bilateralmente em radiografias pré-operatórias e de acompanhamento e submetidos à comparação estatística. Resultados Os pacientes eram 15 meninos e oito meninas. À VDRO, seis quadris estavam no estágio de Waldenström modificado Ib, oito no estágio IIa e nove no estágio IIb. A média de idade à intervenção cirúrgica foi de 8,7 anos. A duração média do acompanhamento foi de 3,5 anos. Todas as cabeças femorais estavam consolidadas no último acompanhamento e os graus finais de Stulberg foram I = 3, II = 8, III = 7 e IV = 5. Havia displasia acetabular significativa do lado acometido no período pré-operatório. No acompanhamento, os pacientes operados apresentaram elevação significativa de AI e redução de CEA. Não houve remodelamento acetabular significativo nos quadris acometidos durante o acompanhamento, mesmo em crianças operadas em idade menor (< 8 anos) ou estágios iniciais (estágio Ib ou IIa). O remodelamento do acetábulo também não correspondeu ao grau final de Stulberg. Conclusão A VDRO do fêmur do quadril acometido não levou à melhora significativa da displasia acetabular, mesmo quando a cirurgia foi realizada nos estágios iniciais da doença ou em pacientes mais jovens. Alterações acetabulares residuais também foram observadas mesmo com graus de Stulberg favoráveis.

Fijación interna combinada con artroplastia total de cadera en fracturas acetabulares inveteradas complejas en ancianos. Reporte de caso / Internal fixation combined with total hip arthroplasty in complex inveterate acetabular fractures in the elderly. Case report

La fijación interna combinada con artroplastia en pacientes de edad avanzada, está indicada en fracturas acetabulares complejas inveteradas, artrosis preexistente, luxación inveterada, Impactación supero-medial de la cúpula acetabular, la finalidad de la cirugía es lograr la fijación de la columna anterior, columna posterior, lamina cuadrilátera y pared posterior para proporcionar estabilidad adecuada al componente acetabular y restaurar el centro de rotación de la cadera. Debido a la complejidad de estas lesiones, se decide presentar el siguiente caso clínico, que corresponde una paciente femenina de 70 años, quien posterior a traumatismo de baja energía presenta fractura inveterada compleja con patrón en T de Acetábulo de 8 meses de evolución. El Objetivo es: Evaluar los resultados del tratamiento de las fracturas acetabulares complejas en pacientes de edad avanzada con reducción abierta más fijación interna combinada con artroplastia total de cadera. Se realiza en un 1er tiempo: Abordaje Ilioinguinal, ORIF con placa de reconstrucción 3,5 mm para CA, 2do Tiempo: Abordaje de Kocher Langenbeck, ORIF con placa de reconstrucción 3,5 mm para CP y PP. 3er Tiempo: ATC izquierda primaria no cementada, con aporte biológico de injerto óseo autologo. Resultado: Se restableció la integridad de las líneas acetabulares, reducción anatómica según Matta, índice de Harris hip score de 88 puntos. Se concluye que el procedimiento combinado de ORIF mas ATC es el tratamiento ideal de las fracturas acetabulares complejas inveteradas en pacientes de edad avanzada(AU)

Internal fixation combined with arthroplasty in elderly patients is indicated in inveterate complex acetabular fractures, preexisting osteoarthritis, inveterate dislocation, supero medial impaction of the acetabular dome, the purpose of surgery is to achieve fixation of the anterior column (AC), posterior column (PC), quadrilateral plate, and posterior wall (PP) to provide adequate stability to the acetabular component and restore the hip center of rotation. Due to the complexity of these injuries, it is decided to present the following clinical case, which corresponds to a 70-year-old female patient, who, after a low-energy trauma, presents a complex inveterate fracture with a T-pattern of the acetabulum of 8 months of evolution. The Objective is: To evaluate the results of the treatment of complex acetabular fractures in elderly patients with open reduction plus internal fixation (ORIF) combined with total hip arthroplasty (THA). It is performed in a 1st stage: Ilioinguinal approach, ORIF with 3.5 mm reconstruction plate for (CA), 2nd Stage: Kocher Langenbeck approach, ORIF with 3.5 mm reconstruction plate for (CP) and (PP). 3rd Time: Uncemented primary left THA, with biological contribution of autologous bone graft. Result: The integrity of the acetabular lines was restored, anatomical reduction according to Matta, Harris hip score index of 88 points. It is concluded that the combined procedure (ORIF plus ATC) is the ideal treatment of inveterate complex acetabular fractures in elderly patients(AU)

Manejo de discontinuidad pélvica debido a fractura de acetábulo mediante cirugía de revisión de artroplastia de cadera y reemplazo de componente acetabular por anillo de Burch-Schneider: reporte de un caso / Treatment for pelvic discontinuity due to acetabular fracture by means of hip arthroplasty revision surgery and acetabular component replacement using a Burch-Schneider ring: a case report

Introducción. La discontinuidad pélvica es una complicación de la artroplastia total de cadera que consiste en la separación de la hemipelvis superior e inferior a través del acetábulo.Presentación del caso. Hombre de 74 años con antecedente de artroplastia total de cadera izquierda que requirió 4 cirugías de revisión de artroplastia, quien consultó al servicio de urgencias de un hospital de segundo nivel de atención de Sogamoso (Colombia) por dolor y limitación de la movilidad de la cadera izquierda durante 7 días luego de haber sufrido trauma por caída de su propia altura en la que el miembro inferior izquierdo recibió la fuerza del impacto. En el examen físico, se evidenció limitación de los arcos de movilidad de la cadera izquierda, por lo que se realizó una radiografía de cadera, en la que se observó fractura del acetábulo, y una tomografía computarizada de cadera, en la que se evidenciaron signos de aflojamiento del componente acetabular y fractura del acetábulo (tipo IIIB según clasificación de Paprosky). Teniendo en cuenta lo anterior, se diagnosticó discontinuidad pélvica y se realizó cirugía de revisión de artroplastia y reemplazo del componente acetabular por un anillo de Burch-Schneider. El paciente tuvo una adecuada evolución posoperatoria con seguimiento a 3 meses. Conclusión. Si bien hay múltiples opciones para el manejo de la discontinuidad pélvica, no hay consenso sobre cuál es la mejor; sin embargo, el uso de componentes acetabulares de refuerzo como el anillo de Burch-Schneider fue una opción con buenos resultados posoperatorios en este caso

Introduction: Pelvic discontinuity is a complication of total hip arthroplasty, consisting of a structural bone defect of the acetabulum with separation of the upper and lower hemipelvis. Case presentation: A 74-year-old male patient with a history of total left hip arthroplasty and 4 arthroplasty revision surgeries visited the emergency department of a secondary care hospital due to pain and limited mobility of the left hip over a period of 7 days after having suffered a fall from his own height in which the left lower limb received the force of the impact. Physical examination showed limitation of the range of motion of the left hip, so a hip X-ray was performed, showing a fracture of the acetabulum. A computed tomography of the hip revealed signs of loosening of the acetabular component and fracture of the acetabulum (type IIIB according to the Paprosky classification). In view of the above, pelvic discontinuity was diagnosed and revision arthroplasty and replacement of the acetabular component with a Burch-Schneider ring was performed. The patient had an adequate postoperative progression and follow-up at 3 months.Conclusion: Although there are multiple options for the treatment of pelvic discontinuity, currently, there is no conclusive data regarding the best therapeutic option. However, the use of reinforcement acetabular components, such as the Burch-Schneider ring, was an option with good postoperative outcomes in this case

Uso de biomodelos impresos en 3D para la planificación preoperatoria de artroplastia total de cadera luego de fractura acetabular: reporte de un caso / 3D printed biomodels for preoperative planning of total hip arthroplasty following an acetabular fracture: a case report

Introducción. Las fracturas de acetábulo constituyen un reto para los ortopedistas por la dificultad de su tratamiento y las complicaciones asociadas.Presentación del caso. Hombre de 53 años que ingresó al servicio de urgencias de un hospital del tercer nivel de atención por policontusión en tórax y pelvis causada por un accidente de tránsito. Presentó dolor en tórax y cadera, y no se identificó lesión ósea, por lo que se dio el alta a las 48 horas. Siete días después, el paciente asistió al servicio de urgencias por dolor en la cadera izquierda y limitación para caminar. En los exámenes imagenológicos, se evidenció fractura de acetábulo izquierdo, pero fue operado luego de dos meses debido a dificultades económicas y del aseguramiento en salud. Se realizó reducción abierta más fijación interna y relleno con injerto de cresta ilíaca, y artroplastia total de cadera (ATC). A los seis meses, el paciente presentó capacidad de ambulación limitada y dolor en la cadera izquierda. Luego de los exámenes físico e imagenológico, se diagnosticó deformación severa del acetábulo izquierdo con migración posterosuperior de la cabeza femoral, necrosis de la cabeza femoral completa y defecto óseo posterosuperior de acetábulo (tipo IIIB según clasificación de Paprosky), por lo que se realizó ATC asistida por biomodelos 3D. El paciente presentó una recuperación óptima. Conclusión. Utilizar biomodelos 3D impresos optimiza la planificación preoperatoria, ya que permite reconocer la lesión, plantear el abordaje más adecuado, elegir los mejores implantes y disminuir el tiempo de operación, el sangrado y las complicaciones

Introduction: Acetabulum fractures are a challenge for orthopedic surgeons due to the difficulty of their treatment and associated complications. Case presentation: A 53-year-old man was admitted to the emergency department of a tertiary care hospital due to multiple trauma to the chest and pelvis following a traffic accident. He presented with chest and hip pain, but no bone lesion was identified, so he was discharged after 48 hours. Seven days later, the patient attended the emergency department again due to pain in the left hip and limited walking. Imaging tests showed a fracture of the left acetabulum, but he was operated on only after two months owing to economic and health insurance difficulties. Open reduction internal fixation and filling with iliac crest graft and total hip arthroplasty (THA) were performed. After six months, the patient presented limited ambulation capacity and pain in the left hip. Upon physical and imaging examinations, severe deformity of the left acetabulum with posterosuperior migration of the femoral head, necrosis of the entire femoral head, and posterosuperior bone defect of the acetabulum (type IIIB according to Paprosky's classification) were diagnosed, so 3D biomodel-assisted THA was performed. The patient had an optimal recovery.Conclusion: The use of 3D printed biomodels optimizes preoperative planning, as it allows identifying the lesion, planning the most appropriate approach, choosing the best implants, and reducing operating time, bleeding and complications

Fracturas de acetábulo tratadas mediante osteosíntesis. Resultados a largo plazo / Surgical treatment of acetabular fractures. Long term outcomes

Resumen: Introducción: las fracturas de acetábulo constituyen entre el 0.3 y 0.6% total de fracturas observadas, siendo estás lesiones relativamente infrecuentes. Objetivo: evaluar los resultados clínico-radiológicos del tratamiento quirúrgico mediante osteosíntesis de fracturas acetabulares con un seguimiento mínimo de 11.5 años. El objetivo secundario fue determinar la tasa de fracaso de la cadera de estos pacientes e identificar los factores de riesgo implicados. Materia y métodos: analizamos retrospectivamente una muestra de 23 pacientes intervenidos de fractura acetabular mediante reducción abierta y fijación interna, con un seguimiento medio de 14 años (11.5-17.5). Clasificamos las fracturas según Judet y Letournel en simples y complejas. Analizamos la evolución clínica y radiológica de estos pacientes mediante la escala de Harris. Resultados: obtuvimos una puntuación media de 81.90/100, objetivamos mejores resultados en fracturas de trazo simple respecto a fracturas complejas (p = 0.027). Evidenciamos mejores resultados clínicos en los pacientes con una reducción anatómica de la fractura (86.9/100), respecto a los que no fue posible (74.38/100) (p = 0.033). Fue necesaria la reintervención con artroplastía por mala evolución clínica en tres pacientes (13%). Como predictores de mal pronóstico para el desarrollo de coxartrosis identificamos las fracturas complejas y la reducción no anatómica de la fractura (p < 0.05). Encontramos relación entre índice de masa corporal (IMC) > 30 con peores resultados funcionales (p = 0.151). Conclusiones: el tratamiento quirúrgico de pacientes tratados con fracturas acetabulares presenta buenos resultados clínicos y radiológicos a largo plazo. Como factores de riesgo para la progresión de coxartrosis con suficiente impronta clínica como para ser necesaria una artroplastía identificamos, las fracturas complejas, la reducción no anatómica y un IMC > 30.

Abstract: Introduction: acetabular fractures constitute between 0.3 and 0.6% of all observed fractures, being these injuries relatively infrequent. Objective: to evaluate clinical and radiological outcomes of surgical treatment of patients with acetabular fracture treated in our hospital with a minimal follow-up of 11.5 years. The secondary objective is to determine the rate of failure in the hip joint of these patients and establish risk factors that are involved. Material and methods: 23 patients with acetabular fractures that were treated by open reduction and internal fixation (ORIF) were retrospectively analysed. They were follow-up during an average of 14 years (range 11.5-17.5). Fractures were classified by Judet y Letournel as simple or complex. Clinical and radiological outcomes were analysed by Harris scale. Results: We obtained an average of 81.90/100 on the Harris scale, aiming at better outcomes on simple fractures compare to those that were complex (p = 0.027). Higher scores were also achieved on those patients with an anatomical reduction (p = 0.033). Three patients required revision and placement of a total arthoplasty (13%). However, patients with body mass index (BMI) > 30 tend to achieve poor clinical results (p = 0.151). Conclusions: ORIF may be suggested for acetabular fractures since good clinical and radiological outcomes were recorded on a long-term follow-up. Complex fractures, non-anatomical reduction and BMI > 30 were identified as risk factors to coxarthrosis progression.

Evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales / Functional, radiological results and complications evaluation in the surgical treatment of bilateral acetabular fractures

Las Fracturas Acetabulares bilaterales tienen una incidencia extremadamente baja. El objetivo es evaluar los resultados funcionales, radiológicos y las complicaciones en el tratamiento quirúrgico de las fracturas acetabulares bilaterales. Este estudio se basa en datos de 722 Fracturas de Acetábulo tratadas por el autor principal durante 15 años desde enero de 2005 a septiembre de 2020. Se realizó un estudio descriptivo y retrospectivo. Se incluyeron 13 casos correspondientes al 1,8% del universo. El 72,7% de las fracturas se presentaron por accidentes de tránsito, el 69,3% corresponden a fracturas de patrón asociado en relación con el 30,7% de fracturas de patrón simple. En el 56,5% se realizó abordaje de Kocher Langenbeck. La reducción anatómica se logró en el 92,30%, en el 7,69% la reducción no fue satisfactoria. Para la evaluación funcional se utilizó el HHS, 88,46% reportaron buenos resultados y 11,53% insatisfactorios. Respecto a las complicaciones, 7,69% presentaron osteoartrosis Tönnis II y 7,69% neuroapraxia del nervio ciático izquierdo. Se encontró supervivencia del 100%. El tiempo ideal para la resolución quirúrgica es antes de las 3 semanas. Los resultados radiológicos y funcionales están directamente relacionados al tiempo de fijación, es importante tomar en cuenta que debido a la magnitud de la energía del impacto que se transmite por ambos acetábulos los patrones de fractura que coexisten entre ambas superficies articulares son diferentes, por lo que optimizar la planificación preoperatoria es fundamental(AU)

Bilateral Acetabular Fractures have an extremely low incidence. The objective is to evaluate the functional and radiological results and the complications in the surgical treatment of bilateral Acetabular Fractures. This study is based on a data of 722 acetabulum fractures cases treated by the lead author for over 15 years from january 2005 to september 2020. A descriptive, retrospective study was made. 13 cases corresponding to 1,8% of the universe were included. 72,7% of the fractures occurred due to traffic accidents, 69,3% correspond to associated pattern fractures in relation to 30,7% of simple pattern fractures. In 56,5% the Kocher Langenbeck approach was performed. The anatomical reduction was achieved in 92,30%, in 7,69% the reduction was not satisfactory. The functional result was evaluated according to the HHS, obtaining good results in 88,46% of the cases and unsatisfactory results in 11,53%. Regarding complications, we found 7,69% with Tönnis II osteoarthrosis, 7,69% with neuropraxia of the left sciatic nerve. Successful results with 100% survival were found. The ideal time for surgical resolution is before 3 weeks. The radiological and functional results are directly related to the fixation time. It is important to take into account that due to the magnitude of the impact energy that is transmitted by both acetabulums, the fracture patterns that coexist between both articular surfaces are different, so optimizing preoperative planning is essential(AU)

The importance of acetabular morphometry in determining hip dysplasia / Importancia de la morfometría acetabular en la determinación de la displasia de cadera

SUMMARY: The aim of this study was to evaluate the relation between acetabulum morphological measurements and present the reference values of the acetabulum. The study had a retrospective design and was conducted with 234 healthy subjects (108 females; 126 males) aged 18-53 years over a period of 4 years from 2018 to 2022. Eleven measurements including the center- edge angle (CEA), acetabular angle (AA), acetabular depth (AD), acetabular width (AW), dept to width ratio (ADWR), Extrusion A (EA)-B (EB), Extrusion index (EI), the lateral subluxation (LS), peak to edge distance (PED), and roof obliquity (RO) were taken. The p<0.05 value was considered significant. A significant difference was found in CEA, AA, EB, LS, and RO values, while there was no significance in the AD, AW, ADWR, EI, and PED measurements in comparison with acetabular morphometry according to gender. Also, in the evaluation of acetabulum to age-related changes, there was a significant difference in values of the CEA, AA, AD, AW, ADWR, LS, and PED from decades 1 to 5. The knowledge of radiological acetabulum findings is paramount for the diagnosis of hip dysplasia and may be useful for prosthesis, orthopedic and forensic experts. Also, the most interesting finding was that ADWR increased based on age in a directly proportional trend. The most apparent change based on age was seen in CEA (between decades 3-4), LS (decades 1-5), PED (decades 2-4), AD, and AW (decades 2-5).

El objetivo de este estudio fue evaluar la relación entre las medidas morfológicas del acetábulo y presentar sus valores de referencia. El estudio tuvo un diseño retrospectivo y se realizó con 234 sujetos sanos (108 mujeres; 126 hombres) de 18 a 53 años de edad durante un período de 4 años, desde 2018 hasta 2022. Once mediciones que incluyeron el ángulo centro-margen (ACM), ángulo acetabular (AA), profundidad acetabular (PA), ancho acetabular (AC), relación de profundidad y ancho (RPAC), extrusión A (EA)-B (EB), índice de extrusión (IE), subluxación lateral (SL). Se midió la distancia al margen (DAM) y la oblicuidad del techo (OT). Se consideró significativo el valor de p<0,05. Se encontró una diferencia significativa en los valores de ACM, AA, EB, SL y OT, mientras que no hubo significación en las medidas de AA, AC, RPAC, IE y DAM en comparación con la morfometría acetabular según el sexo. Además, en la evaluación del acetábulo respecto a los cambios relacionados con la edad, hubo una diferencia significativa en los valores de ACM, AA, PA, AC, RPAC, SL y DAM de las décadas 1 a 5. El conocimiento de los hallazgos radiológicos del acetábulo es primordial para el diagnóstico de displasia de cadera y puede ser útil para expertos en prótesis, ortopedia y medicina forense. Además, el hallazgo más interesante fue que RPAC aumentó según la edad en una tendencia directamente proporcional. El cambio más aparente según la edad se observó en ACM (entre las décadas 3 y 4), LS (décadas 1 a 5), DAM (décadas 2 a 4), PA y AC (décadas 2 a 5).

Role of magnetic resonance imaging in assessment of acetabular and femoral version in developmental dysplasia of the hip / Papel da ressonância magnética na avaliação da versão acetabular e femoral na displasia do desenvolvimento do quadril

Abstract Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

Resumo Objetivo: Avaliar o papel da ressonância magnética (RM) na avaliação da versão femoral e acetabular na displasia do desenvolvimento do quadril (DDQ). Materiais e Métodos: Estudo transversal de 20 pacientes consecutivos com DDQ (27 quadris displásicos) que foram examinados com RM. Nos quadris displásicos e normais (grupos DDQ e comparação, respectivamente), avaliamos os seguintes parâmetros: anteversão acetabular óssea (AAO), anteversão acetabular cartilaginosa (AAC), anteversão femoral, índice de Mckibbin ósseo (IMO), índice de Mckibbin cartilaginoso (IMC) e espessura da cartilagem acetabular anterior e posterior. Resultados: A AAO foi significativamente maior nos quadris displásicos. A AAC, anteversão femoral, IMO e IMC não diferiram significativamente entre os quadris normais e displásicos. Nos grupos DDQ e comparação, a AAO foi significativamente menor que a AAC, o IMO foi significativamente menor que o IMC, e a cartilagem acetabular posterior foi significativamente mais espessa que a anterior. Conclusão: Nossos achados confirmam que a RM é uma ferramenta valiosa para a avaliação da versão femoral e acetabular na DDQ. A avaliação pré-operatória por RM tem grande potencial para melhorar o planejamento das osteotomias pélvicas e femorais.

Radiographic evaluation of immediate loading safety after surgical reduction in acetabular fractures: a comparative-retrospective study / Avaliação radiográfica da segurança na carga imediata após redução cirúrgica em fraturas acetabulares: estudo comparativo-retrospectivo

ABSTRACT Objective Radiographically evaluate the quality of reduction over six weeks of follow-up in patients with surgically treated deviated acetabular fractures who underwent rehabilitation with immediate loading as tolerated and compare this with the results of the unloaded protocol. Methods We retrospectively evaluated the records of 137 patients with deviated acetabular fractures treated with open reduction and internal fixation. Sixty-six (48.2%) patients underwent postoperative rehabilitation with immediate loading as tolerated, while 71 (51.8%) patients completed rehabilitation using a no-load protocol. The quality of the reduction was assessed radiographically by measuring the fracturing step and gap on radiographs taken immediately after surgery and three and six weeks after surgery. Results Comparing the joint step, group 1 had an average of 0.44 ± 1.4 mm, 0.47 ± 1.5 mm, and 0.51 ± 1.6 mm immediately, three and six weeks after surgery, respectively. Group 2 had a mean step of 0.24 ± 0.8 mm, 0.27 ± 0.9 mm, and 0.37 ± 1.2 mm immediately, three, and six weeks after surgery. No statistically significant differences were observed between the groups. With a joint gap, group 1 had a mean of 1.89 ± 1.7 mm, 2.12 ± 1.8 mm, and 2.36 ± 2.1 mm; and group 2 had a mean of 2.16 ± 2.4 mm, 2.47 ± 2.6 mm, and 2.67 ± 2.8 mm in the immediate postoperative period, three, and six weeks, respectively. There was also no statistical difference between groups in these measurements. Conclusion Immediate loading after surgical treatment of deviated acetabular fracture had no negative impact on radiographic reduction parameters and had similar results to the protocol without weight bearing. Level of evidence III; Therapeutic Retrospective Cohort Study.

RESUMO Objetivo Avaliar radiograficamente a qualidade da redução ao longo de 6 semanas de acompanhamento em pacientes com fratura desviada do acetábulo tratados cirurgicamente e submetidos à reabilitação com carga imediata conforme tolerado e comparar com os resultados do protocolo sem carga. Métodos Avaliamos retrospectivamente os prontuários de 137 pacientes com fraturas desviadas do acetábulo que foram tratadas com redução aberta e fixação interna. Sessenta e seis (48,2%) pacientes foram submetidos à reabilitação pós-operatória com carga imediata conforme tolerado, enquanto 71 (51,8%) pacientes completaram a reabilitação utilizando um protocolo sem carga. A qualidade da redução foi avaliada radiograficamente pela medição do degrau da fratura e do gap nas radiografias feitas imediatamente após a cirurgia e três e seis semanas após a cirurgia. Resultados Comparando o degrau articular, o grupo 1 teve uma média de 0,44 ± 1,4 mm, 0,47 ± 1,5 mm e 0,51 ± 1,6 mm imediatamente, três e seis semanas após a cirurgia, respectivamente. O grupo 2 teve um degrau médio de 0,24 ± 0,8 mm, 0,27 ± 0,9 mm e 0,37 ± 1,2 mm imediatamente, três e seis semanas após a cirurgia. Não foram observadas diferenças estatísticas significantes entre os grupos. Com gap articular, o grupo 1 teve uma média de 1,89 ± 1,7 mm, 2,12 ± 1,8 mm e 2,36 ± 2,1 mm; e o grupo 2 de 2,16 ± 2,4 mm, 2,47 ± 2,6 mm e 2,67 ± 2,8 mm nos pós-operatório imediato, três e seis semanas, respectivamente. Também não houve diferença estatística entre os grupos nessas medidas. Conclusão A carga imediata após o tratamento cirúrgico da fratura do acetábulo desviada não teve impacto negativo nos parâmetros de redução radiográfica e teve resultados semelhantes em comparação com o protocolo sem descarga de peso. Nível De Evidência III; Estudo Terapêutico de Coorte Retrospectivo.

Abordaje combinado Kocher-Langenbeck y Stoppa en el tratamiento de fracturas complejas de acetábulo / Combined Kocher-Langenbeck and Stoppa approach in the treatment of complex acetabulum fractures

Resumen: Introducción: Las fracturas de acetábulo complejas son un desafío para los cirujanos ortopedistas. Se realizó una evaluación de la reducción radiográfica y resultado funcional de los pacientes con fractura compleja de acetábulo sometidos a abordaje combinado Kocher-Langenbeck y Stoppa. Material y métodos: Diseño transversal, descriptivo, ambispectivo. Se incluyeron pacientes con fractura compleja de acetábulo que se sometieron a abordaje combinado Kocher-Langenbeck y Stoppa entre 2016 y 2020. Se revisaron los expedientes clínicos y se evaluó la calidad de la reducción radiográfica según criterios de Matta. Además, se realizó evaluación funcional con la escala de Merle d'Aubigné y Postel pasados por lo menos 12 meses de la lesión. Resultados: De los 31 pacientes, el tiempo promedio entre la fecha de fractura y la intervención quirúrgica fue de 13.7 días (de tres a 38 días). En la evaluación radiográfica según criterios de Matta, 21 pacientes tuvieron resultados radiográficos anatómicos (67.7%), siete casi anatómicos (22.5%) y tres imperfectos (9.6%). Los resultados funcionales según la escala Merle d'Aubigné y Postel dieron como resultado ocho pacientes (25.8%) con resultados excelentes, 16 (51.6%) con resultado bueno, con resultado moderado cinco (22.5%) y con resultado malo dos (16.1%). Hubo correlación estadística entre la edad del paciente con el resultado funcional (p = 0.029), también entre el índice de masa corporal y pérdida sanguínea (p = 0.027). Conclusión: Los abordajes combinados Kocher-Langenbeck y Stoppa son una alternativa en estas lesiones, en su mayoría con resultados radiográficos anatómicos y casi anatómicos, según la escala radiográfica de Matta, y con excelentes y buenos resultados funcionales, según la escala de Merle d'Aubigné y Postel.

Abstract: Introduction: Complex acetabulum fractures are a challenge for orthopedic surgeons. An evaluation of the radiographic reduction and functional result of the patients with complex fracture of the acetabulum who underwent the combined Kocher-Langenbeck and Stoppa approach was carried out. Material and methods: Cross-sectional, descriptive, ambispective design. Patients with complex acetabulum fracture who underwent the combined Kocher-Langenbeck approach plus Stoppa between 2016 and 2020 were included. The clinical records were reviewed, and the quality of the radiographic reduction was evaluated according to Matta criteria. In addition, a functional evaluation was performed with the Merle d'Aubigne and Postel scale at least 12 months after the injury. Results: Of the 31 patients, the average time between the date of fractures and the surgical intervention was 13.7 days (3-38 days). In the radiographic evaluation according to Matta criteria, 21 anatomical patients (67.7%), 7 almost anatomical (22.5%), 3 imperfect (9.6%). Functional results according to the Merle d'Aubigne and Postel scale resulted in 8 (25.8%) with excellent results, 16 (51.6%) with good results, 5 (22.5%) moderate and 2 (16.1%) poor patients. There was a statistical correlation between the age of the patient and the functional result (p = 0.029), also between the body mass index and blood loss (p = 0.027). Conclusion: The combined Kocher-Langenbeck plus Stoppa approaches are a valid alternative in these lesions, mostly with anatomical and almost anatomical radiographic results according to the Matta radiographic scale, and with excellent and good functional results according to the Merle d'Aubigne and Postel scale.

Measuring Acetabular Version after Total Hip Arthroplasty: A Comparison of Two Radiographic Methods / Medição da versão acetabular após artroplastia total do quadril: Comparação de dois métodos radiográficos

Abstract Objective The objective of the present work was to compare the measurement of acetabular component version on anteroposterior (AP) and on cross-table radiographs after total hip arthroplasty (THA). Methods Radiographs of 60 hips with a primary THA were selected. Version was calculated on the AP radiograph using the Lewinnek method and, on the cross-table, using the Woo and Morrey direct method. Results Mean and standard deviation (SD) were different on both radiographs, being 9.7° ± 5.5° on the AP, whereas in the cross-table the measurements were 20.6° ± 8.4° (p < 0.001). Minding our aim of 10°, the cross-table measurements were statistically different from it (p < 0.001), while the AP measurement did not differ (p = 0.716). Conclusion The present study showed that the best way to correctly evaluate the acetabular component positioning following a THA is by measuring anteversion and abduction on an AP radiograph after confirming, in a cross-table radiograph, that the component is not retroverted.

Resumo Objetivo O objetivo do presente trabalho foi comparar a medição da versão do componente acetabular em radiografias em incidência anteroposterior (AP) e crosstable após artroplastia total do quadril (ATQ). Métodos Foram selecionadas radiografias de 60 quadris com ATQ primário. A versão foi calculada na radiografia AP usando o método de Lewinnek e, na cross-table, usando o método direto do Woo e Morrey. Resultados A média e o desvio padrão (DP) foram diferentes em ambas as radiografias, sendo 9,7° ± 5,5° no AP, enquanto na cross-table foram 20,6° ± 8,4° (p < 0,001). Considerando nosso objetivo de 10°, as medidas da cross-table foram estatisticamente diferentes dele (p < 0,001), enquanto a medição AP não diferiu (p = 0,716). Conclusão O presente estudo mostrou que a melhor maneira de avaliar corretamente o posicionamento do componente acetabular após uma ATQ é medindo a anteversão e a abdução em uma radiografia AP após confirmar, em uma radiografia cross-table, que o componente não é retrovertido.

Prótesis de roy camille a 30 años de implantación. Reporte de caso / Roy camille prosthesis 30 years after implantation. case report

Se presenta un Caso Clínico de una paciente de género femenino, 90 años 6 meses de edad, con diagnóstico inicial de Coxartrosis Bilateral de Cadera. Se le realizó Reemplazo Total de Cadera hace 30 años del lado izquierdo (1990) con una Prótesis de Roy Camille, y hace 25 años se intervino el lado derecho (1997) con una Prótesis Bipolar Cementada. En el año 2019 se llevó a Revisión de Prótesis de Cadera.

We present a Clinical Case of a female patient, 90 years 6 months of age, with an initial diagnosis of Bilateral Hip Coxarthrosis. Total Hip Replacement was performed 30 years ago on the left side (1990) with Roy Camille Prosthesis, and 25 years ago the right side (1997) was intervened with a Cemented Bipolar Prosthesis. In the year 2019 he took o hip Prosthesis Review.

Tratamiento quirúrgico de las fractura de pared posterior de acetábulo: resultados a corto y mediano plazo / Surgical treatment in acetabular posterior wall fractures: short and medium-term results

OBJETIVO: Evaluar los resultados radiológicos a corto y mediano plazo de pacientes operados de fractura de pared posterior de acetábulo, describir la morfología de la fractura, presencia de lesiones asociadas y la necesidad de artroplastia total de cadera (ATC) durante la evolución. MATERIAL Y MÉTODOS: Estudio retrospectivo-descriptivo de una serie consecutiva de 40 pacientes operados entre julio de 2012 y julio de 2017 por fractura de pared posterior de acetábulo. Treinta y siete hombres y tres mujeres con una edad promedio de 41 años fueron operados (mediana de seguimiento 17,7 meses). Se registró el mecanismo del accidente y presencia de lesiones asociadas. Se registraron el número de fragmentos que presentaba la fractura, presencia de impactación marginal, compromiso de la cabeza femoral, presencia de fragmentos intra-articulares y complicaciones postoperatorias. Para el análisis estadístico se utilizó el test de Wilcoxon. RESULTADOS: Todos los casos fueron secundarios a un accidente de alta energía. Un 70% de los pacientes presentó luxación posterior. La mayoría de los pacientes presentó una fractura entre 2 y 5 fragmentos (70%), 47,5% de los pacientes presentó impactación marginal, 37,5% compromiso de la cabeza femoral en zona de carga, 30% fragmentos intra-articulares. La complicación que más frecuente se observó fue la artrosis post-traumática la cual se presentó en un 22,5%. Cinco pacientes (12,5%) requirieron ATC. CONCLUSIÓN: Aunque se categorizan dentro de los patrones simples, las fracturas de pared posterior son lesiones complejas. La tomografía axial computada preoperatoria es esencial para determinar lesiones intra-articulares dada su alta frecuencia y también permite realizar un buen plan preoperatorio.

OBJECTIVE: Evaluate radiologic results in short and medium-term in surgically treated patients with acetabular posterior wall fracture. Describe fracture morphology, the presence of associated lesions and the necessity of total hip arthroplasty (THA) during the evolution. MATERIALS AND METHODS: A retrospective-descriptive study design of 40 patients treated during July 2012 and July 2017 for acetabular posterior wall fracture. 37 men and 3 women, 41 years old mean age. The mean follow-up was 17.7 months. Accident mechanism and presence of associated lesions were registered, as well as the number of fragments of the fracture, the presence of marginal impaction, femoral head compromise, intra-articular fragments and postoperatory complications. Wilcoxon test was used for the statistical analysis. RESULTS: Every case resulted due to a high energy accident. 70% of patients had posterior luxation of the hip. 70% of patients presented 2 to 5 fragments. 47.5% of patients presented marginal impaction, 37.5% compromised femoral head and 30% intra-articular fragments. The most frequent complication was post-traumatic arthrosis, which appeared in 22.5% of patients. Five patients required THA. CONCLUSION: Though it is categorized as simple fracture pattern, posterior wall fractures are complex. Preoperatory CT scan is essential to determine intra-articular lesions due to its high frequency and permits to plan an adequate intervention.

Pelvic Bone Deformity and Its Correlation with Acetabular Center-edge Angle / Deformidade dos ossos pélvicos e sua correlação com o ângulo centro-borda acetabular

Abstract Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5º (20 o to 40º), and in the left 32.3º (20 o to 40º). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry (p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.

Resumo Objetivos O objetivo do presente trabalho é avaliar a deformidade dos ossos pélvicos e sua correlação com ângulo centro-borda acetabular (CE). Métodos Foi realizado um estudo prospectivo caso-controle, entre agosto de 2014 e abril de 2015. Os critérios de inclusão foram pacientes consecutivos com idades entre 20 e 60 anos. Os critérios de exclusão foram: doença metabólica, cirurgia prévia de quadril ou coluna, radiografia evidenciando artrose de quadril ≥ Tönnis 2, displasia do desenvolvimento do quadril (DDQ) severa, sobrecobertura acetabular global, sinal do cruzamento das linhas acetabulares, deformidades decorrentes de epifisiólise ou Legg-Perthes-Calveé, e radiografia sem qualidade adequada. Foram avaliados na radiografia anteroposterior (AP) de pelve: o ângulo CE, índice acetabular (IA), sinal do cruzamento das linhas acetabulares, mensuração do eixo horizontal e vertical da hemipelve superior e inferior (H1: Linha Horizontal 1, hemipelve superior; H2: Linha Horizontal 2, hemipelve superior; V1: Linha Vertical, hemipelve superior; HR: Linha Horizontal, hemipelve inferior; VR: Linha Vertical, hemipelve inferior). As mensurações H1, H2, V1, HR e VR foram consideradas assimétricas quando, na comparação de uma hemipelve em relação ao lado contralateral, evidenciou-se uma diferença > 5 mm. Os pacientes foram separados em dois grupos: controle e grupo 1. Resultados O total de pacientes avaliados no período foi de 228 (456 quadris). De acordo com os critérios estabelecidos, foram incluídos neste estudo 93 pacientes. A idade média foi de 39,9 anos (20 a 60 anos, desvio padrão [DP] = 10,5), e o ângulo CE médio do quadril direito foi de 31,5º (20º a 40º) e do esquerdo de 32,3º (20º a 40º). Um total de 38 pacientes foi incluído no grupo controle, sendo que com relação à H1, foi constatada aferição assimétrica em 4 casos (10,5%), H2 em 5 (13,1%), V1 em 7 (18,4%), HR em 5 (13,1%), e VR em 1 caso (2,63%). No grupo 1, foram incluídos 55 pacientes, sendo que com relação à H1, foi constatada aferição assimétrica em 24 casos (43,6%), H2 em 50 (90,9%), V1 em 28 (50,9%), HR em 16 (29,09%), e VR em 8 casos (14,5%). Na comparação entre o grupo controle e o grupo 1, observou-se diferença estatisticamente significativa para a assimetria das mensurações H1, H2 e V1 (p < 0,001). Conclusão No presente trabalho, evidenciou-se correlação entre variação do ângulo CE acetabular e assimetria da hemipelve superior. Os presentes autores acreditam que o melhor entendimento das alterações morfológicas pélvicas permite uma maior facilidade no diagnóstico das deformidades articulares do quadril.

Demographic analysis of acetabular fractures treated in a quaternary care hospital from 2005 to 2016 / Análise demográfica das fraturas do acetábulo tratadas em um hospital quaternário de 2005 a 2016

ABSTRACT Objective: Analyze the clinical and sociodemographic data on acetabular fractures in a Brazilian quaternary care hospital and compare with data reported in the literature. Methods: A descriptive, analytical cross-sectional epidemiological study analyzing 87 patients with acetabular fractures at Hospital São Paulo (UNIFESP/EPM) between 2005 and 2016. Demographic variables such as age, sex, occupation, educational level and color were investigated. Acetabular fractures were classified according to the AO/OTA group and Judet and Letournel classification. Therapeutic approach, hospital length of stay and waiting time for surgery as well as complications were analyzed. Associations were established among the various variables obtained. Results: The mean age of patients with acetabulum fractures was 39.8 years (SD 13.1 years). There was a predominance of posterior wall (34.5%) and dual-column (14.9%) fractures. The average hospital length of stay was 14.4 days. More than 90% of patients underwent a surgical procedure. One-fourth of patients had complications, the main one being infection (12.6%). Conclusions: Unimodal age distribution was obtained with a predominance of white male economically active patients. There was a predominance of posterior wall fractures. More than 90% of patients underwent surgery before they had been in hospital for 14 days. A statistically significant association was found between complications and exceeded length of hospital stay. Level of evidence II, Retrospective study.

RESUMO Objetivo Analisar os dados clínicos e sociodemográficos das fraturas acetabulares em um hospital quaternário brasileiro e comparar com dados relatados na literatura. Métodos: Estudo epidemiológico, descritivo, analítico transversal, em que foram analisados 87 pacientes com fraturas acetabulares no Hospital São Paulo (UNIFESP/EPM) entre 2005 e 2016. Variáveis demográficas como idade, sexo, profissão, escolaridade e cor foram pesquisadas. As fraturas acetabulares foram classificadas conforme o grupo AO/OTA e conforme Judet e Letournel. A terapêutica, o tempo de internação e de espera para cirurgia bem como as complicações foram analisadas. Foram feitas associações entre as diversas variáveis obtidas. Resultados: A média de idade dos pacientes vítimas de fraturas do acetábulo foi de 39,8 anos (DP 13,1 anos). Houve predomínio das fraturas da parede posterior (34,5%) e dupla coluna (14,9%). Os pacientes ficaram, em média, 14,4 dias internados. Mais de 90% dos pacientes foram submetidos à abordagem cirúrgica. Um quarto dos pacientes tiveram complicações, sendo a principal, infecção (12,6%). Conclusões: Foi obtida uma amostra etária unimodal com predomínio de pacientes do sexo masculino, brancos e economicamente ativos. Houve um predomínio das fraturas da parede posterior. Mais de 90% dos pacientes foram operados antes dos 14 dias de internação. Constatou-se uma associação estatisticamente significante entre complicações e tempo excedido de permanência hospitalar. Nível de evidência II, Estudo retrospectivo.

Morphometry and morphology of the acetabulum within the black African population of South Africa / Morfometría y morfología del acetábulo dentro de la población africana negra de Sudáfrica

The acetabulum is the large cup-shaped cavity on the lateral surface of the hip bone, which articulates with the head of the femur to form the hip joint. The morphometry and morphology of the acetabulum is important in the diagnosis and treatment of hip joint injuries and disease. Population specific differences exist regarding the acetabulum, therefore, this study aimed to document the morphometry and morphology of the acetabulum within a Black African population in Kwa-Zulu Natal, South Africa. A total of 100 dry hip bones (R= 44; L= 56) from the University of KwaZulu-Natal (Westville and NRMSOM campuses) were examined for this study. The hip bones, with documented sex, were all from the Black African population. A sliding digital caliper was used to measure the acetabular diameter, depth and acetabular notch width. The morphology of the acetabular margin was document in accordance with Govsa et al. (2005). Statistical analysis was conducted using SPSS version 24 software. A p-value of less than 0.05 was considered statistically significant. The means and standard deviations of the morphometric measurements for the entire population were as follows: (a) acetabular diameter of 54.84 ± 4.18 mm, (b) acetabular depth of 31.30 ± 3.18 mm and (c) acetabular notch width of 21.72 ± 2.98 mm. The observed shapes of the acetabular margin that were angular (41 %), curved (22 %), irregular (23 %) and straight (14 %). Knowledge of the anatomy of the acetabulum is useful to surgeons, prosthetists, anthropologists and forensic anthropology experts. The morphometry and morphology of the Black African population group of KwaZulu-Natal presented with differences when compared to other population groups studied in literature.

El acetábulo es una cavidad grande, en forma de copa, ubicada en la superficie lateral del hueso coxal, que se articula con la cabeza del fémur para formar la articulación coxofemoral. La morfometría y morfología del acetábulo son importantes en el diagnóstico y tratamiento de las lesiones y enfermedades de las articulaciones de la cadera. Existen diferencias específicas de la población con respecto al acetábulo, por lo tanto, este estudio tuvo como objetivo documentar la morfometría y la morfología del acetábulo en una población Africana negra, perteneciente a Kwa-Zulu Natal, Sudáfrica. Para este estudio se examinaron un total de 100 huesos coxales secos (Right = 44; Left = 56) de la Universidad de KwaZulu-Natal (campus de Westville y NRMSOM). Los huesos coxales, con sexo documentado, eran todos de población africana negra. Se utilizó un calibrador digital deslizante para medir el diámetro acetabular, la profundidad y el ancho de la incisura acetabular. La morfología del margen acetabular anterior se documentó de acuerdo con Govsa et al. (2005). El análisis estadístico se realizó utilizando el software SPSS versión 24. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. Las medias y desviaciones estándar de las medidas morfométricas para toda la población fueron las siguientes: (a) diámetro acetabular de 54,84 ± 4.18 mm, (b) profundidad acetabular de 31,30 ± 3,18 mm y (c) ancho de la incisura acetabular de 21,72 ± 2,98 mm. Las formas observadas del margen acetabular fueron angulares (41 %), curvas (22 %), irregulares (23 %) y rectas (14 %). El conocimiento de la anatomía del acetábulo es útil para cirujanos, antropólogos y expertos en antropología forense. La morfometría y morfología del grupo poblacional de África negra de KwaZulu-Natal presentaron diferencias cuando se compararon con otros grupos poblacionales estudiados en la literatura.

Modified stoppa approach for pelvic and acetabular fracture treatment / Stoppa modificada para tratamento de fraturas pélvicas e acetabulares

ABSTRACT Objective: A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures. Methods: 18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations. Results: Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good. Conclusions: Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

RESUMO Objetivo: Uma revisão retrospectiva tem como objetivo investigar os métodos operatórios e efeitos terapêuticos da abordagem modificada de Stoppa para o tratamento de fraturas pélvicas e acetabulares. Métodos: 18 pacientes com fratura acetabular da coluna anterior e fratura do anel anterior pélvico foram submetidos a tratamento cirúrgico utilizando a abordagem de Stoppa modificada. Parte do tratamento foi feita em conjunto com a abordagem da fossa ilíaca ou com a abordagem pelo acesso posterior de K-L. A redução da fratura e a função pós-operatória foram avaliadas pelo padrão de pontuação de Matta e o sistema de pontuação de Majeed. O sistema do Oxford Centre for Evidence-Based Medicine foi usado para classificar a revisão de literatura e criar as recomendações de grau B. Resultados: O comprimento da incisão foi de 6 a 12 cm (média de 10 cm), a duração da cirurgia foi de 50 a 150 minutos (média de 85 minutos) e o volume de perda sanguínea intraoperatória foi de 400 a 1.000 ml (média de 500 ml). 18 pacientes foram acompanhados por 12-36 meses após a operação. Nos resultados dos filmes radiográficos, 12 casos foram de reduções anatômicas e os demais casos foram de reduções satisfatórias. De acordo com o padrão de Majeed, 13 pacientes foram considerados excelentes e cinco pacientes foram considerados bons. Conclusões: O tratamento que utilizou a abordagem de Stoppa modificada foi adequado para abordagens anteriores, nas quais as fraturas pélvicas e acetabulares estavam suficientemente expostas, a fratura foi convenientemente reduzida, ocorreram menos complicações e o efeito curativo foi satisfatório. Nível de evidencia III, Estudo retrospectivo comparativo.

Recovery of the Hip Rotation Center with Tantalum in Revision Arthroplasty / Recuperação do centro de rotação do quadril com tântalo em artroplastias de revisão

Abstract Objective The objective of the present study is to evaluate the restoration capacity of the hip anatomic rotation center with the use of acetabular tantalum cups, associated or not with addition wedges. Methods Retrospective analysis of patients undergoing hip arthroplasty revision using tantalum between June 2013 and April 2017. The abduction angle of the acetabular component and the horizontal and vertical distances of the component to the center of anatomical rotation of the hipwere evaluated. The measurements were made through baseline radiographs performed in the preoperative period and at the last follow-up visit. Results A sample of 21 patients was obtained, 11 (52%) men and 10 (48%) women, with amean age of 62 ± 13 years old. The mean abduction angle of the acetabular cup decreased from 48.76° ± 13.88 ° in the preoperative period to 38.52° ± 10.08 ° in the postoperative period, and this difference was statistically significant (p = 0.001). The distances from the center of rotation of the prosthesis relative to the center of anatomical rotation of the hip were also lower after revision surgery with tantalum. The mean horizontal distance of 12.74 ± 10.59 mm was reduced to 7.11 ± 4.84 mm, and the mean vertical distance was reduced from 14.79 ± 10.05 mm to 4.89 ± 6.21 mm, and these reductions were statistically significant (p < 0.001). Conclusion Hip arthroplasty revision with tantalum cups, associated or not with addition wedges, significantly recovered the anatomical rotation center of the hip.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril comuso de tântalo entre o período de junho de 2013 e abril de 2017. Foramavaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componenteao centro de rotação anatômicodoquadril.Asmedidas foramrealizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pósoperatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p < 0,001). Conclusão As revisões de artroplastia do quadril comcopas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.