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This study showed a case of a patient with central dislocation of the femoral head without involvement of anterior or posterior column of the acetabulum. The patient was associated with endocrine disorders caused by pituitectomy, severe osteoporosis caused by a long-term gulucocorticoids intake history, and poor bone quality of the quadrilateral plate. The direct impact of the femoral head on the quadrilateral plate after trauma resulted in purely central dislocation of the femoral head. 3D printing technique was used to print the fracture model for observation of the fracture morphology and the simulated operation before surgery. The variable-angle locking acetabular plate with a propeller-like shape was designed on the basis of the mirror of the ipsilesional semi-pelvis. This fracture was reduced via the lateral-rectus approach under direct vision. The quadrilateral surface fractures were fixed by the variable-angle locking acetabular plate which was used as a template for reduction. The follow up after surgery showed good reduction and fixation, equal length of double lower limbs, good positive and passive motion of the injured hip joint and without perioperative complications. This report describes an isolated quadrilateral plate fracture that has not yet been classified. It was effectively treated by using a customized variable-angle locking acetabular plate with a propeller-like shape via the lateral rectus approach.
RESUMO
This study showed a case of a patient with central dislocation of the femoral head without involvement of anteri?or or posterior column of the acetabulum. The patient was associated with endocrine disorders caused by pituitectomy, severe osteo?porosis caused by a long-term gulucocorticoids intake history, and poor bone quality of the quadrilateral plate. The direct impact of the femoral head on the quadrilateral plate after trauma resulted in purely central dislocation of the femoral head. 3D printing technique was used to print the fracture model for observation of the fracture morphology and the simulated operation before sur?gery. The variable?angle locking acetabular plate with a propeller?like shape was designed on the basis of the mirror of the ipsile?sional semi-pelvis. This fracture was reduced via the lateral?rectus approach under direct vision. The quadrilateral surface frac?tures were fixed by the variable?angle locking acetabular plate which was used as a template for reduction. The follow up after sur?gery showed good reduction and fixation, equal length of double lower limbs, good positive and passive motion of the injured hip joint and without perioperative complications. This report describes an isolated quadrilateral plate fracture that has not yet been classified. It was effectively treated by using a customized variable?angle locking acetabular plate with a propeller?like shape via the lateral rectus approach.
RESUMO
Objective To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach.Methods Data of 11 elder patients of complex acetabular fractures (mean age 75 y,range:60-93 y;8 males,3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed.According to Judet-Letournel classification of acetabular fractures,there were 2 cases of anterior column and posterior hemitransverse fractures,9 cases of both-column fractures.The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery.During the operation,the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataralrectus approach.The effect of fracture reduction was assessed by Matta's criteria.The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigné-Postal score at the 6th month of postoperative follow-up.Results The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d),the average operation time was 95 min (45-150 min),and the average intraoperative bleeding was 600 ml (250-1 400 ml).All patients were followed up,with an average follow-up of 18 m (6-24 m).All fractures were healed,with an average healing time of 8 weeks (6-12 weeks).Reduction quality:excellent in 8 cases,good in 2 cases,poor in 1 case,with an overall excellent and good rate of 90.9％.The result of Harris Hip scoring:excellent in 7 cases,good in 3 cases,and acceptable in 1 case,with a total excellent and good rate of 90.9％;Modified Mere d' Aubigné-Postal soring:excellent in 6 cases,good in 3 cases,and acceptable in 2 cases,with an overall excellent and good rate of 81.8％.There were 2 cases of obturator nerve injury,1 case of fat liquefaction of incision,3 cases of traumatic hip arthritis.During the follow-up,no complications such as ectopic ossification,plate fracture and screw loosening were found.Conclusion The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation.
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Objective To explore the efficacy of the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly.Methods A total of 52 elderly patients with acetabular fracture were admitted to Department of Orthopaedics and Trauma,The Third Affiliated Hospital to Southern Medical University from January 2014 to December 2017.They were 36 males and 16 females,with an average age of 71.6 years (from 65 to 88 years).According to the Judet-Letournel classification,there were 5 anterior column fractures,6 transverse fractures,18 anterior and posterior hemi-transverse fractures,and 23 both-column fractures.For all cases a preoperative surgical simulation was implemented based on their 3D-printed acetabular models.A pre-bent reconstruction plate or a custom acetabular aliform plate was placed to fixate the fracture after reduction via the anterior lateral-rectus approach.The reduction quality,healing time,function of affected hip and complications were recorded.Results The operation time for this cohort ranged from 85 to 138 min (average,102 min);the intraoperative bleeding ranged from 280 to 750 mL(average,520 mL).Perioperatively,implant failure,wound infection or symptomatic lower extremity phlebothrombosis was observed in none of the patients.According to the Matta radiological evaluation,the postoperative reduction was rated as excellent in 40 cases,as good in 7 and as poor in 5 (an excellent and good rate of 90.4％).All cases were followed up for 6 to 18 (mean,10.6 months).All the acetabular fractures united after 8 to 20 weeks (average,12 weeks).According to the modified Merle d'Aubigne-Postal scoring at the final follow-up,the function of affected hip was categorized as excellent in 29 cases,as good in 12 and as fair in 11 (an excellent and good rate of 78.8％).Walking pain was experienced by 5 patients 6 months after operation,diagnosed by imaging examination as traumatic arthritis of the hip joint.Follow-ups observed no such complications as screw loosening or heterotopic ossification.Conclusion In the treatment of acetabular fractures in the elderly,the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing can achieve effective reduction and fixation,decrease intraoperative hemorrhage,shorten operation time and reduce such complications as screw loosening caused by osteoporosis.
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Objective@#To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach.@*Methods@#Data of 11 elder patients of complex acetabular fractures (mean age 75 y, range: 60-93 y; 8 males, 3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed. According to Judet-Letournel classification of acetabular fractures, there were 2 cases of anterior column and posterior hemitransverse fractures, 9 cases of both-column fractures. The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery. During the operation, the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataral-rectus approach. The effect of fracture reduction was assessed by Matta's criteria. The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigné-Postal score at the 6th month of postoperative follow-up.@*Results@#The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d), the average operation time was 95 min (45-150 min), and the average intraoperative bleeding was 600 ml (250-1 400 ml). All patients were followed up, with an average follow-up of 18 m (6-24 m). All fractures were healed, with an average healing time of 8 weeks (6-12 weeks). Reduction quality: excellent in 8 cases, good in 2 cases, poor in 1 case, with an overall excellent and good rate of 90.9%. The result of Harris Hip scoring: excellent in 7 cases, good in 3 cases, and acceptable in 1 case, with a total excellent and good rate of 90.9%; Modified Merle d' Aubigné-Postal soring: excellent in 6 cases, good in 3 cases, and acceptable in 2 cases, with an overall excellent and good rate of 81.8%. There were 2 cases of obturator nerve injury, 1 case of fat liquefaction of incision, 3 cases of traumatic hip arthritis. During the follow-up, no complications such as ectopic ossification, plate fracture and screw loosening were found.@*Conclusion@#The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation.