An epidemiological trend in surgical management of pelvis and acetabulum fractures at Indira Gandhi Institute of Medical Sciences level-1 trauma centre in Patna: a retrospective study

Background: Pelvic and acetabular fractures, principally resulting from high-energy trauma like motor vehicle accidents, are challenging orthopedic injuries that can lead to significant morbidity and functional impairment. Understanding their epidemiology, treatment, and outcomes is crucial for improving patient care. Methods: This retrospective cohort study involving 34 patients who underwent surgery for pelvic and acetabular fractures from April 2021 to September 2023. Data on patient demographics, injury mechanisms, fracture types, surgical approaches, and post-operative outcomes were collected and analyzed. Results: The study group comprised predominantly males (67%) with mean age of 35 years. Road traffic accidents were the leading cause of injuries (95%). The most common fracture types were the posterior wall of the acetabulum (10%) and type II anteroposterior compression fractures (10%). Related injuries included long bone fractures (62.5%) and posterior hip dislocation (33.33%). Surgical treatment primarily involved open reduction and internal fixation with various approaches. Postoperative complications included sciatic nerve palsy (4.17%), venous thromboembolism (20.83%), and wound infections (12.5%), but both post-operative mortality and heterotopic ossification were absent. Conclusions: The study highlights the prevalence of pelvic and acetabular fractures due to road traffic accidents and the complexity of their surgical management. The associated injuries and postoperative complications underscore the need for specialized orthopedic care.

Incidencia de fracturas de pelvis y acetábulo en el adulto mayor por trauma de alta energía / Incidence of pelvic and acetabular fractures in the elderly due to high energy trauma

Resumen: Introducción: a medida que se invierte la pirámide poblacional, se viven vidas más largas y activas, se vuelven más frecuentes los pacientes geriátricos con trauma de alta energía; requiriendo más recursos, obteniéndose peores resultados, con más complicaciones perioperatorias, hacen a estas fracturas difíciles de manejar. Establecida la hipótesis de que la incidencia de las fracturas de pelvis y acetábulo, en el adulto mayor por trauma de alta energía, es superior a la reportada en la literatura mundial, se generó la pregunta de investigación: ¿Cuál es la incidencia de fracturas de pelvis y acetábulo por trauma de alta energía en el adulto mayor en un período de cinco años? Material y métodos: una vez obtenida la autorización del Comité de Ética, se realizó un estudio observacional de una cohorte retrospectiva, utilizando registros médicos, identificando la incidencia de estas fracturas, tratadas quirúrgicamente en nuestro hospital de III nivel, Clínica Las Vegas, Medellín, Colombia, del 1 de Julio de 2016 a 30 de Junio de 2021. Resultados: se calculó una incidencia acumulada de 1.95 nuevos casos por cada 100,000 personas-año, una prevalencia de 13.8%; resultando en una mayor incidencia y prevalencia, confirmándose nuestra hipótesis. Conclusión: el tratamiento debe orientarse a mejorar la calidad de vida con una fijación estable, identificación y tratamiento de lesiones asociadas, minimizando el riesgo de complicaciones mecánicas y priorizar el reforzamiento de medidas preventivas y a la mejora del comportamiento del rol masculino, que aparentemente, seguirán realizando actividades de riesgo a pesar de su edad.

Abstract: Introduction: as the population pyramid gets inverted, more active and longer lives are lived, geriatric patients with high energy trauma (HET) become more frequent; requiring more resources, getting worse results with more perioperative complications, coupled with a fragile state of health and osteopenia, make these fractures difficult to manage. With the hypothesis that the incidence of pelvic and acetabular fractures in the elderly due to HET is higher than that reported in the world literature, the research question was generated: What is the incidence of pelvic and acetabular fractures in the elderly due to HET, in a 5-year period? Material and methods: with the authorization of the Ethics Committee, an observational study of a retrospective cohort was carried out, using medical records, identifying the incidence of these fractures, surgically treated in our institution Clínica Las Vegas, Medellin, Colombia, a level III hospital, from July 1, 2016 to June 30, 2021. Results: a cumulative incidence of 1.95 new cases per 100,000 person-years was calculated, a prevalence of 13.8%; resulting in a higher incidence and prevalence, confirming our hypothesis. Conclusion: treatment should be aimed at improving quality of life with stable fixation, identification and treatment of associated injuries, minimizing the risk of mechanical complications and prioritizing the reinforcement of preventive measures, also in the improvement of male role behavior, whom, as it seems, will keep carrying out risky activities despite their age.

Measurement of the maximum corridor parameters of infra acetabular screw and evaluation of the feasibility of screw insertion by digital analysis / 中国骨伤

OBJECTIVE@#To measure the maximum corridor parameters of the infra acetabular screw and evaluate the feasibility of screw insertion through digital analysis of the acetabular structure.@*METHODS@#The pelvic CT data of 100 patients who received plain pelvic CT scan from April 2013 to June 2015 were retrospectively analyzed. There were 50 males, aged 20 to 84 years, with an average age of (48.42±17.48) years, and 50 females, aged 18 to 87 years, with an average age of (55.02±19.54) years. Patients with acetabular fractures, hip dysplasia, and metal implants in the acetabulum were excluded. Import CT data into Mimics software in DICOM format to generate a three-dimensional model, and find the axialprojection of the infra-acetabular corridor in the middle of the pubis ramus in the inlet view. A virtual screw was placed in the infra-acetabular space and measure the parameters including the diameter and the length of the maximum corridor, the distance from the insertion point to the pubic symphysis, to the anterosuperior iliac spine and to the medial edge of the pelvis. Then import the pelvic model into 3- matic software, establish the pelvic model anterior pelvic plane and median sagittal plane, and measure the angle between the screw axis and the two planes. A minimum corridor diameter of at least 5 mm was defined as a cutoff for placing a 3.5 mm screw, and calculate the screw insertion rate.@*RESULTS@#In 100 cases, 49% of patients had a infra acetabular corridor with a diameter ≥5 mm, and the rate of screw placement in men was significantly higher than that in women. The average diameter of the maximum corridor of infra-acetabular screw was (4.86±1.72) mm, the average length was (94.04±8.29) mm, the average distance from the insertion point to the pubic symphysis was (60.92±4.84) mm, to the anterosuperior iliac spine was (85.15± 6.85) mm, and to the medial edge of the pelvis was (6.12±3.32) mm. The mean angle between the axis of the screw and the median sagittal plane was (-1.38±4.74)°, and the mean angle between the axis of the screw and the anterior pelvic plane was (56.77±7.93)°. There are significant differences between male and female measured parameters, except for the angle between the screw axis and the anterior pelvic plane. There was no statistically significant difference in the maximum corridor parameters of infra-acetabular screw on both sides of the pelvis.@*CONCLUSION@#This study shows that the insertion rate of infra-acetabular screws is low in local patients, and the feasibility of screw insertion should be fully evaluated before surgery.

Three-dimensional printing combined with open reduction and internal fixation versus open reduction and internal fixation in the treatment of acetabular fractures: A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#This meta-analysis compared the clinical outcome of three-dimensional (3D) printing combined with open reduction and internal fixation (ORIF) to traditional ORIF in the treatment of acetabular fractures.@*METHODS@#We searched the Cochrane Library, PubMed, Embase, VIP database, CNKI, and Wanfang database with keywords "acetabular fracture", "3D printing", "three-dimensional printing", "open reduction and internal fixation", "Acetabulum", "Acetabula" from January 2000 to March 2020. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' s tools and/or Newcastle-Ottawa scale. When the two analysts had different opinions, they would ask the third analyst for opinion. Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF (3D printing group) versus traditional ORIF (conventional group) in the treatment of acetabular fractures were selected. The data of operation time, intraoperative blood loss, intraoperative fluoroscopy times, incidence of complications, excellent and good rate of Matta score for reduction, and excellent and good rate of hip function score were extracted. Stata14.0 statistical software was used for data analysis.@*RESULTS@#Altogether 9 articles were selected, including 5 randomized controlled trials and 4 retrospective studies. A total of 467 patients were analyzed, 250 in the conventional group, and 217 in the 3D printing group. The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant (standardized mean difference (SMD) = -1.19, 95% CI: -1.55 to -0.82, p  0.05). There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups (OR = 0.84, 95% CI: 0.46-1.56, p > 0.05), but the follow-up time varies from 6 months to 40 months.@*CONCLUSION@#Compared with traditional ORIF, 3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively, but also effectively reduces operation time, intraoperative blood loss, intraoperative fluoroscopy times, and postoperative complications. However, there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.

Cup-Cage Construct Using Porous Cup with Burch-Schneider Cage in the Management of Complex Acetabular Fractures / 대한고관절학회지

PURPOSE: Cup-cage construct technique was developed to address the massive acetabular defects during revision hip arthroplasty. Indications have extended to complex acetabular fractures with pelvic discontinuity necessitating acute total hip arthroplasty. However, its use is constrained in low socioeconomic countries due to non-availability of the original cages from Trabecular Metal Acetabular Revision System and high cost. We used a novel technique using the less expensive Burch-Schneider (BS) cage and Trabecular Metal Revision Shell (TMRS) to address the problem. MATERIALS AND METHODS: We reviewed a consecutive series of 8 cases of acetabular fractures reconstructed using a ‘cup-cage construct’ technique using a BS cage along with a TMRS. The mean age of the patients was 61.4 years. Patients were followed up for a mean period of 50.5 months (24 to 72 months). The patients were assessed clinically with Harris Hip Score and radiologically with serial X-rays. RESULTS: All the patients were available at the latest follow up. The mean Harris Hip Score was 87.2. There was no radiological evidence of failure. One patient had dislocation two months following the surgery, which was treated by closed reduction and hip abduction brace. One patient developed an infection at 3 weeks necessitating debridement. The same patient had sciatic nerve palsy that recovered after 4 months. CONCLUSION: This novel technique of the cup-cage construct seems to provide a stable construct at short to midterm follow-up. However, a long-term follow up would be required.

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice.</p><p><b>METHODS</b>From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20-65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction.</p><p><b>RESULTS</b>The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%.</p><p><b>CONCLUSION</b>The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.</p>

Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture.</p><p><b>METHODS</b>Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies.</p><p><b>RESULTS</b>With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%.</p><p><b>CONCLUSION</b>Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.</p>

Biomechanical stability study on different internal fixation for acetabular fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the biomechanical stability of the acetabular fracture with three different internal fixation methods.</p><p><b>METHODS</b>Sixteen both-column acetabular fracture models were randomly divided into three groups:The specimens of 16 hip joints were randomly divided into 4 groups. Among them, 1 group of complete acetabulum were used as normal control group, and the other 3 groups simulated two column fracture models and were fixed in the following methods, respectively: anterior wall with screw and posterior with plate(SP), anterior wall with plate and posterior wall with screw(PS) and both wall with plate (PP). The degree of fracture displacement and the contact characteristics of the acetabulum were recorded by continuous vertical loading.</p><p><b>RESULTS</b>The mean longitudinal displacement under the load 800 N of SP, PS and PP three groups were (1.92±0.81), (2.09±1.13) and (3.44±0.75) mm, there was significant difference between SP and PP group (0.033). And the mean horizontal displacement of SP, PS and PP three groups were(0.63±0.33), (0.77±0.45) and (1.44±0.56) mm, there was significant difference between SP and PP group(0.047).Compared with normal control group in the acetabular area under the loading 800 N, the contact area of SP, PS and PP groups were increased by 6%, 9% and 27%, there was significant difference between PP and normal control group (0.027). Meanwhile, the mean stress of SP, PS and PP groups were increased by 4%, 29% and 39%, there was significant difference between PP and intact acetabulum group (0.003).</p><p><b>CONCLUSIONS</b>Anterior column screw combined with posterior column plate has better biomechanical stability and contact characteristics than other two methods.</p>

A case of Galen vein thrombosis occurring after bilateral acetabular fractures in the Tibet plateau - what can we learn? / 中华创伤杂志(英文版)

Hypoxia leads to increased red blood cells and blood viscosity at high altitude while moderate trauma increases coagulation in blood. Under the above-mentioned conditions, venous sinus thrombosis is more likely to occur. A patient suffering bilateral acetabular fractures together with the gradual disturbance of consciousness was admitted to our hospital. Though computed tomography arteriogram (CTA) of the brain displayed normal blood vessels; bilateral thalamus and brainstem infarction were found on head computed tomography (CT) and Galen vein thrombosis on cerebral computed tomography venography (CTV). Dehydration and tracheotomy were immediately conducted with antiplatelet, anticoagulant and neurotrophic medicine administered to the patient. After three days' treatment, the patient's consciousness gradually improved and eventually became clear enough to leave the hospital. On follow-up, no dysfunction was documented.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures.</p><p><b>METHODS</b>From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system.</p><p><b>RESULTS</b>Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period.</p><p><b>CONCLUSION</b>Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.</p>

Surgical Site Infection Following Fixation of Acetabular Fractures / 대한고관절학회지

PURPOSE: Acetabular fractures are mainly caused by high energy trauma. Surgical fixation of these fractures requires extensive surgical exposure which increases the length of operation and blood loss as well. This may increase the risk of surgical site infection. Our aim is to evaluate the prevalence of surgical site infections and the risk factors associated with it so as to minimize its chances. MATERIALS AND METHODS: A total of 261 patients who underwent acetabular fracture surgery were retrospectively reviewed. Patients were divided into 2 groups, with or without surgical site infection. Factors examined include patients' gender, age, body mass index (BMI), time between injury and surgery, operative time, estimated blood loss, number of packed red blood cell transfused, length of total intensive care unit (ICU) stay, fracture type, surgical approach, smoking status, patients' comorbids and associated injuries. RESULTS: Fourteen patients (5.4%) developed surgical site infection. Out of 14 infections, 4 were superficial and 10 were deep. The factors that were found to be associated with surgical site infection following acetabular fracture fixation were prolonged operation time, increased BMI, prolonged ICU stay, larger amount of packed red blood cell transfused and associated genitourinary and abdominal trauma. CONCLUSION: In our study, we conclude that measures should be undertaken to attenuate the chances of surgical site infection in this major surgery by considering the risk factors significantly associated with it.

Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular fractures.</p><p><b>METHODS</b>Case-controlled trials (CCTs) published from January 2010 to August 2015 that compared the ilioinguinal approach and Stoppa approach in the management of displaced acetabular fractures were retrieved from the databases of Cochrane Library, Pubmed, CNKI, and so on. Methodological quality of the trials was critically assessed. Statistical software RevMan 5.0 was used for data analysis.</p><p><b>RESULTS</b>Eight articles were included in the meta-analysis. Through comparing the efficacy and safety of ilioinguinal approach and Stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time [WMD = 68.29, 95% CI (10.52, 126.05), p < 0.05] and the median intraoperative blood loss [WMD = 142.26, 95% CI (9.30, 275.23), p < 0.05]. However, there existed no statistical significance in the fracture end reset satisfaction rate [RR = 0.63, 95% CI (0.17, 2.37), p > 0.05], the early complications rate [RR = 0.89, 95% CI (0.33, 2.40), p > 0.05], the late complications rate [RR = 0.91, 95% CI (0.27, 3.01), p > 0.05], and Harris hip score good function rate [RR = 0.52, 95% CI (0.25, 1.10), p > 0.05].</p><p><b>CONCLUSION</b>Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.</p>

Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital / 대한고관절학회지

PURPOSE: Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. MATERIALS AND METHODS: Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. RESULTS: There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. CONCLUSION: Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome.

Unstable posterior acetabular fractures: Early results of delayed reduction and fracture fixation using the Kocher-Langenbeck approach with trochanteric flip osteotomy

@#<p style="text-align: justify;">Unstable posterior acetabular fractures resulting from high energy trauma present major challenges to any orthopedic surgeon especially if the treatment has been delayed.<br /><strong>OBJECTIVE:</strong> The purpose of this paper is to describe the early results of delayed treatment of a series of patients with posterior acetabular fractures with concomitant hip dislocations, surgically approached using the Kocher-Langenbeck with a trochanteric flip osteotomy.<br /><strong>METHODS:</strong> Five (5) male patients (mean age 35.6 years, range 23-58 years) who sustained unstable posterior acetabular fractures, underwent surgical treatment using the Kocher-Langenbeck approach with the trochanteric flip osteotomy, during the period of May 2014 to October 2015. Clinical and radiographic evaluations of each patient were performed, while complications were documented.<br /><strong>RESULTS:</strong> Mean follow-up was 8 weeks (range 2-12 weeks). There was adequate exposure of the posterior and superior acetabulum in all patients. Post-operative radiographs in four of five patients were graded "anatomic" while hip range of motion of these four patients averaged 78.7% of the uninjured hip. One patient with "poor" reduction underwent a second operation to reserve a failure of the initial fixation using the same surgical approach. No other complications were reported.<br /><strong>CONCLUSION:</strong> This modified approach provides adequate exposure of both posterior and superior acetabulum and also allows inspection of the articular surfaces of both acetabulum and femoral head, which are limited in the standard Kocher-Lagenbeck approach. With excellent exposure, congruent reduction can readily be achieved while permitting early hip range of motion post-surgery.</p>

Heterotopic ossification after reconstructive acetabular surgery in single centre experience, Khartoum North Teaching Hospital, Sudan

Acetabular reconstructive surgery is a good alternative method to treat acetabular fractures. The aims of this study were to assess the incidence, clinical pattern, and the relationship between various factors and heterotopic ossification (HO). This was a retrospective study involving all cases of acetabular fractures that underwent reconstructive surgery at Khartoum North Teaching Hospital in Khartoum state during the study period, (December 2006 to December 2011). A total of 132 patients with acetabular fractures were reviewed. The complete preoperative and post-operative data, together with information on regular follow up visits at 3 months, 6months and 2 years for each patient were collected. The SPSS was used for data processing. The male to female ratio was 4.3:1. Of the 132 cases 13 (9.8%) of them developed heterotopic ossification as a complication of the surgery. This consisted of 12 (92.3%) male and 1 (7.7%) female patients. The age range of the patients was 26-50 years. Road Traffic Accidents (RTA) /occupant constitute the most common mode of trauma 46.2%. AO (Arbeitsgemeinschaftfür Osteosynthesefragen foundation fracture classification) class A1 and B1 were the commonest types associated with HO. The mean hospital stay was 14 days. Male patients over 25 years of age with posterior hip dislocation, class A1 or A2, treated by posterior approach, were the highest at risk of developing Heterotopic Ossification.

Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

OBJECTIVE: The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area. METHODS: A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations. RESULTS: As the load was added, the displacements were A<B, increasing in line. In the 600 N physiological loading, the differences were significant (standing position: p = 0.013; sitting position: p = 0.009) between groups A and B. CONCLUSION: The anterior construct plate - 1/3 tube buttress plate fixation provided a better stable construct for early sitting. The standing mode yielded more significant differences between the groups. Placing a 1/3 tube buttress-plate via an anterior approach is a novel method of providing quadrilateral area support in this setting. .

Osteotomía del trocánter mayor tipo flip en el tratamiento quirúrgico de fracturas de acetábulo / Trochanteric flip osteotomy in the treatment of acetabular fractures

Objective: Analyze a series of patients that underwent surgery for an acetabular fracture in which a trochanteric flip osteotomy was used and discuss the advantages of this surgical procedure. Materials and Method: The clinical files of 8 patients treated of acetabular fractures with this approach is reported. Functional results are evaluated with the Merle d´Aubigne scale. Also, postoperative complications were age of patients was 41 years (range: 28-60 years). Mean follow-up was 13.8 months (range: 4-41 months). Functional results were excellent in 2 patients, good in 4 patients, regular in one patient and poor in one patient. Postoperative complications include two cases of heterotopic ossifications. No loosening of the osteotomy or avascular necrosis of the femoral head was observed. Conclusions: This technique facilitates in selected acetabular fractures, to obtain better visualization and more accurate reduction, by allowing safely dislocation of the femoral head and assessment of the intraarticular reduction.

Objetivo: Revisar los resultados radiológicos y funcionales de una serie de pacientes operados por fractura de acetábulo en que se utilizó un abordaje posterior con osteotomía del trocánter mayor tipo "flip", discutir ventajas y complicaciones potenciales de esta técnica. Material y Método: Se revisaron las fichas clínicas de 8 pacientes operados por fractura de cotilo en que se utilizó la osteotomía del trocánter mayor tipo "flip". Se evaluaron las complicaciones observadas y los resultados clínicos con la escala de Merle d`Aubigne. Resultados: La edad promedio de los pacientes fue de 41 años (rango: 28-60 años). El seguimiento promedio fue de 13,8 meses (rango: 4-41 meses). En cuanto a los resultados funcionales, en 2 pacientes fueron excelentes, en 4 pacientes buenos, en 1 paciente regular y en 1 paciente malo. Las complicaciones fueron 2 casos de osificaciones heterotópicas grado I y II de Broker. No hubo casos de aflojamiento de trocánter mayor o necrosis avascular. Conclusiones: Esta técnica quirúrgica facilita el tratamiento en casos seleccionados de fracturas acetabulares, al permitir luxar la cadera y mejorar la visualización de la reducción intraarticular, sin agregar mayores complicaciones.

Resultados a largo plazo en el tratamiento quirúrgico de las fracturas acetabulares / Long term results in surgical treatment of acetabular fractures

The objective of the present retrospective study is to describe the results in the treatment of displaced acetabular fractures in a 20 year period. One hundred and twenty six patients were surgically treated between 1982 and 2002. There were 98 males and 28 females with a mean age of 39 years-old and a mean follow-p of 6 years. Following Judet and Letournel`s classification the series was divide in to 48 (38 percent) simple and 78 (68 percent) complex fractures. Treatment was done by open reduction and internal fixation with plates and screws through different approaches. Clinical results were excellent in 60 patients (48 percent), good in 26 (21 percent), regular in 18 (14 percent) and bad in 22 (17 percent). The most frequent type of complications was neurological damage and femoral head a vascular necrosis. At long term follow-up 21percent developed post traumatic arthritis of the hip. The most important bad prognostic factor was inadequate joint reduction.

El presente trabajo retrospectivo tiene como objetivo describir los resultados obtenidos en el tratamiento de las fracturas desplazadas del acetábulo en un período de 20 años. Ciento veintiséis pacientes fueron tratados quirúrgicamente entre 1982 y 2002. El grupo estudiado estaba compuesto por 98 hombres y 28 mujeres con edad promedio de 39 años, con un seguimiento promedio de 6 años. Utilizando la clasificación de Judet y Letournel la serie se dividió en 48 (38 por ciento) fracturas simples y 78 (62 por ciento) complejas. El tratamiento efectuado fue reducción abierta y osteosíntesis con tornillos y placas, a través de diferentes abordajes quirúrgicos. Los resultados clínicos fueron excelentes en 60 pacientes (48 por ciento), buenos en 26 (21 por ciento), regulares en 18 (14 por ciento) y malos en 22 (17 por ciento). Las principales complicaciones observadas fueron lesiones de tipo neurológico y necrosis avascular de la cabeza femoral. El 21por ciento de los pacientes desarrollaron artrosis post traumática en el seguimiento a largo plazo. El factor más importante de mal pronóstico fue la reducción articular insatisfactoria.

Factors Influencing the Result of Transverse Acetabular Fractures / 대한정형외과학회잡지

PURPOSE: To review the results and factors affecting the surgical treatment of transverse acetabular fractures. MATERIALS AND METHODS: Among 15 cases of transverse fractures with an average follow-up period of 43 months (mean age, 46.6 years), there were 8 cases with and 7 cases without posterior wall fractures. Seven cases included those with a comminution of the weight-bearing dome. The post-operative radiographic results were evaluated using Matta's criteria. The final clinical results were evaluated using a modified Merle d'Aubigne scoring system. RESULTS: All the fractures united. The average time for fracture healing was 17.5 weeks. The post-operative radiology results revealed 6 cases with an anatomic reduction, 5 cases with an imperfect reduction, and 4 cases with a poor reduction. The clinical results showed nine cases with satisfactory results but 6 cases with unsatisfactory results. Regarding complications, there were 4 cases with traumatic osteoarthritis and 3 cases with heterotropic ossification. The cases of an anatomic reduction showed a higher rate of satisfactory results. The comminution of the transverse fracture appeared to have an adverse influence on the radiological results after surgery, and also appeared to correlate with the development of traumatic arthritis. CONCLUSION: Transverse acetabular fractures, if not reduced anatomically, may have a tendency toward traumatic osteoarthritis and a poor clinical outcome. Comminution of the dome may produce a poor outcome.

Close-reduction and percutaneous fixation of pelvi-acetabular fractures with fluoro-navigation / 中华创伤骨科杂志

Objective To explore the application of fluoro-navigation in close reduction and fixation of pelvi-acetabular fractures. Methods After imaging reconstruction from plan X-rays and CT tomographs, close reduction and fixation of pelvi-acetabular fractures were conducted under fluoro-navigation based on the indications. If the reduction was found satisfactory, surgical planning was discussed together with the patients. Results No complications occurred among patients with pelvi-acetabular dislocation. Apart from few cases postoperative CT scan showed satisfactory crew fixation. Conclusion The current experiences suggest that the fluoro-navigation is indicated for fixation of pelvi-acetabular fractures with close reduction.