[Anatomic measurements and quantitative analysis of posterior acetabular wall].

OBJECTIVE: To explore morphological character and clinical significance of superior-posterior acetabular wall by anatomically measuring and quantitatively analyzing thickness of posterior acetabular wall, then provide a theoretical reference for clinical treatment of acetabular fracture. METHODS: Fifteen adult formalin-preserved cadaveric pelvises (8 males and 7 females) were used for this investigation. Excess soft tissue was removed and the whole acetabular posterior walls were marked with "angle" sector method and the thickness was measured with caliper in different levels of the different split points. The measurement results were validated and analyzed statistically. RESULTS: At 5 mm away from acetabular rim, the average thickness of superior-posterior acetablar wall fluctuated between (6.47±0.61) mm and (7.43±0.71) mm; the average thickness of inferior-posterior acetabuluar wall fluctuated between (5.62±0.51) mm and (6.33±0.61) mm; the average thickness of acetabular roof fluctuated between (7.71±0.74) mm and (8.27±0.99) mm. There was no statistical difference between average thickness of superior-posterior wall of acetabulum and inferior-posterior wall of acetabulum (P>0.05), but the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.05). At 10 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (8.81±0.67) mm and (13.35±0.89)mm; the average thickness of inferior-posterior acetabular wall fluctuated between (7.02±0.63) mm and (7.66±0.69) mm; the average thickness of acetabular roof fluctuated between (14.46±0.97) mm and (17.05±1.35) mm. Comparatively, the average thickness of superior-posterior acetabular wall was significantly larger than inferior-posterior wall of acetabulum (P<0.05), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.01). At 15 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (12.08±0.78) mm and (19.84±1.03) mm; the average thickness of inferior-posterior acetabular wall fluctuated between (10.17±0.76) mm and (11.12± 0.77) mm; the average thickness of acetabular roof fluctuated between (23.23±1.12) mm and (26.01±1.53) mm. Comparatively, the average thickness of superior-posterior wall of acetabulum was significantly larger than inferior-posterior acetabular wall (P<0.01), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P< 0.01). CONCLUSION: The thickness of entire acetabular posterior edge revealed an increasing tendency from inferior-posterior wall to the superior-posterior wall to acetabular roof. And this trend became more obvious with increasing distance away from acetabular rim. Therefore, the superior-posterior acetabular wall could not only maintain the stability of hip joint but also bear loading.

Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique.

The purpose of this prospective study is to present and evaluate a new technique using suture anchors for the treatment of the avulsion fractures of the tibial eminence. Twenty-three consecutive patients with the displaced avulsion fracture of the tibial attachment of anterior cruciate ligament were treated using mini-open technique with suture anchors between 2005 and 2008. According to the classification of Meyers and McKeever, there were 5 type II, 13 type III, and 5 type IV fractures. The median follow-up period was 18 months (range, 12-32 months). The patient assessment included Lysholm score, Tegner score, IKDC score, and radiographic evaluation. The median Lysholm score improved from 32 (range, 28-48) preoperatively to 98 (range, 85-100) postoperatively. The median preoperative Tegner score was 3 (range, 2-5), and the median postoperative Tegner score was 7 (range, 5-9). The global IKDC objective score was normal (A) in 21 knees and nearly normal (B) in 2 knees. At final follow-up, the Lachman test and anterior drawer test were negative. The results showed that mini-open reduction and fixation of avulsion fracture of the tibial eminence with suture anchors have achieved satisfactory results. We suggest the use of this technique for treating avulsion fractures of the tibial eminence.

Long-term outcomes after deltoid muscular flap transfer for irreparable rotator cuff tears.

We reviewed 20 cases (18 patients) with massive, irreparable rotator cuff tears that were treated with a deltoid flap transfer. The mean follow-up was 13.9 years. The mean absolute Constant score increased from 49.1 points preoperatively to 71.9 points at the last follow-up (P < .001). Pain scores improved from 5.3 to 13.8 points, regardless of the state of the deltoid flap (P < .001), and the scores for activities of daily living increased from 8.6 to 17 points (P < .001). The mean muscular strength improved from 4.4 points preoperatively to 7.6 points at the last follow-up (P = .009), and 16 patients (80%) had a positive test for supraspinatus strength. Deltoid flaps were completely ruptured in 3 cases in the short term and 10 cases at later follow-up; the mean thickness of nonruptured deltoid flaps was 4.2 mm. The mean acromiohumeral distance decreased from 6.95 mm preoperatively to 3.05 mm postoperatively (P < .00001). Osteoarthritis rates increased from stage 0.6 to stage 2.0 by the classification of Samilson and Prieto (P < .0001). This study shows that the results of a deltoid flap transfer over short- or medium-term follow-up were satisfactory for individuals who wished to return to work or for pain relief, with an improvement in the total function of the shoulder. However, the long-term outcomes were poor; deltoid flaps were ruptured in 10 shoulders (50%), and stage 2 or 3 osteoarthritis occurred in 14 shoulders (70%). Therefore, we do not recommend further use of this procedure in the treatment of massive, irreparable rotator cuff tears.