Bilateral Acetabular Fractures Research Articles

Clinical Management, Prognosis, and Outcomes of Bilateral Acetabular Fractures: A Case Report

Background: Bilateral acetabular fractures are a rare type of acetabular fracture, and due to the scarcity of information regarding these types of fractures, managing bilateral acetabular fractures presents significant challenges. We presented a 25-year-old man with bilateral acetabular fractures (left transverse fracture of the acetabulum and right posterior column fracture of the acetabulum) secondary to severe trauma following a road accident with no other pelvic damage. Case Report: Because the displacement was more on the patient's left side (although the patient's pain was more on the right side), the open reduction and internal fixation (ORIF) surgery was first performed on the left side, and secondary ORIF surgery was performed on the right side, under general anesthesia with Kocher-Langenbeck approach for both sides. Conclusion: Due to the increase in road traffic accidents (RTAs) and improper safety of cars, especially in developing countries, this type of fracture may be repeated in the future, and regarding the complexity and comorbidities associated with this type of fracture, the high experience of the surgeon and detailed investigations are required to achieve successful results.

A Bilateral Acetabular Physeal Fracture Treated with External Fixation in an Immature Cat

This study aimed to assess the outcome of a bilateral acetabular physeal fracture treated with external fixation in an immature cat, a surgical technique not usually employed in immature patients. The fixator took 40 days, and it was removed after radiographic bone healing was achieved. No significant complications related to the technique were identified, and the outcome was classified as good based on the functional assessment and pain scales employed. The use of external fixation for stabilising acetabular fractures in immature cats should be considered a viable technical option, especially for minimally invasive stabilisation.

Traumatic bilateral acetabular fracture secondary to high-energy trauma in healthy adults

BackgroundBilateral acetabular fracture is a very rare presentation among the trauma patients, as the pattern and the degree of the forces required to fracture both acetabula is very unique. The primary purpose of this study is to report a series of adult patients presenting with post-traumatic bilateral acetabular fracture without any history of pathological or metabolic bone disease.Patients and methodsIn this retrospective study, 18 cases of traumatic bilateral acetabular fracture were included. There was predominance of both column (four patients on left and six on right) followed by anterior column (two patients left and four on right) and posterior wall (three patients left and right). They were treated surgically through open reduction and internal fixation. All cases were followed up for at least 13 months. Matta’s criteria were used for radiological evaluation on plain radiographs. Functional outcome was evaluated using the Merle d’Aubigne and postel score at final follow-up.ResultsNo patients were lost during the follow-up period; there was one case of surgical site infection. There were three cases of postoperative osteoarthritis, one case of heterotrophic ossification, one case of persistent sciatic nerve palsy and one case of lateral femoral cutaneous nerve palsy. The radiological evaluation according to Matta’s criteria revealed anatomic reduction in 12 patients, imperfect reduction in three patients while other three patients had poor reduction. According to modified Merle d’Aubigne and Postel score, 10 cases were rated as excellent, five cases as good and three cases presented fair (one case) to poor (two cases) results.ConclusionWe report an unusual case series of bilateral acetabular fracture successfully managed surgically with good clinical outcome. With the increasing incidence of route traffic accidents, such cases would probably be recurrent in the upcoming years.

Simultaneous Bilateral Acetabular Fractures: A Case Report

Simultaneous bilateral acetabular fractures are extremely rare. The authors report a rare case of simultaneous bilateral acetabular fracture in an adult due to a road accident. Clinical diagnosis can be misleading in many patients seen in the context of polytrauma. Managing these fractures is a complex task that requires careful planning and surgical intervention, and the foremost goal of surgical intervention is to achieve an anatomically precise reduction of the fracture, as this factor greatly influences the future function of the hip joint.

Fixation of bilateral acetabular fractures using the modified Stoppa approach: Two-year clinical outcomes.

This study aims to evaluate the two-year clinical results of bilateral acetabular fractures operated via a single incision with the modified Stoppa approach. Between January 2013 and January 2020, a total of 22 acetabular fractures of 11 patients (7 males, 4 females; mean age: was 42.9±13.7 years; range, 19 to 62 years) who were operated via the modified Stoppa approach were retrospectively analyzed. The medical records were analyzed in terms of time to surgery, fracture patterns, Injury Severity Score (ISS), operation duration, blood loss, reduction quality, perioperative complications and concomitant injuries. Reduction quality was assessed according to Matta's criteria. The Harris Hip Score (HHS) and modified Merle d'Aubigne score (MDS) were utilized for functional assessment. The mean follow-up was 49±15 (range, 30 to 79) months. The mean ISS was 28.2±7.2. The mean modified MDS was 15.90±1.57. The mean HHS was 84.27±8.85. For both sides, reduction was anatomical-anatomical (63.6%) in seven patients, anatomical-imperfect in three (27.3%) patients, and imperfectpoor in one (9.1%) patient. According to the Kellgren-Lawrence radiological evaluation at 24 months of follow-up bilaterally, Grade 0-1 osteoarthritis was observed in six (54.5%) patients, Grade 1-1 in four (36.4%) patients, and Grade 1-2 osteoarthritis in one (9.1%) patient. The modified Stoppa approach in bilateral acetabular fractures seems to be more preferable than other approaches, as it can be performed with a single incision and provides less bleeding, shorter operation duration, and satisfactory results.

Non-traumatic bilateral comminated acetabular fracture

High-energy trauma has been confirmed as a cause of bilateral acetabular fracture. However, there are few reports on nontraumatic bilateral acetabular fracture. We report a case of bilateral acetabular fracture that occurred acutely with no preceding trauma in a 50-year-old man with osteoporosis. The case shows the significance of regular annual calcium and vitamin D screening of patients at a high risk of pathological fracture.

890 Bilateral Acetabular Fractures Induced by An Epilepticseizure In a Paediatric Patient: A Unique Case Andits Management

Abstract Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

FIXATION OF ACETABULAR (ANTERIOR RIM, QUADRILATERAL PLATE) FRACTURES WITH MODIFIED STOPAA APPROACH “OPTIMUM APPROACH”

Introduction: Pelvis is important bony structure of body that provide main weight bearing surface for the hip joint in form of acetabulum, with the advancement of the high speed transportations, pelvic trauma has been raised in numbers so as acetabular fractures. Stable acetabular fractures fixation with accurate anatomic reduction always has been a big challenge for orthopaedic surgeons. Acetabular fractures fixation has risen step ahead after evolution of modified stoppa approach, as this approach allow minimum soft tissue handling, easy accessibility and provide adequate exposure to intrapelvic structures. Recently modified stoppa approach has evolved as primary approach for acetabular fractures fixation. AIM: To perform acetabulum fracture fixation through an optimum surgical exposure “modified stoppa approach” Materials And Method: this study conducted on 20 patients who presented with acetabular fractures after an RTA or fall from height or due to other various cause. Fracture fixation done through modified stoppa approach for those who met in our inclusion criteria ,to provide pelvic and hip joint stability. Patients demographics, location, duration from injury to surgical interventions, duration of hospital stay, if any complication occurred during surgery were recorded. Result: Out of total 20 patients 17 were male and 3 patients were female, average age 39year[Range from 18 to 60 yr], 12 patients having isolated unilateral acetabulum fracture present, 2 having bilateral acetabular fracture and 4 having associated pelvic bone fracture along with unilateral acetabulum fracture, 2 patients having long bone of lower limb fracture along with acetabular injury. All the fixation done through modified stoppa approach. Intraoperatively in all the patients easy accessibility and wide exposure obtain for intrapelvic structures. All the neurovascular structures easily identified and protected over the surgical site. Intraoperatively no clinical and radiological complication were observed in all patients. Post operatively all the patients were able to bear weight, within the 12±4 week,. Conclusion: We got a conclusion that the modified stoppa approach is anterior intrapelvic approach which provides an excellent view to the acetabular[anterior column, quadrilateral plate, posterior hemitransverse] and other intrapelvic structures, with minimal soft tissue handling, easy accessibility to preserve neurovascular structures. This approach provides direct access to the pubis, the posterior surface of the ramus, the quadrilateral surface, the pubic eminence, and the infrapectineal surface, as well as the sciatic buttress, sciatic notch, and the anterior sacroiliac joint. It can be used in most of the acetabular fractures fixation, the only downside is being the steep learning curve and familiarity of the structures while addressing these fractures. Keywords: Acetabulum, Acetabular fracture, Modified stoppa approach, quadrilateral plate.

Bilateral acetabular fractures: Mechanism, fracture patterns and associated injuries

IntroductionAcetabular fractures are uncommon and their management is often reserved for specialist pelvic and acetabular surgeons. Bilateral acetabular fractures are a particularly rare subgroup. We report the incidence, fracture pattern, mechanism of injury and outcome of patients presenting to a tertiary trauma centre with traumatic bilateral acetabular fractures. MethodBilateral acetabular fractures were identified from a prospective database of acetabular fractures presenting to one institution over a six-year period. Patient notes and imaging studies were reviewed to identify demographics, mechanism of injury, Injury Severity Score, fracture pattern and management. Timing of operative management was explored. Patient outcomes were collected in the form of radiographs and Oxford Hip Scores at a minimum of one-year post injury. ResultsEight patients with bilateral acetabular fracture were identified from a database which contained records of 519 patients with acetabular fractures (incidence of 1.5% amongst patients with acetabular fractures). Motor vehicle accidents were the most common mechanism. Four acetabular fracture patterns were observed within the cohort. Radiographic union occurred in all cases and Oxford Hip Scores are suggestive of moderate to well functioning hip joints. Fractures were treated as single or staged procedures. ConclusionBilateral acetabular fractures are very rare due to the unique degree and pattern of force required to fracture both acetabula. They are associated with 4 main fracture patterns and present with Injury Severity Scores that averaged 25 (severe). They are typically observed in young males with road traffic collision being the most common mechanism of injury.

Acute atraumatic bilateral acetabular insufficiency fractures

Bilateral acetabular fractures have been documented in the setting of high-energy trauma, but few reports regarding atraumatic bilateral acetabular fractures exist. The following is a case report of bilateral insufficiency acetabular fractures which occurred acutely in the absence of trauma in a 49-year-old female. The case highlights the importance of perioperative awareness of those patients at significant risk of insufficiency fractures and offers a relatively elegant, less invasive solution for early mobilization in the context of acetabula insufficiency fractures.

Effects of different anesthesia techniques on intraoperative blood loss in acetabular fractures undergoing the Modified Stoppa approach.

This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

Complication of a bilateral acetabular fracture after multiple surgeries and 30 years of evolution. Presentation of a case

Bilateral acetabular fracture, open reduction and internal fixation, without achieving anatomical reduction; it required placement of short-term total prostheses, both cemented. We made a revision of both left hip components in the eighth year because of loosening of the cup and stem, with uncemented components. The femur evolved satisfactorily, but the acetabulum required six subsequent revisions, with bone grafts and placement of metal reinforcements, initially very stable, but with screw rupture and lack of osseointegration of both implants and grafts at 12 and 18 months in the different surgical events. She developed pseudoaneurysm of the left external iliac artery, treated by a vascular surgeon; it got complicated with local infection first and later, deep infection of the left hip by Staphylococcus aureus. The implants were removed from the iliac and polymethylmethacrylate with antibiotics was used to fi ll the large bone defect while the infection was being controlled, ending with a saddle rescue prosthesis (Link, Hamburg). It currently has a good function, without pain, but with limited mobility, especially fl exion. The right hip has only been checked once; the acetabular cup began to migrate cephalically and vertically, but without losing stability, shortly after the loosening of the left one; it never developed femoral stem involvement, allowing acceptable function and being «her good leg» during the time of the left hip dysfunction. It was reviewed by placing a structural bone graft with two femoral heads from a corpse and cementing a new cup. The patient’s recovery has been very good, returning to an active life in which she is self-suffi cient in all her daily activities; uses a crutch with her right hand, drives a van, is pain-free.

Postmortem radiological case series of acetabular fractures after fatal aviation accidents

The purpose of this study was to describe radiological fracture patterns of the acetabulum sustained after fatal small aircraft aviation accidents, aiming at facilitating a better understanding of trauma mechanisms in a forensic setting. Postmortem conventional radiographs or CT scans of 29 victims of 20 small aircraft aviation accidents were analyzed for skeletal acetabular trauma. Among the 29 fatalities (27 males and 2 females, median age 55 years (range: 21–76 years)), 20 victims had pelvic fractures (69%), of which 19 victims (66%) had one or more acetabular fractures. Bilateral acetabular fractures occurred in 11 victims. When considering left and right acetabula in each victim as separate entities, 38 of the 58 acetabula included in this case series exhibited one or more fractures. Both the anterior and posterior acetabular columns were fractured in 28 acetabula. Acetabular fractures were frequently encountered in this series of 29 victims of small fatal aircraft accidents. Fractures of the acetabulum occur from ventrally directed impact (i.e. to the knee) or laterally directed impact (i.e. to the greater trochanter of the femur). Radiological descriptions of the fracture patterns can therefore aid in the forensic analysis of the mechanism of trauma in aviation accidents. Postmortem multi-slice CT scan images are preferrable in the assessment of acetabular fractures.

Abdominal Pain Caused by Bilateral Acetabular Fractures Secondary to an Epileptic Seizure Case Report and Review of the Literature

Background: Epileptic patients have increased risk of fractures. This is related to the traumatic event itself and to concomitant factors. Clear fracture related complaints are not always present at primary survey of these patients. This indicates a thorough primary evaluation of the complete individual post-seizure. We present a unique case of abdominal pain due to bilateral acetabular fracture after an epileptic seizure. Case Report: A 66-year old patient, who chose to live solitary and was in suboptimal hygienic condition, was admitted to the neurological department after two epileptic seizures. Three days after admission, an abdominal radiograph revealed bilateral acetabular and pubic fractures as chance findings. Treatment was challenging due to patient and fracture specific conditions. Conservative treatment options were limited and eventually failed. Eventually, bilateral total hip prosthesis with bone impaction grafting were performed. At one-year follow up, no restriction in active daily living was noted. Conclusion: Seizure induced bilaterally acetabular fractures are very rare. Thorough physical examination after an epileptic seizure is imperative to identify fractures. Abdominal pain can be the only symptom of a fractured acetabulum. Treatment options are dependent of patient’s morbidity, bone quality and surgeon’s preference. Primary total hip arthroplasty might be indicated and can offer good results even in case of bilateral acetabular fractures.

High-risk mechanism of injury: A new indication for screening for blunt cerebrovascular injury?

Blunt cerebrovascular injury is a rare but catastrophic injury. Screening for blunt cerebrovascular injury after high-impact mechanism remains ill-defined but several associated lesions have been identified as high risk for concomitant blunt cerebrovascular injury and are used to prompt further investigation for early identification and intervention. We describe a case of a large cerebral infarction caused by a high cervical internal carotid dissection after a motorcycle collision. Upon presentation, the patient had a Glasgow coma scale of 14 and an open pelvic fracture, which was immediately addressed in the operating room. His subsequent imaging revealed a nasal fracture, bilateral rib fractures, bilateral pubic rami fractures and left acetabular fracture without evidence of traumatic brain injury, cervical spine injury or extensive facial fractures. After 48 h, he displayed a depressed sensorium and an abnormal pupillary exam. He was diagnosed by computed tomography angiogram with a carotid dissection resulting in a large infarct of the right hemisphere with herniation requiring emergent craniectomy. This case suggests screening for blunt cerebrovascular injury beyond the current recommendations especially in patients with high-impact mechanism.

Bilateral acetabular fracture. Two case reports with literature review

Bilateral acetabular fractures represent a challenge, even for experienced Orthopedic surgeons .We present two patients who had an isolated acetabular bilateral fracture, following a violent trauma caused by a traffic accident, which were treated in our department .The treatment strategy is planned by a team of surgeons. After a proper preoperative preparation and using a surgical treatment by postero-lateral Moore and Kocher-Langenbeck approach with internal fixation. Our clinical and radiological results were very satisfying.

Unusual bilateral rim fracture in femoroacetabular impingement.

This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI), which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson.

Percutaneous fixation of bilateral anterior column acetabular fractures: A case report

We report a rare case of a multiple fractures with bilateral anterior column acetabular fractures treated with percutaneous screw fixation for both acetabular fractures under fluoroscopy guidance. It is a demanding procedure due to the complex anatomy of the pelvis and the varying narrow safe bony corridors. But it is a safe option in patients with multiple medical co-morbidities (which may be hazardous to long surgical procedures and extensile surgery) and in minimally displaced fractures.

The importance of imaging for status epilepticus patients to rule out fractures – A case report

Status epilepticus could be the first presentation of underlying epilepsy or may occur in patients with known epilepsy. The literature has reported many cases of seizures severe enough to cause dislocations or fracture-dislocations of the shoulder or hip joints and death from hemorrhaging. Although shoulder and hip injuries due to seizures are rare, such events are known to occur, especially in patients with a history of osteoporosis or other risk factors for fractures. We describe a case of a 35-year-old healthy male with no history of osteoporosis or reduced bone density. His first presentation of epilepsy manifested with status epilepticus. This prolonged seizure resulted in bilateral acetabular fracture with left proximal humerus fracture without any trauma or falls. Although fractures associated with seizures have been reported in the literature, dislocation and fractures from seizures involving both the hip and the shoulder joints have only been described in a few cases. Two of these cases involved patients with known epilepsy, osteoporosis and osteomalacia. To the best of our knowledge, this is the first described case of a patient with bilateral hip and one shoulder fracture that had no previous history of epilepsy or seizures, except for febrile seizure as a child, which did not requiring any treatment. He was also not taking any antiepileptic medications, which are known to reduce bone density. This case shows the severity of status epilepticus and the importance of screening for fractures in patients, especially in those with risk factors for reduced bone density. يمكن أن تكون الحالة الصرعية هي الظهور الأول لمرض الصرع وقد تحدث عند مرضى الصرع المعروفين. وفي الأدبيات البحثية المنشورة هناك تقارير عدة عن حالات كانت فيها النوبة شديدة بدرجة أدت إلى خلع أو كسر في الكتف أو الورك, كما قد تسبب الوفاة نتيجة النزف. ومع أن إصابة الكتف والورك نتيجة النوبة نادرة ولكنها ممكنة, خاصة عند المرضى الذين لديهم تاريخ مرضي لهشاشة العظام أو عوامل خطر أخرى لحدوث الكسور. نعرض هنا حالة مريض عمره 35 عاما صحيح البنية, وليس لديه تاريخ مرضي لهشاشة العظام أو انخفاض في كثافة العظام. وكان الظهور الأول للصرع لديه هو الحالة الصرعية التي كانت عبارة عن نوبة طويلة أدت إلى كسر في الحق على الجهتين مع كسر في أدنى العضد الأيسر. مع أن هناك تقارير كتبت عن حالات كسور وخلوع في الأوراك والأكتاف مصاحبة لنوبات حدثت, ولكنها حدثت في حالات قليلة فقط. حالتان منها كانت لمرضى يعانون من صرع وهشاشة ولين العظام. وحسب معرفتنا فإن هذه الحالة هي الأولى في الأدبيات المنشورة التي حدث لها كسور في الوركين والكتف وليس لديها تاريخ مرضي لصرع أو نوبات. باستثناء نوبة حموية قبل سن الخامسة لم تستدع العلاج, ولم يستعمل أي علاج آخر للصرع يمكن أن يسبب انخفاض في كثافة العظام. توضح هذه الحالة شدة الحالة الصرعية وأهمية المسح الكامل للكسور في المرضى المصابين, خاصة من لديهم عوامل خطر أخرى لحدوث انخفاض في كثافة العظام.

Bilateral Acetabular Fractures in an Adolescent After Low-Energy Trauma

Pediatric pelvic fractures are rare, accounting for approximately 2.4% to 5.5% of annual admissions at large level I trauma centers. An acetabular fracture is involved in only about 1% to 15% of these cases and is almost exclusively caused by a high-energy trauma. This is a report of an otherwise healthy 15-year-old male adolescent who sustained a nondisplaced bilateral anterior column and wall acetabular fracture after a low-energy mechanism during a hockey game. The patient was managed nonoperatively with non-weight-bearing restrictions and had complete resolution of his symptoms by 10 weeks. This case shows that a low-energy mechanism can create significant bilateral acetabular fractures in the immature skeleton. The presented case may represent an underdiagnosed cause of hip and groin pain in the adolescent patient/athlete when initial radiographs appear normal.