Column Acetabular Fractures Research Articles

Lag screw fixation of posterior wall through single ilioinguinal approach for both column fractures

Objective To evaluate the clinical outcomes in patients with both column acetabular fractures involvement posterior wall using lag screw through single ilioinguinal approach. Methods Between August 2008 to August 2014, 35 consecutive patients with both columns acetabular fractures and fracture also involved posterior wall and fixed by lag screws were retrospectively analyzed. There were 25 males and 10 females. The average age was 44.4±12.5 years (range, 18-72 years). According to Letournel classifications, the acetabular fracture involved both columns and posterior wall in all cases, and 2 cases with additional seagull sign. The surgeon reduced posterior wall by pressing the fragment through a small tunnel in the soft tissue leaning against the external cortex of iliac bone and fixed the fragment using lag screws from the anterior side. Clinical and functional outcomes were assessed using the modified Merle d’Aubigne scoring system. Radiographic results were evaluated based on Matta scoring system. Results The patients were follow for an average of 44.7±18.9 months (range, 24-96 months). The average operative time was 257.7±60.4 min (range, 160-490 min). The average blood loss during the operating was 742.9±614.5 ml (range, 300-4 000 ml). Loss of reduction of the posterior wall was not found in any case. At the latest follow-up, radiographic results were excellent in 11, good in 19, and poor in 5. The average modified Merle d’Aubigne score was 16.4 (range, 13-18). There were 8 cases of excellent, 23 cases of good, and 4 cases of fair. Four patients developed deep venous thrombosis of the lower extremities after 3-4 days of operation. Warfarin was used for anticoagulation therapy and thrombi disappeared 6 months postoperatively. One case had superficial wound infection and was treat with vacuum sealed drainage (VSD) and anti-infection therapy. The incision healed without infection after one month. One case with poor quality of reduction and remaining seagull sign was treated with total hip arthroplasty after 35 months because of severe traumatic arthritis. The total reoperation rate was 5.7% (2/35). Iatrogenic sciatic nerve injury as well as heterotopic ossification was not found in any case. Conclusion Satisfactory quality of reduction and good clinical outcomes can be achieved in patients with acetabular fractures involved both columns and posterior wall by single ilioinguinal approach and lag screw fixation for posterior wall. Iatrogenic sciatic nerve injury as well as heterotopic ossification was not found in any case. Key words: Acetabulum; Fractures, bone; Fracture fixation; Internal fixators

Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement

PurposeTo evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only. MethodsWe conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D’Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification). ResultsThe study showed no significant differences in all preoperative variables (P>0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P>0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8±2.5mm (range: 24–35mm), 71.5±5.4% (range: 65–88%), 23.0±2.3mm (range: 17–28mm). The mean posterior wall fracture displacement is 5.0±3.2mm (range: 0–11mm). There was no difference regarding the quality of reduction between the two groups (P>0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P>0.05). There was no difference in rate of complications between the two groups (P>0.05). ConclusionsLag screws fixation of posterior wall through single ilioinguinal approach in associated both column fractures of acetabulum is a safe and effective method. Our results shown that the presence of posterior wall fracture in cases of associated both column fractures does not compromise the clinical outcomes.

Safety of screw placement on the medial iliosciatic plate for acetabular posterior column: a comparison between males and females by 3D reconstruction technique

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique. Methods Normal pelvic CT scans of 52 adults (27 males and 25 females; aged from 18 to 74 years, averaging 47.2 years) were obtained to create pelvic 3D models. After the acetabulum was thickened by 5 mm, the width (d) of the safe zone for placement of the medial iliosciatic plate was measured. After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured, the ratio (r) of d/w was calculated. The recombined innominatum model was cut through the center of the ac-etabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch. The cross-section was marked as M. In males, 4 points at distances of 1.0 cm, 1.5 cm, 2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked. At the 4 points, the angulations (∠a, ∠b, ∠c and ∠d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M. In females, 3 points at distances of 1.0 cm, 1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a, ∠b, and ∠c were measured. The differences in the above parameters were compared between males and females. Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56±2.44 mm in males and 24.36±2.47 mm in females; the ratio (r) was 0.61±0.07 in males and 0.54±0.05 in females. The safe angulations for screw placement in males, ∠a, ∠b, ∠c and ∠d, were 88.04°±3.18°, 77.81°±3.85°, 68.01°±4.11° and 56.81°±4.81° while those in females, ∠a, ∠b and ∠c, were 91.29°±4.52°, 76.23°±3.82° and 62.79°±3.51°, respectively. There were statistically significant differences between males and females in values of d, r, ∠a and ∠c (P< 0.05). Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate, the differences between males and females should be taken into account. Besides, specific safe angles should be chosen according to the position of the plate. Key words: Acetabulum; Bone plates; Bone nails; Imaging, three-dimensional

Surgical Outcome of Posterior Column Acetabular Fractures Treated By Modified Kocher Lagenbeck Approach

Surgical Outcome of Posterior Column Acetabular Fractures Treated By Modified Kocher Lagenbeck Approach

Comparative study on digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures. Methods A retrospectivecase-control analysis was made on 19 cases undergone percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation from January 2015 to 2016 March. There were 12 males and 7 females, aged from 21 to 66 years (mean, 39.3 years). AO fracture classification was A3 type in 17 cases and B1 type in 2. Based on the application of three-dimensional digital programming, the cases were assigned to two groups: group A (n=9), virtual three-dimensional model was reconstructed and the virtual screw were inserted to uninjured side by software Mimics and group B (n=10), patients were only prepared for routine preoperative preparation. Time of anterior column screw insertion, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction and Majeed score were compared between the two groups. Results All cases were followed up for mean 8.4 months (range, 3-12 months). There were no significant differences between groups A and group B in intraoperative bleeding [(14.1±3.0)ml, (15.1±2.2)ml], good to excellent rate of reduction (89%, 80%), good to excellent rate of Majeed score (89%, 80%)(P>0.05). Time of anterior column screw insertion [(22.4±3.4)min] and intraoperative fluoroscopy frequency [(24.9±3.8)times] in group A were significantly less than those[(29.4±4.5)min, (30.5±5.8)times] in group B (P<0.05). Conclusion Digital orthopedic three-dimensional visualization technology is associated with shortened time of anterior column screw insertion and reduced intraoperative fluoroscopy frequency, indicating an effective adjuvant technique for percutaneous screw fixation of acetabulum anterior column under navigation. Key words: Acetabulum; Imaging, three-dimensional; Surgery, computer-assisted

Combined approach to treatment of Tile type B and C old pelvis fracture

Objective To investigate the operative methods in treatment of Tile type B and C old pelvis fracture. Methods The study enrolled 19 cases (13 males and 6 females) with a mean age of 53.4 years (range, 25-66 years) treated from July 2009 to July 2014. Injury resulted from traffic accidents in 14 cases, high falls in 3 cases and hit by heavy objects in 2 cases. Time from injury to operation was 1.5-10.3 months. According to the Tile classification, the type of fracture was 5 B2, 5 B3, 3 C1, 4 C2 and 2 C3. Four cases of type B and two cases of type C were combined with acetabulum fracture. Type B fracture deformity was operated through the anterior letournel approach, during which the malunion had osteotomy and reconstruction plate fixation. When posterior wall or column acetabular fracture existed, additional posterior Kocher-Langenbeck incision was used to achieve fracture reduction and stabilization through bilateral fenestration in the floating position. Type C fracture undergone osteotomy through anterior letournel approach and posterior sacral osteotomy or ilio-lumbar fixation following sacroiliac osteotomy. With regard to the combined posterior wall or column acetabular fracture in type C fracture, the surgical method was the same as type B. Radiological and functional results were respectively evaluated using the Mears-Velyvis system and Majeed criteria. Results Mean duration of follow-up was 11.4 months (range, 3-24 months). All fracture united in the one-stage, with mean union time of 5.2 months (range, 3-7 months). According to the Mears and Velyvis system, 10 cases obtained anatomical reduction, 6 were satisfied, and 3 were unsatisfied. According to the Majeed criteria, the results were excellent in 6 cases, good in 10 and fair in 3. After operation, 2 cases sustained poor control of urination caused by sacral nerve injury; 1 case still had hip pain caused by old acetabular fracture, but the symptom could be controlled by non-steroidal anti-inflammatory drugs; 2 cases had sacroiliac joint pain. There was no fixation failure. Conclusion Through the combined approach, osteotomy and fixation of malunion in anterior and posterior rings of pelvis that restores the pelvic ring is an effective method to improve the quality of fracture reduction and rectify limb shortening. Key words: Pelvis; Acetabulum; Fracture fixation, internal; Lumbosacral fixation

Minimally invasive plate osteosynthesis of acetabular anterior column fractures using the two-incision minimally invasive approach and a preshaped three dimension plate.

To investigate the treatment of acetabular anterior column fractures using a two-incision minimally invasive (TIMI) approach and minimally invasive plate osteosynthesis (MIPO) technique using a preshaped 3D plate. A group of 12 consecutive cases of acetabular fractures from March 2013 to July 2014 were treated with the TIMI approach. 3D mirror models of the uninjured side of the hemipelvis were printed preoperatively; the plates used in surgery were preshaped according to these models. MIPO surgical techniques were applied. All patients had a minimum one year radiographic and clinical follow-up. Seven fractures involved the anterior column, four were anterior column with posterior hemitransverse, and one was anterior column with the pubic symphysis. The average surgery time was 200minutes, and mean blood loss was 1004ml. The fracture reduction results as assessed by Matta radiographic outcome scores were good in eight, satisfactory in three, and poor in one patient. Functional outcomes according to the Harris hip scores were excellent for seven, good for three, and fair for two. Post-operative complications included incomplete femoral nerve damage and abdominal cavity injury. The TIMI approach is an alternative to the ilioinguinal approach for anterior column acetabular fracture treatment, especially for fractures involving the dome and quadrilateral plate that are feasible for application of MIPO techniques. The technique of preshaping the 3D plate makes the plate better accommodated to the fracture surface and easier to apply in MIPO procedures. All dissection was between the anatomical interval, which allowed less soft tissue injury and related complications, and caused less bleeding. The fracture types in our case series were relatively simple, and follow-up time was short; more clinical trials are necessary for evaluation of middle- and late-term results.

An Effective and Feasible Method, "Hammering Technique," for Percutaneous Fixation of Anterior Column Acetabular Fracture.

Objective. The objective of this study was to evaluate the effectiveness and advantages of percutaneous fixation of anterior column acetabular fracture with “hammering technique.” Materials and Methods. We retrospectively reviewed 16 patients with percutaneous fixation of anterior column acetabular fracture with “hammering technique.” There were 11 males and 5 females with an average age of 38.88 years (range: 24–54 years) in our study. Our study included 7 nondisplaced fractures, 6 mild displaced fractures (<2 mm), and 5 displaced fractures (>2 mm). The mean time from injury to surgery was 4.5 days (range: 2–7 days). Results. The average of operation time was 27.56 minutes (range: 15–45 minutes), and the mean blood loss was 55.28 mL (range: 15–100 mL). The mean fluoroscopic time was 54.78 seconds (range: 40–77 seconds). The first pass of the guide wire was acceptable without cortical perforation or intra-articular perforation in 88.89% (16/18) of the procedures, and the second attempt was in 11.11% (2/18). Conclusion. Our study suggested that percutaneous fixation of anterior column acetabular fracture with “hammering technique” acquired satisfying surgical and clinical outcomes. It may be an alternative satisfying treatment for percutaneous fixation of anterior column acetabular fracture by 2D fluoroscopy using a C-arm with less fluoroscopic time.

Two-Incision Minimally Invasive Approach for the Treatment of Anterior Column Acetabular Fractures.

We describe an alternative to the Letournel ilioinguinal approach for anterior column acetabular fractures that is performed with a unique retraction device that decreases the rate of soft-tissue complications. Identify the sites for both incisions with the help of an image intensifier. Make the first incision to expose the central area of the fracture. Make the second incision to expose the area for the distal plate fixation. For better visualization, use a soft-tissue retraction system. Clean and reduce the fracture through the first incision. Perform temporary and definitive fixation according to the standards for anterior acetabular fracture fixation. After radiographic documentation in three views, close the wound. We reported the results of a case-control study of the first twenty-six patients operated on with the two-incision minimally invasive technique.IndicationsContraindicationsPitfalls & Challenges.

Surgical hip dislocation is a reliable approach for treatment of femoral head fractures.

Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26-122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach. The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. Using this technique we are able to reduce all displaced femoral head fractures under direct view. Definitive fixation is performed through this approach with 2.7-mm nonabsorbable screws. The same technique may be used also for Pipkin IV fractures to fix transverse, T-type, posterior wall, or posterior column acetabular fracture. Between 2004 and 2011, we used this approach to manage all displaced femoral head fractures in patients younger than 55 years old. A total of 17 patients were thus treated; of those three were lost to followup before 2 years, and one was excluded from study because of severe preoperative neurological impairment, leaving 13 for analysis here. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs. Outcomes were evaluated with the modified Harris hip score. Minimum followup was 24 months (mean, 77 months; SD, 32.8 months). Fracture reduction was anatomic in eight hips and imperfect in five. Mean clinical score was 82 points (SD, 7.7). One patient developed symptomatic femoral head AVN and underwent total hip arthroplasty 4 years after the index procedure; no other patient underwent arthroplasty. Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic. Our experience with surgical dislocation shows clinical results comparable to previously reported outcomes in femoral head fractures treated with common approaches; we also present a similar rate of AVN and a lower rate of posttraumatic arthritis, but a higher risk of heterotopic ossification. Further case-control studies are necessary to confirm these statements. Level IV, therapeutic study.

Percutaneous fixation of anterior and posterior column acetabular fractures.

Although open reduction and internal fixation (ORIF) has been the standard of care for acetabular fractures, recent advancements in minimally invasive techniques have allowed percutaneous fixation to gain popularity. Percutaneous technique has been described in the literature as an adjuvant to ORIF. However, isolated percutaneous fixation has the advantage of limiting soft tissue disruption, length of surgery, and blood loss when compared with ORIF. The technique also allows for earlier return to activity and better pain control when compared with nonsurgical management. This article reviews both indications and limitations, while highlighting the technique for percutaneous fixation of both anterior and posterior column acetabular fractures.

Percutaneous Retrograde Posterior Column Acetabular Fixation

The purpose of this cadaveric study was to determine the proximity of the neurologic structures to the path of the screw inserted percutaneously into the ischial tuberosity. Cadaver study. Ten screws were inserted in 10 limbs (5 cadavers) under fluoroscopic guidance. Dissection was then performed to expose the head of the screw and was extended laterally to expose the sciatic nerve, the posterior cutaneous nerve of the thigh, and its inferior cluneal branches. The distance from the screw head to the sciatic nerve, posterior cutaneous nerve of the thigh, and the inferior cluneal nerves. The distance from the center of the screw head to the sciatic nerve averaged 58 mm (range, 40-70 mm). The average distance between the screw head and the posterior cutaneous nerve of the thigh was 42 mm (range, 30-60 mm). The inferior cluneal branches were the closest to the path of the screw with an average distance of 3.5 mm in 6 specimens (range, 1-6 mm) and were injured by the screw in 3 and could not be located in another specimen. The sciatic nerve and the posterior cutaneous nerve of the thigh appear to be safe during retrograde percutaneous screw fixation of a posterior column acetabular fracture through a central entry point in the ischial tuberosity. However, the inferior cluneal nerves that are responsible for the cutaneous sensitivity of the lower half of the gluteal region are at risk of injury.

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.

Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study

Background and PurposeAcetabular fractures are often combined with associated injuries to the hip joint. Some of these associated injuries seem to be responsible for poor long-term results and these injuries seem to affect the outcome independent of the quality of the acetabular reduction. The aim of our study was to analyze the outcome of both column acetabular fractures and the influence of osseous cofactors such as initial fracture displacement, hip dislocation, femoral head lesions and injuries of the acetabular joint surface.MethodsA retrospective cohort study in patients with both column acetabular fractures treated over a 30 year period was performed. Patients with a follow-up of more than two years were invited for a clinical and radiological examination. Displacement was analyzed on initial and postoperative radiographs. Contusion and impaction of the femoral head was grouped. Injuries of the acetabular joint surface consisting of impaction, contusion and comminution were recorded. The Merle d’Aubigné Score was documented and radiographs were analysed for arthritis (Helfet classification), femoral head avascular necrosis (Ficat/Arlet classification) and heterotopic ossifications (Brooker classification).Results115 patients were included in the follow up examination. Anatomic reduction (malreduction ≤ 1mm) was associated with a significantly better clinical outcome than nonanatomical reduction (p = 0.001). Initial displacement of more than 10mm (p = 0.031) and initial intraarticular fragments (p = 0.041) were associated with worse outcome. Other associated injuries, such as the presence of a femoral head dislocation, femoral head injuries and injuries to the acetabular joint surface showed no significant difference in outcome individually, but in fractures with more than two associated local injuries the risk for joint degeneration was significant higher (p < 0.001) than in cases with less than two of them.In the subgroup of anatomically reconstructed fractures no significant influence of the analyzed cofactors could be observed.ConclusionAnatomical reduction appears to be an important parameter for a good clinical outcome in patients with both column acetabular fractures. Additional fracture characteristics such as the initial displacement and intraarticular fragments seem to influence the results. Patients should also be advised that both column acetabular fractures with more than two additional associated factors have a significantly higher risk of joint degeneration.

Percutaneous fixation of anterior column acetabular fracture in a renal transplant recipient.

Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

Transgluteal Posterior Column Screw Stabilization for Fractures of the Acetabulum

The traditional exposure of high posterior column or transverse acetabular fractures can pose a challenge for lag screw stabilization. The authors describe an adjunctive percutaneous transgluteal lag screw technique for the internal fixation of the high posterior column. In the senior author's experience, this technique has been helpful to achieve the optimal trajectory for a stable perpendicular lag screw to maintain an anatomical reduction. In our experience, this technique has been used in conjunction with the standard Kocher-Langenbeck exposure and posterior column plating techniques.

Reduction and fixation techniques in the treatment of both column fractures of acetabulum

Reduction and fixation techniques in the treatment of both column fractures of acetabulum

Acute total hip replacement combined with open reduction internal fixation (ORIF) for the management of acetabular fracture in the elderly

The elderly patient with an acetabular fracture presents a unique surgical challenge because of medical comorbidities, decreased physiological reserve, reduced healing capacity, osteopenic bone, and atypical fracture patterns. Goals include rapid mobilization, early weight bearing, and a pain-free functional hip. Treatment options include initial nonoperative management with delayed total hip arthroplasty (THA), open reduction and internal fixation (ORIF), minimally invasive osteosynthesis, and acute total hip replacement combined with ORIF. Advantages of acute THA combined with ORIF in the elderly patient include the potential for 1-stage treatment with faster recovery and the avoidance of problems that can occur with delayed arthroplasty. Disadvantages include major technical challenges of simultaneously obtaining both implant and fracture stability. This review discusses the indications, contraindications, technique, and results of acute THA combined with ORIF for the management of acetabular fractures in the elderly. The technique for combined surgical treatment of an associated posterior wall/posterior column acetabular fracture with an ipsilateral femoral neck fracture is described.

The characteristic and treatment of high anterior column fracture of acetabulum with intact true pelvic brim

Objective To investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim.Methods From January 2006 to January 2010,12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified.There were 9 males and 3 females,with the average of 35.6 years (range,29-46).The injury was caused by crush in 7 cases,smash of heavy object in 3 cases,and fall-down from height in 2 cases.These fractures were classified into three types:isolated high anterior column fracture of acetabulum without involvement of true pelvic brim,high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture.Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approaches.One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach.Results The mean follow-up time of all patients was 26.7 months (range,14-37months).The quality of reduction was grade as anatomical in 8 patients,imperfect in 3,poor in 1 by Matta's score system.The fracture union was uneventful.There was nonunion and loss of internal fixation.At the final follow-up,the mean score was 16.8 (range,11-18),7 cases were graded as excellent,4 good,1 fair,according to modified Merle d'Aubigne and Postel score system.Heterotopic ossification and traumatic osteoarthritis were recorded in 1 patient.Conclusion Good clinical results can be achieved by anatomical reduction and rigid fixation through optimal approach. Key words: Acetabulum; Fractures, bone; Surgical procedures, operative

Single-Stage Total Hip Arthroplasty and Fracture Fixation for a Both Column Acetabular Fracture in Type I Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is an inherited disease characterised by abnormal collagen formation leading to increased risk of fracture.1 Depending on the sub-type, modes of inheritance largely occur via an autosomal dominant fashion and clinical manifestations vary from very mild disease to lethal forms, which can involve intrauterine death.1,2 In addition to concerns regarding suitable bone stock, increased risk of intraoperative fracture, and soft tissue considerations, the operative surgeon should also be aware of hemorrhagic diathesis found in OI patients.