Acetabular Fractures Research Articles

A Case of Successful Perioperative Rehabilitation in Two-Stage Revision Total Hip Arthroplasty for an Intraoperative Acetabular Fracture: Insights Into Interim-Period Rehabilitation Strategies

A Case of Successful Perioperative Rehabilitation in Two-Stage Revision Total Hip Arthroplasty for an Intraoperative Acetabular Fracture: Insights Into Interim-Period Rehabilitation Strategies

3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures.

The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up. A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm2) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis. Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm2 (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm2 differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm2 (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up. For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.

The Use of External Beam Radiation Therapy for Heterotopic Ossification Prophylaxis After Surgical Fixation of Acetabular Fractures: A Randomized Controlled Trial.

To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery. Randomized controlled trial. Two level I academic trauma centers. Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach. Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker classes III-IV). The secondary outcome was any HO (Brooker classes I-IV). The incidence of radiographic HO was compared between patients who did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis. Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio 0.24, 95% confidence interval, 0.05 to 0.94; P = 0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (odds ratio 0.39; 95% confidence interval, 0.13 to 1.05; P = 0.07). The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared with patients who did not receive XRT. These results can help guide shared decision making between surgeons and patients regarding the use of XRT for HO prophylaxis. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Intraoperative Complications in Acetabular Fracture Management Using the Stoppa Approach: A Retrospective Cohort Study

Intraoperative Complications in Acetabular Fracture Management Using the Stoppa Approach: A Retrospective Cohort Study

Clinico-demographical Profile of Pelvis and Acetabular Fracture Presenting in Tertiary Care Center of Nepal: An Observational Study

Introduction: Pelvis and acetabular fractures are complex, high-energy trauma and are often associated with life threatening injuries. The majority of them require surgical intervention and extensive rehabilitation. The epidemic figures are necessary to make plan for their management and its complications. We aim to analyze epidemiological profile of patients presented with pelvis and acetabular fracture in our center.Methods: This was observational cross-section study, analyzed on patients admitted with pelvis and acetabular fracture at a tertiary care center through emergency and outpatient department between January to December 2023. The collected parameters were age, gender, mechanism of injury, site of injury, classification of fracture, associated other injuries, management operative or non-operative, early post-operative complications, duration of hospital stay, mortality and Intensive Care Unit admission and they were analyzed. Ethical approval was obtained from Institutinal Review Committee (Reference number: 19/2024)Results: There were 48 (7.27%) pelvis and/or acetabular fracture amongst 660 patient with traumatic fractures. Pelvic fracture was 29 (4.39%) and acetabular fracture was 16 (2.42%). The median age was 38 years (IQR: 25.25-46.75) and 36 (75%) were male. Thirty three (69%) patients required surgery, 17 (35%) patients had additional surgery for associated injury and 14 (29%) required intensive care unit admission. The median hospital stay was 12.5 days and mortality rate were 2%.Conclusions: The proportion of pelvis fracture was comparable to other studies while the proportion of actebular was comparatively higher in this study.

Implant Failure and Acetabular Protrusion Post Austin Moore Prosthesis: A Case Report

Implant failure and acetabular protrusion are significant complications following Austin Moore prosthesis insertion, particularly in elderly patients with hip fractures. Total hip arthroplasty (THA) offers superior outcomes compared to hemiarthroplasty (HA) but comes with its own set of challenges. Understanding the risk factors and implications of these complications is crucial for choosing effective management. In this article, we report a 76-year-old woman who presented with severe left hip pain post-fall, eight years after HA with an Austin Moore prosthesis due to a trochanter fracture. The patient was able to walk with a walker before the fall. Physical examination revealed tenderness and limited range of motion. Radiographic imaging confirmed acetabular protrusion and AMP neck fracture. Conversion to THA using a hybrid system was performed successfully, with the patient exhibiting no post-operative complications. This case report showed that implant failure and acetabular protrusion pose complex challenges, exacerbated by patient demographics, implant design, and bone quality. THA emerges as a preferred option due to its superior outcomes, although conversion from HA is associated with increased risks. Early diagnosis and intervention, as well as a multidisciplinary approach and careful consideration of patient-specific factors, are crucial for optimizing patient outcomes and quality of life.

Prevalence of Asymptomatic Acetabular Labrum Abnormalities in the Active Pediatric Population.

The prevalence of labral tears in asymptomatic active adults has been reported, but the prevalence of labral tears and other incidental hip lesions in the asymptomatic active pediatric population remains unclear. The purpose of this study was to determine the prevalence of hip abnormalities detected on 3T MRI in an active pediatric population with no hip symptoms and to compare with hip abnormalities found in children and adolescents who underwent an MRI for a hip-related condition. After IRB approval, pediatric patients self-reporting as athletes and presenting with isolated, acute-onset knee pain requiring knee MRI were prospectively recruited to undergo 3T MRI of their asymptomatic contralateral hip (ASx). A comparison group of pediatric subjects who underwent an MRI for hip pain was enrolled retrospectively (Sx). All MRI scans were anonymized and randomized. Fifty subjects were enrolled for each cohort. Two fellowship-trained musculoskeletal radiologists independently evaluated MRIs for abnormal hip lesions, including labral tears. Inter-reader reliability was evaluated using Cohen Kappa. χ2 or Fisher exact test was used to compare the prevalence of hip lesions between the 2 cohorts. The average patient age was 14.9 years for both cohorts (range 9 to 18y) and 48% were male. In the ASx group, incidental labral tears were found in 18%, labral/paralabral cysts 6%, cartilage lesion 0%, subchondral cyst 0%, ligamentum teres tear 0%, femoral fibrocystic change 0%, cam lesion 30%, acetabular bone edema 0%, acetabular rim fracture 0%. The prevalence of labral tears (30%, P-value 0.16) and cam lesion (36%, P-value 0.52) in the Sx group was not significantly different from the ASx cohort. No significant correlation was found between the presence of femoral neck osseous bump and labral tear, labral cyst, or paralabral cyst in either cohort. Labral tears were present on 3T MRIs of active pediatric patients with and without hip pain. Although MRI is essential to confirm the surgeon's suspicion and to detect unexpected pathology, clinical examination and history are crucial in pinpointing clinically relevant abnormal imaging findings. Level III.

Predictors of prolonged hospital stay of pelvic ring and acetabular fractures - a retrospective analysis in a 10-year period of a level 1 trauma center.

Pelvic ring and acetabular fractures are among the most complicated and severe injury patterns in orthopaedic trauma surgery. Inpatient treatment is not only costly but also very time-consuming. The aim of this study is to identify predictors leading to a prolonged length of hospital stay. This study is a retrospective review of data of 211 patients admitted to a Level-1 trauma centre. In this cohort a surgical treatment of pelvic ring and acetabular fractures between 2010 and 2020 was performed. Preclinical data and clinical parameters were analysed. Injury severity was the most important factor for a prolonged stay. High-energy trauma resulted in significantly longer hospital stays. Multiple injury had a significant effect. Low haemoglobin levels measured on admission and an increased shock index, as indicators of the severe trauma, could be identified as good predictors of a longer intensive care period and a long total length of stay. Except for the number of surgical procedures to treat the pelvic fracture, surgical approach and technique showed no predictive value. Age and gender do not play a role. Increased patient age does not result in a longer hospital stay or longer intensive care times. Pelvic fractures demonstrate a prolonged hospital stay. It depends on the severity of the injury. There are good predictors of a long length of stay at admission. These include the presence of multiple injury, the complexity of the fractures, haemoglobin levels, and the shock index.

Mortality and reoperations following treatment of acetabular fractures in patients ≥ 70 years: a retrospective cohort study of 247 patients.

Evidence for long-term outcomes following acetabular fractures in older adults is limited. We aimed to evaluate mortality, complications, and need for subsequent surgical procedures in operatively and nonoperatively treated older patients with acetabular fractures. Patients aged ≥ 70 years with acetabular fractures treated at Uppsala University Hospital between 2010 and 2020 were included. Fractures were classified according to Letournel. Local medical records were analyzed and cross-referenced with the Swedish Arthroplasty Register to identify reoperations and delayed arthroplasty procedures. Follow-up time ranged from 2-12 years. Primary outcome was mortality 1 year after injury. Descriptive statistics, survival analysis using the Kaplan-Meier method, and logistic regression models were used. 247 patients (67% men) with a median age of 80 years (range 70-102) were included. Most patients were ASA class 3 (67%). 148 (60%) patients were treated operatively. The 1-year mortality was 15% (95% confidence interval [CI] 9-21) in the operatively and 29% (CI 19-37) in the nonoperatively treated group. Difference in adjusted mortality rates between treatments did not reach statistical significance. 20% of patients treated with open reduction internal fixation (ORIF) underwent some form of reoperation. In the nonoperatively treated group, 1% had a delayed THA. The 1-year mortality following acetabular fractures in older people was 21% (CI 15-26), underscoring the frailty of this patient group. ORIF alone was associated with a 20% reoperation rate while the rate of delayed surgical treatment in patients selected for nonoperative treatment was 1%.

Post-Traumatic Hip Osteoarthritis after Pelvic Ring Injuries.

While rates of post-traumatic osteoarthritis after acetabulum fracture have been thoroughly studied, there has been less emphasis on hip osteoarthritis after pelvic ring injuries. The objective of this study was to determine the frequency of post-traumatic hip osteoarthritis in pelvic ring injury patients. It was hypothesized that more severe pelvic ring injuries would be associated with greater rates of post-traumatic hip osteoarthritis. Design: Retrospective Cohort. Urban/Suburban Academic Level I Trauma Center. Subjects were identified using a retrospective search for AO/OTA type A, B, and C pelvic ring injuries. Patients were included if they were age 18 or greater, had a pelvic ring injury, and one year or more of radiographic follow-up. Patients were excluded if they had prior total or hemi-arthroplasty of either hip, femoral neck fracture, acetabulum fracture, femoral head fracture, or inadequate radiographic follow-up. Both hips were graded using the Tönnis classification at the time of injury and available follow-up pelvis films. Comparison of rate of osteoarthritis progression was made between stable (LC I injuries stable on examination under anesthesia, all APC I injuries) and unstable (APC II, APC III, LC II, LC III, LC I injuries unstable on examination under anesthesia) pelvic ring injury patients, as well as severity of injury using the Young-Burgess classification. Two hundred and eleven patients were included for final analysis. Average age was 58.8 years (SD 28.1 years, range 18-100 years). Eighty-eight patients (41.7%) were male. 127 patients underwent non-operative management, and 84 underwent surgical stabilization. 34.5% (29/84) of patients with unstable pelvic ring injuries and 6.2% (8/127) of patients with stable pelvic ring injuries demonstrated progression of osteoarthritis on the ipsilateral side of their injury (p < 0.001). More severe pelvic ring injury patterns had a greater rate of post-traumatic osteoarthritis (PTOA) based on the Young-Burgess injury classification (44.4% of LC III versus 11.1% of LC I pelvic ring injury patients, p < 0.001). A significant frequency of post-traumatic osteoarthritis after pelvic ring injuries was identified. A higher rate of preogression to PTOA was found with unstable injuries compared with stable pelvic injuries. III, Retrospective Cohort Study.

The Impact of Modifier-22 on Reimbursement Following Acetabular Fracture Fixation.

The 22-modifier in the Current Procedural Terminology (CPT) system indicates increased surgical procedure complexity, aiming to secure greater reimbursement for surgeons. This study investigated the 22-modifier on reimbursement amounts after acetabular fracture fixation. Design: Retrospective cohort study. Academic Level I Trauma Center. Included were patients with third party reimbursement for acute acetabular fracture (AO/OTA 62A-C) fixation through an open approach from 2005 to 2021 as identified using CPT codes 27226, 27227 and 27228. Chart review identified procedures where the 22-modifier for obesity or fracture complexity was applied. A cohort without the 22-modifier matched by diagnosis, primary CPT code and insurance carrier was made for comparison. The primary outcome measure was the difference in financial reimbursement when the 22-modifier was used. Secondary outcomes were the difference in billed charges and operative time. A total of 785 cases were initially identified with 747 meeting the inclusion criteria, and 73 having the 22-modifier applied. After removing surgeries that did not receive compensation from their insurance, 52 of these patients were compared to 52 matched cases without a 22-modifier. The 22-modifier group and the non-modifier group had no significant difference in reimbursed amounts ($4,112.71 USD vs. $3,851.00, p = 0.644). However, patients in the 22-modifier group had significantly greater billed charges ($8,007.35 vs. $7,120.94 USD; p = 0.0096), longer operative times (301.7 vs. 240.2 minutes, p < 0.001) and greater body mass index (BMI) (43.1 vs 29.3 kg/m2; p < 0.001). Despite increased complexity and greater billed charges, the use of a 22-modifier in acetabular fracture cases did not result in improved collected reimbursements, and reimbursement is equal to when the 22-modifier is not used. Policymakers and insurers should revise reimbursement structures to better align reimbursements for acetabular fixation with surgical complexity. Level III.

Sexual and Urinary Dysfunction Following Isolated Acetabulum Fractures: A Systematic Review of the Literature.

Background/Objectives: Acetabular fractures are rare fractures of the pelvis which usually result from trauma. Whilst data are reported on sexual and genitourinary function in those with pelvic fractures, less is known about those with isolated acetabulum fractures. This systematic review aimed to determine, first, the frequency of sexual and genitourinary dysfunction following isolated acetabulum fractures and, second, the nature of these complications. Methods: A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Results: Seven studies based on 648 individuals were identified with a mean follow-up time of 33.6 ± 22.4 months. Five papers described sexual functional outcomes, and two reported genitourinary function. Acetabulum fractures were noted to have an impact on sexual function ranging from 20.0% to 39.8% within the groups analysed. With respect to genitourinary outcomes, incidence of lower urinary tract injury and spontaneous voiding failure was quite low, but due to the existence of little data, firm conclusions cannot be made. Conclusions: This review has highlighted a paucity of data related to outcomes of sexual and genitourinary function in patients who are post-acetabulum fracture. The limited available data suggests that acetabular fractures have an impact on sexual function, but the impact on genitourinary function is less clear. Further prospective work is required to better understand the relationship between baseline demographics, injury characteristics, injury mechanism and concurrent injuries, and surgical fixation and acetabular-fracture outcomes.

Radiological Outcome of the Gradual Increase in Skeletal Traction in Acetabular Fracture.

This prospective study aimed to assess the effect of gradual increment of vector traction weight on reducing displaced acetabular fractures preoperatively. Conducted at Hospital Tuanku Jaafar, Seremban, Malaysia, between June 2016 and December 2017, 21 patients with displaced acetabular fractures were included. Traction was applied using supracondylar and lateral methods, with reduction assessed by serial radiographs. Displacement was defined as greater than 2 cm in both iliopectineal and ilioischial lines. The majority of patients were male with 23 (82.1%) patients and 21 of them (75.0%) having fractures caused by road traffic accidents. Fracture reduction was achieved in 18 cases, with traction weight ranging from 5% to 33.33% of body weight. Traction applied within seven days of trauma significantly improved fracture reduction (p = 0.025). Complications, including pain and pin-tract infection, occurred in 17.9% of cases, but traction weight and duration did not significantly affect complications. The study concludes that vector traction of approximately 20% body weight effectively reduces displaced acetabular fractures preoperatively.

Periacetabular metastases: Proposed extension of the Harrington classification.

To describe the functional outcomes, complications, and reconstruction types in patients with periacetabular metastases and to propose an extension of the Harrington classification. Twenty-eight patients (13 males, 15 females) with a mean age of 63.8±15.5 years presented with periacetabular metastases from January 2010 to December 2021. The periacetabular metastases were graded according to Harrington's classification, with four additional categories introduced: A) joint involvement, B) Enneking zone 1 involvement, C) pathological acetabular fracture, and X) none of the above. All patients underwent surgery at a single national referral center. Based on the Harrington classification, the acetabular destruction results were as follows: Class 1, two cases (7%); Class 2, eight cases (29%); Class 3, 17 cases (61%); and Class 4, one case (3%). The results for the additional categories were: A, five cases (18%); B, five cases (18%); C, seven cases (25%); and X, 11 cases (39%). The most frequent type of reconstruction was total hip prosthesis with a reinforcement ring. Four patients (14%) required reintervention. After a mean follow-up of 43±45 months (range 2-144), seven patients (25%) could walk unaided, 16 (57%) required assistance, and five (18%) could not walk. Three patients (11%) died before the third postoperative month. Most patients in this study achieved functional outcomes that allowed ambulation. The type of reconstruction was determined by the classification of the bone defect. We propose extending Harrington's classification to include the four additional categories introduced in this study.

Effects of Prophylactic Coil Embolization of Pelvic Arteries on Surgical Outcomes in Hemodynamically Stable Patients with Complex Acetabular Fractures.

To investigate the efficacy of prophylactic embolization of the internal iliac artery (IIA) or superior gluteal artery (SGA) before open reduction and internal fixation (ORIF) in reducing intraoperative blood loss (IBL) in hemodynamically stable patients with complex acetabular fractures. A total of 136 patients with complex acetabular fractures were retrospectively included and divided into the prophylactic transcatheter arterial embolization (PTAE) group and non-PTAE group, depending on whether ipsilateral IIA or SGA was embolized using coils within 3 days before ORIF. Demographic characteristics, injury severity score (ISS), fracture classification, and intraoperative and postoperative data were compared between the two groups. Propensity score matching (PSM) was also performed to balance the baseline characteristics of the patients. The determinants of IBL were investigated using multivariate linear regression analysis. The PTAE and non- PTAE groups consisted of 64 and 72 patients, respectively. PSM yielded 43 matched pairs. Post-matching, IBL in the PTAE group was less than that in the non-PTAE group (median [interquartile range], 800 [400-1200] mL vs 1300 [1000-1600] mL, p < 0.001). Furthermore, the PTAE group showed a shorter ORIF duration and lower intraoperative and 24-h postoperative blood transfusion requirements (all p < 0.05). Multivariate analysis revealed that PTAE and the duration of surgery were associated with IBL (PTAE: β = -0.407, p < 0.001; duration of surgery: β = 0.237, p = 0.021). Prophylactic IIA or SGA embolization may be beneficial in reducing IBL during ORIF in hemodynamically stable patients with complex acetabular fractures.

Surgical hip dislocation for posterior hip dislocation with femoral head fracture pipkin classification type II: A case report

Introduction: Surgical hip dislocation is a powerful and safe approach. It allows for simultaneous treatment of intra-articular pathologies, either preexisting or as a result of trauma, and improves long-term results. It can be used to treat a wide variety of intra-articular pathologies that would be extremely challenging or impossible arthroscopically or with other common open approaches to the hip. Surgical hip dislocation has been used in the trauma setting for open reduction and internal fixation of femoral head fractures and posterior wall acetabular fractures that do not extend into the posterior column. Case Report: A 28-year-old male with a posterior hip dislocation had difficulty flexing and extending his hip, internal rotation, and shortening his leg. During physical examination, we found a prominent head left femur on the posterior gluteus. During an X-ray examination, we found a posterior dislocation of the femoral head with a fracture. Treatment: Open reduction is preferable whenever there is a nonconcentric hip reduction. This reduces the risk of additional trauma, thus avoiding abrasion to the articular cartilage and bone contusion at the head of the femur. The surgeon who performs open reduction must be fully familiar with the surgical anatomy of the hip and must be aware of the fixation techniques used on fractures in this region. The fragment can be fixed both with 2.0-mm Herbert screws or mini fragment screws, taking care of the head of the implant into the articular cartilage. The joint capsule should always be repaired. When femoral head impaction is present, and the patient is an adult, the goal is to save the femoral head. In this situation, it is preferable to use the Watson-Jones or anterolateral approach with greater trochanteric osteotomy to perform the controlled dislocation of the hip.

A Survey on Outcomes of Patients Operated with Kocher Approach in the Posterior Acetabulum Wall Fractures

Background: There are many challenges in using the type of treatment method for acetabular fractures, and the incorrect treatment of these fractures can have many complications for the patient. Therefore, we decided to do some research to examine the treatment results of patients who underwent surgery with a posterior approach. Methods: The files of patients admitted to the orthopedic department of the hospital were examined. After contacting the patients, performance outcomes were examined six months after the treatment results and final follow-up using the Harris Hip Score (HHS). Results: In this study, the total number of patients was 25, of which 80% were men and 20% were women. Treatment results were evaluated as good or excellent in 15 (60%) patients and had no statistically significant relationship with age and gender. 48% had no pain and lameness, and the others showed different degrees of pain. 96% of the people were able to climb the stairs, but 4% were unable to climb the stairs. 76% of the people could use public transportation, and the rest of the people could not. 40% of the people did not need to use crutches, and the rest depended on crutches to varying degrees. Conclusion: According to the therapeutic results obtained from the surgery, it can be concluded that this surgery has acceptable results.

Increased risk of adverse events following the treatment of associated versus elementary acetabular fractures: a matched analysis of short-term complications

PurposeThis retrospective cohort study aims to compare short-term complication rates between patients receiving open reduction and internal fixation (ORIF) for associated versus elementary acetabular fractures, with a secondary objective of identifying independent risk factors for adverse outcomes.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent ORIF for associated acetabular (CPT 27228) or elementary acetabular fractures (CPT 27226, 27227) from 2010 to 2021. Propensity score matching was employed to account for baseline differences and the short-term complication rates were compared between the cohorts.ResultsWe identified 1,330 patients who underwent ORIF for an acetabular fracture between 2010 and 2021, including 868 patients with elementary fractures and 462 with associated fractures. After matching, there were 462 patients in each cohort. The matched associated acetabular fracture group experienced higher rates of any adverse event (AAE, p = 0.029), transfusion (p = 0.010), and reoperation (p = 0.049). Increased age, increased operative time, higher body mass index (BMI), and prolonged hospital length of stay (LOS) augmented the risk of any complication.ConclusionThe findings of this study identify areas of greater risk of postoperative complications after ORIF in individuals with associated versus elementary acetabular fractures. Discussion of these heightened risks is critical to appropriate patient care. Understanding these risks plays an important role in the clinical decision-making process and may identify areas to monitor patients postoperatively.

Treatment of acetabular fractures with the two-incision minimally invasive (TIMI) approach

We present the two-incision minimally invasive (TIMI) approach for the treatment of anterior acetabular fractures. Displaced fractures of the anterior column of the acetabulum; complex fractures of the acetabulum in combination with the posterior approach (Kocher-Langenbeck); periprosthetic fractures of the acetabulum with or without additional revision of the cup. Possibly previous extended surgery in the anatomical region of the approach. The first TIMI incision is performed by an alternate cut through at the level of the proximal third of the pelvic brim. After transection of the abdominal wall, the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held using aretraction system. After fracture reduction and fixation by isolated screws, areconstruction plate is inserted for fracture neutralization. Depending on the fracture type and the severity of the damage to the acetabular dome, the involved extremity is allowed partial weight bearing for 6weeks to 3months. In our experience, arelatively short operation time of approximately 1.5-2 h for acetabular osteosynthesis. Wound infections and revisions are very rare. Radiological follow-up shows an anatomical result in over 75% of cases. The 24-month follow-up examination shows aHarris Hip Score of over 85points. The quality of life measured by the EQ5D is comparable to the quality of life of anormal collective of the same age.

RESEARCH ON OCCUPANT INTEGRATED SAFETY UNDER AUTOMATIC EMERGENCY BRAKING ON LOWER LIMB INJURIES DURING CAR ACCIDENT

Objective: This study aims to identify significant factors influencing lower limb injury trends during integrated active–passive collision processes, and further analyze the influence of automatic emergency braking (AEB) on lower limb injuries. Methods: First, an integrated active–passive simulation environment is being established. Subsequently, nine sets of simulations are being designed using the orthogonal experiment method to identify significant factors related to AEB. Finally, impact simulations are being conducted based on the significant factors, and the disparities in lower limb injuries between AEB-activated and nonactivated conditions are being compared. Results: The analysis of variance (ANOVA) shows that the duration of AEB has a significant effect on lower limb injury, and the main effect value of left femoral force increases by 19.33% (0.79[Formula: see text]kN) when AEB lasts for 300[Formula: see text]ms compared with 100[Formula: see text]ms. An acetabular fracture has been found in the AEB-activated condition, which is a serious injury not found in the AEB-nonactivated condition, indicating the importance of careful application of the AEB. Discussion and Limitations: Lower limb injuries warrant attention in future research on integrated active and passive safety. The negative effect of AEB on lower limb injury can be attributed to dangerous pre-impact body posture resulting from inadequate performance of the restraint system. The study investigates the respective levels of AEB parameters on lower limb injuries and quantitatively analyzes the effects of AEB, providing a process reference for future integrated active–passive safety assessments.