Internal Fixation Of Acetabular Fractures Research Articles

A retrospective and prospective study of functional outcome of surgical management of acetabular fractures

Background: Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons Objective:The aim of the present study was to evaluate the functional outcome of surgically treated acetabular fractures. Methods:A prospective longitudinal study was undertaken in this hospital during the period from February 2012 to December 2014. A total number of 52 patients with the diagnosis of acetabular fracture were included in the study. The main cause of the acetabular injury was a road traffic accident. All the patients were treated surgically with plates and screws. Outcome was assessed radiologically and functionally, employing the Matta‘s radiological criteria. The mean follow-up period of the patients in the postoperative period was 30 months (24–36months). Results: In the present study, Majority of the patients were Males 46 (88.46%). Major injuries were caused by Road accidents. All Posterior wall, Posterior column, Associated Posterior Column and Posterior wall fractures were managed with open reduction and internal fixation through Kocher- Langenback approach with patient in lateral position. In the present study, we observed emergency closed reduction in 8 patients and open reduction done along with fixation in 6 patients. According to radiological assessment 75% were excellent and good. Whereas functional assessment made by Modified Merle d’Aubigne Scale, more than 80.76% patients were satisfied with the results of acetabular surgeries. In the present study, post-operative complications of acetabular fracture such as heterotopic ossification were found in 2.17%, skin infections in 4.34 and vascular necrosis in 4.34% of patients. Conclusion:These results show that internal fixation of acetabular fractures leads to a good outcome in the majority of patients. Early surgical intervention and experienced management is a prime factor in achieving good results.

Cementless total hip arthroplasty after failed internal fixation of acetabular fractures: A single center experience of 25 consecutive patients.

Total hip arthroplasty (THA) is an available surgical option for failed acetabular fracture, previously managed by open reduction and internal fixation. This study aimed to report the postoperative outcomes of cementless THA in patients with this condition. Between November 2000 and September 2016, 25 consecutive cementless THAs for failed internal fixation after acetabular fractures with a minimum follow-up of 2 years were analyzed. The mean age at the time of surgery was 58 years (36-85 years), and the time elapsed between fracture and THA was 70 months (7-213 months). Clinical and radiologic evaluations were performed on all patients. Clinically, the mean Harris hip score at the last follow-up was 88 points. Walking ability recovered to pre-injury status in 92% patients, and activities of daily living recovered in 96% patients. Radiographically, none of the acetabular cups showed evidence of migration and loosening during the mean follow-up of 50 months. All cases showed stable femoral stem fixation at the last follow-up. Dislocation occurred in three cases (12%). Outcomes of cementless THA after failed internal fixation for acetabular fractures were satisfactory. However, a relatively high incidence of postoperative dislocation is still a concern.

Efficacy of total hip arthroplasty after operatively treated acetabular fracture.

We evaluated the clinical and radiological outcomes of patients following total hip arthroplasty (THA) for acetabular fracture. This was a retrospective cohort study in a single center. The medical records of patients who underwent THA from March 2002 to March 2017 were reviewed. Inclusion criteria were THA and a history of open reduction and internal fixation of acetabular fractures. Thirty-seven patients with a mean age of 56.2years were enrolled. The Harris hip score (HHS), acetabular fracture classification, time interval between acetabular fracture and THA, cause of THA, surgical approach, implant type, complications, radiographic results, and Kaplan-Meier survival curves were analyzed. All patients were followed up for an average of 6.6years. The mean preoperative HHS of 42.5 had improved to 83.5 at the final follow-up (p < 0.05). There were 29 cases of post-traumatic arthritis, 6 cases of avascular necrosis, and 4 cases of non-union. The average interval from injury to THA was 58months (range 4-336months). The re-admission rate was 18.9%. Patients who underwent conversion to THA due to post-traumatic arthritis combined with non-union acetabular fracture developed clinical failure more frequently than patients with post-traumatic arthritis (p = 0.037). At 12years, 83.4% of patients were free from revision of femoral and acetabular components. THA secondary to an operatively treated acetabular fracture provides good symptomatic relief, but shows relatively inferior survival rates, and clinical failure was related to post-traumatic arthritis with acetabular non-union.

Annual case volume is a risk factor for 30-day unplanned readmission after open reduction and internal fixation of acetabular fractures

BackgroundSurgical fixation of acetabular fractures is technically challenging, and quality of reduction directly correlates to patient outcomes. Considering the difficulty of open reduction and internal fixation (ORIF), increased case volumes may improve patient outcomes. No studies have investigated case volume as a risk factor for readmission after acetabular fracture ORIF. The present study sought to answer the question of whether annual case volume is a risk factor for 30-day unplanned readmission after acetabular fracture ORIF, if there is an identifiable threshold number of cases most predictive of a readmission, and if differences exist between reasons for readmission between high and low-volume centers. HypothesisInstitutions with a lower annual case volume will have a higher incidence of 30-day unplanned readmissions. Materials and methodsThe national readmissions database (NRD) was queried for acetabular fractures that underwent ORIF during 2016. Comorbid conditions were summed, and annual hospital case volume was identified. A receiver operating characteristic (ROC) curve was generated and the Youden index identified threshold case volume most predictive of a 30-day readmission. A multivariable logistic regression was performed with 30-day readmission as the dependent variable and case volume below the threshold an independent variable. ResultsA total of 3,407 cases were included with a median age of 43. The 30-day readmission for this cohort was 6.5% (220/3407). ROC curve analysis identified 22 annual cases as the threshold value most predictive of 30-day readmission. Multivariable logistic regression identified age (Odds Ratio (OR)=1.01, p=0.005), number of comorbidities (OR=1.35, p<0.0001), and ≤22 cases (OR=1.50, p=0.006) as statistically significant risk factors for 30-day readmission. The most common reason for readmission at both high and low-volume centers was surgical site infection. DiscussionAnnual case volume is a statistically significant predictor of 30-day readmission after acetabular fracture ORIF. Performing ≤22 acetabular ORIFs places patients at greater risk for a readmission. Patients at low-volume centers may be predisposed to readmission, and it is paramount to optimize patients prior to discharge, and have appropriate surgeon and hospital resources to treat these complex injuries. Level of evidenceIII, Cross-sectional study.

Fractures of the acetabulum - surgical treatment and complications

Acetabular fractures represent severe injuries that mostly occur in car accidents, or after falling from greater heights, most often in the working male population. Acetabular fractures are present in our clinical practice and their treatment requires good education and surgical training. Surgical experience is one of the prerequisites for achieving good treatment results, since these fractures are accompanied by numerous complications. In order to acquire knowledge and skills in this field of surgery, it is necessary to have a national center for education at one of the medical faculties in Serbia. All dislocated acetabular fractures (? 2 mm) require early surgery, anatomical reduction, and stable internal fixation of acetabular fracture. Acetabular fracture-dislocation requires urgent reduction of the dislocated femoral head. The anatomic reduction of the fracture is related to the time of definitive bone fixation of the fracture. Fourteen days after the fracture, anatomic reduction is more difficult to achieve. In addition to the factors that positively affect the results of treatment, there are negative factors as well, which result in poor outcomes. They are directly correlated to the initial trauma that occurs at the time of injury. Fracture comminution, large dislocation (&gt; 20 mm), injury of the femoral head, posterior dislocation of the hip, impaction, traumatic or iatrogenic sciatic nerve palsy ? these are all factors that negatively affect the outcome and are responsible for complications, as opposed to positive factors.

A new method for reduction quality assessment in acetabular fractures: acetabular congruency measurement.

The determination of adequate reduction is difficult perioperatively due to inadequate radiographic scanning and objective measurement methods. The purpose of the present study is to evaluate an objective measurement of the weight bearing acetabular dome congruency. The sensitivity and specificity of 2 measurement methods after acetabular fracture fixation are compared. Postoperative acetabular reduction was assessed based on postoperative anteroposterior radiographs according to hip joint congruency and Matta's classification in 55 patients. For hip joint congruency measurements, one circle was drawn as superior femoral head border and another one was drawn as weight-bearing acetabular dome border. The difference between the centres of the circles was measured in millimetres. Comparative studies were performed between groups according to reduction quality and clinical and radiological results. The threshold value for the difference between the 2 circle centres was found as 4.4 mm according to the clinical outcomes; 3.8 mm according to radiological outcomes in joint congruency method. The sensitivity of this method was found as 90.2% and 92.7%, and specificity as 64.3% and 57.1% considering the clinical and radiological results, respectively. In the assessment of joint congruency, false positive rate was lower than assessing reduction quality using the method defined by Matta. Joint congruency assessment based on a postoperative anteroposterior radiograph in patients treated with open reduction internal fixation for acetabular fractures is a suitable method for assessing the adequacy of reduction. This method can be used intraoperatively using fluoroscopy imaging during surgery.

Open Reduction and Internal Fixation of Acetabular Fractures Using the Modified Stoppa Approach.

The modified Stoppa approach is performed for safe and efficient management of acetabular fractures involving the anterior column. This approach avoids dissection of the inguinal canal, the femoral nerve, and the external iliac vessels as seen in the "second window" of the ilioinguinal approach and has thus been shown to be less invasive than the ilioinguinal approach1. As an intrapelvic approach, it facilitates the management of medial displacement fracture patterns involving the quadrilateral plate and dome impaction that typically occur in the elderly2,3. The reduced morbidity of this approach is of particular relevance for elderly patients who must respond to the stresses of injury and surgery with diminished physiological reserves. The specific surgical steps include preoperative planning, patient positioning and setup, a Pfannenstiel incision, superficial and deep dissection, development of the Retzius space and retraction of the bladder, exposure of the superior pubic ramus and iliopectineal eminence, dissection and ligation of a potential corona mortis, exposure of the obturator nerve and vessels, subperiosteal preparation of the pubic ramus with retraction of the external iliac vessels, subperiosteal exposure of the quadrilateral plate with detachment of the internal obturator muscle and exposure of the posterior column, assessment of residual displacement by fluoroscopic views, longitudinal soft-tissue or lateral skeletal traction (optional) for reduction of medial displacement of the femoral head, disimpaction of the acetabular dome fragment and grafting of the supra-acetabular void (optional) under fluoroscopic and arthroscopic (optional) control, and reduction and fixation of extra-articular components (iliac wing posteriorly and pubic ramus anteriorly), the posterior column (infra-acetabular screw), and the quadrilateral plate (buttress plate). Before wound closure, the urine output is checked for occurrence of hematuria, an indication of bladder penetration. The anterior lamina of the rectus sheath is then sutured, and a layered closure performed. The ilioinguinal approach might be used instead. The modified Stoppa approach avoids dissection within the inguinal canal, the second window of the ilioinguinal approach. Therefore, this approach is less invasive and might be an alternative for joint-preserving surgery, especially in the elderly.

Effects of topical tranexamic acid during open reduction and internal fixation of acetabular fractures: A retrospective study

ObjectiveThe aim of this study was to assess the effect of topical tranexamic acid on blood loss and transfusion rates in acetabular fracture surgery. MethodsThe medical records of 61 patients who underwent open reduction and internal fixation for acetabular fracture between 2012 and 2015 were retrospectively reviewed. The patients were divided into two groups: Group I consisted of 31 patients (19 men and 12 women, mean age: 52 ± 19 years) who received intraoperatively a topical tranexamic acid solution of 3 g and Group 2 consisted of 30 control patients (17 men and 13 women, mean age: 48 ± 24 years) who received only 0.9% saline solution. The groups were compared based on their intraoperative blood loss, Postoperative drain output at 24 and 48 h, and postoperative hemoglobin levels, and transfusion rates. ResultsThe mean intraoperative blood loss was 410 ± 100 ml in Group 1, compared to 570 ml ± 160 ml of the control group (p < 0.05). The postoperative drain output after 24 h was 210 ± 70 ml in Group 1 compared to 330 ± 90 ml of the control group (p < 0.05). The drain output at 48 h was (50 ± 20 ml) in group 1 compared to 90 ± 40 ml of the control group (p < 0.05). The transfusion rate was significantly low group 1 (42%) than the control group (97%). Hemoglobin drop was again significantly less in tranexamic acid group (2.1 ± 1.1) than the control group (3.2 ± 1.3). The nadir postoperative hemoglobin was higher in the Group 1 (10.4 ± 1.5) than the control group (9.2 ± 1.3). ConclusionTopical administration of tranexamic acid reduces intraoperative and postoperative blood loss in acetabular fracture surgery, decreasing transfusion rates. Level of EvidenceLevel III, Therapeutic Study.

Progress in research on infra-acetabular screwing for acetabular fracture

Surgical treatment of acetabular fracture is very challenging because the acetabular geometry is complex. As anterior and posterior columns are the main support structures of the acetabulum, anatomical reduction and strong internal fixation of the two acetabular columns can achieve the best prognosis for patients with acetabular fracture. Constant study of the complex anatomy around the acetabulum reveals an infra-acetabular screw channel that can pass through both columns. Biomechanical studies show that use of an additional infra-acetabular screw can greatly strengthen the internal fixation of acetabular fracture. Biomor-phological studies prove that an infra-acetabular screw channel of 5 mm in diameter is available in more than 90% of people which allows insertion of a 3.5 mm screw. Imaging studies demonstrate that one in-fra-acetabular screw can be safely placed under the guidance of C-arm roentgenography. In surgery of acetabular fracture, surgeons have used infra-acetabular screws, the clinical value of which has been confirmed by good functional recovery of the patients after surgery. This paper presents an overview of the progress in research on infra-acetabular screwing for acetabular fracture. Key words: Acetabulum; Fractures, bone; Bone nails; Fracture fixation, internal

Internal fixation of acetabular fractures in an older population using the lateral-rectus approach: short-term outcomes of a retrospective study

PurposeThis study aims to examine the clinical efficacy and surgical techniques of the lateral-rectus approach for treatment of acetabular factures in elderly patients.MethodsAfter appropriate exclusion, 65 elderly patients with an acetabular fracture who was treated through the lateral-rectus approach from January 2011 and October 2016 were selected retrospectively. By analyzing the medical records retrospectively, the patients’ characteristics, fracture type, mechanism of injury, comorbid conditions, ASA class, operative time, intra-operative blood loss, and post-operative complications were assessed. Clinical examination radiographs have been taken, align with the Matta evaluation system. Functional outcomes were evaluated using surveys including SF-36, Harris hip score, and modified Merle D’Aubigne-Postel.ResultsAll 65 patients had undergone the single lateral-rectus approach successfully. Surgery duration was 101.23 min on average (45–210), and intra-operative bleeding was 798.46 ml on average (250–1800). According to the Matta radiological evaluation, the quality of reduction evaluated 1 week after surgery was rated as “anatomical” in 41 (63.1%) cases, “imperfect” in 12 (18.5%) cases, and “poor” in 12 (18.5%) cases. The modified Merle D’Aubigne-Postel score performed 18 months after surgery was categorized as excellent in 40 (61.5%) cases, good in 10 (15.4%) cases, and fair in 15 (23.1%) cases. The mean Harris Hip score was similar as present researches, being 87.18. The mean SF-36 score was 69.12 which was considered as normal for the group age 60 and older. Several complications were found, including screw loosening in 10 cases, fat liquefaction of incision in 2 cases, deep vein thrombosis in 2 cases, and temporary weakness of hip adductors in 5 cases. None of the patients had heterotopic ossification.ConclusionsThe lateral-rectus approach is a valuable alternative to the ilioinguinal and modified Stoppa approach, being the treatment of acetabular fractures in elderly patients.

Difficulty of Total Hip Arthroplasty Following Open Reduction and Internal Fixation of Acetabular Fractures.

The incidence of posttraumatic arthrosis after acetabular fractures is significant, and patients frequently require secondary total hip arthroplasty. Conversion arthroplasty is more technically difficult, and there is higher risk than with routine primary total hip arthroplasty. The goal of this study was to identify the challenges and risks of secondary total hip arthroplasty compared to primary total hip arthroplasty. We retrospectively identified 30 patients who underwent secondary total hip arthroplasty after open reduction and internal fixation of an acetabulum fracture and compared them with 20 patients who had undergone primary total hip arthroplasty for degenerative joint disease. Demographic data were similar between groups. Hardware removal was deemed necessary in 21 patients (70%). Allograft was needed for bone defects in 33% of secondary total hip arthroplasty cases, while no primary cases required grafting. Operative time (217.4 vs. 113.7 min, P < 0.01) and estimated blood loss (875.8 vs. 365 mL, P < 0.01) were significantly greater in the secondary arthroplasty group. Early postoperative complications were also higher in the secondary arthroplasty group. Total hip arthroplasty after acetabular fracture open reduction and internal fixation is a more complex procedure due to exposure difficulty, possible implant removal, management of bony deficits, and the potential use of cages and revision components. Experienced surgeons managing these complicated cases must take great care not only in ensuring appropriate technique but also in appropriate patient education regarding increased risk of major and minor complications. Level III.

The Pararectus Approach: A New Concept.

Even 50 years after the introduction of the extrapelvic ilioinguinal approach for open reduction and internal fixation of acetabular fractures involving predominantly the anterior column, this approach is still acknowledged as being the so-called gold standard1. The pattern of acetabular fractures has changed within the last 10 to 20 years2,3, with a greater prevalence of quadrilateral plate fractures that is due in part to the increase in elderly trauma. The intrapelvic approach, also called the modified Stoppa approach4-6, was introduced as a less invasive alternative to the extrapelvic ilioinguinal approach, mostly combined with the first window of the ilioinguinal approach. The Pararectus approach also offers intrapelvic surgical access and has demonstrated safe surgical dissection with enhanced exposure and favorable outcome compared with the Stoppa approach7-10. The skin incision runs along the lateral border of the rectus abdominis muscle to develop the anterior rectus sheath. The retroperitoneal space lateral to the rectus abdominis muscle is entered and the inferior epigastric vessels and the round ligament in females or the spermatic cord in males are identified. The superior pubic ramus and the iliopectineal eminence are exposed. If the corona mortis vessels (a vascular anastomosis between the obturator vessels and the external iliac artery) are present, they are ligated. The obturator nerve and vessels are exposed. The dissection is then directed posteriorly under retraction of the external iliac vessels with further subperiosteal exposure of the pubic ramus, the quadrilateral plate, and the posterior column. Any nonessential iliolumbar vessels are ligated. Residual displacement is assessed with fluoroscopic views. For reduction of a medially displaced femoral head, longitudinal extremity soft tissue or lateral skeletal traction (optional), with a Schanz pin in the greater trochanter, is used. For disimpaction of acetabular dome fragments and grafting of a supra-acetabular void (optional), a fluoroscopy unit is used to assess reduction and identify the void; in addition, arthroscopy can be used. The scope is introduced through the fracture gap to check for reduction without any water or specific setup. For reduction and fixation of extra-articular components (iliac wing posteriorly and superior pubic ramus anteriorly), the posterior column, and the quadrilateral plate, the fluoroscopy unit is used. The anterior lamina of the rectus sheath is sutured, and a layered closure performed. The ilioinguinal or modified Stoppa approach might be used instead. The Pararectus approach combines the advantages of the ilioinguinal approach and the Stoppa approach. The Pararectus approach facilitates surgical access directly above the hip joint, which is comparable with the access obtained through the second window of the ilioinguinal approach, but without dissection of the inguinal canal. Moreover, the Pararectus approach provides intrapelvic visualization that is at least equivalent to that offered by the Stoppa approach but without losing any direct access to the hip joint.

The pararectus approach for internal fixation of acetabular fractures involving the anterior column: evaluating the functional outcome

IntroductionAim of this retrospective analysis of prospectively collected data was to evaluate the functional mid-term outcome two years after open reduction and internal fixation of acetabular fractures involving the anterior column with affection of the quadrilateral plate using the pararectus approach on a large cohort.MethodFifty-two patients (12 female, 40 male) with a median age of 55 (range 18–90) years and displaced acetabular fractures involving the anterior column were surgically treated in a single level I trauma centre between July 2012 and February 2016 using the pararectus approach. Thirty-four patients (8 female and 26 male) with a median age of 58 (range 20–85) years were available for complete clinical follow-up at regular intervals, finally 24 months post-operatively. Functional outcome was evaluated according to modified Merle d’Aubigné score, Lower Extremity Functional Scale, WOMAC, and SF-36.ResultsRange of time between trauma and surgical treatment was three (range 0–19) days. Operation time was 140 (range 60–240) minutes, and duration of hospital treatment was 19 (range 7–38) days. Functional results in 34 patients available for final follow-up demonstrated 68 points (median; range 39–80) according to the Lower Extremity Functional Scale, 6% according to the WOMAC (mean; SD ± 14.5%), and 69% (mean; SD ± 20.1%) according to the SF-36. The modified Merle d’Aubigné score was excellent in 22 patients, good in eight patients, and fair in four patients.Discussion/conclusionBased on the good to excellent functional mid-term follow-up results of this study, the pararectus approach can be recommended as sufficient alternative single access to address displaced acetabular fractures involving the anterior column, independent of patients’ age.

Resultado do tratamento cirúrgico de fraturas acetabulares desviadas: estudo prospectivo

ObjectiveThe aim of this study was to evaluate the functional outcome of surgically treated acetabular fractures. MethodsA prospective longitudinal study was undertaken in this hospital during the period from December 2010 to December 2014. A total number of 46 patients with the diagnosis of acetabular fracture were included in the study. The main cause of the acetabular injury was a road traffic accident. All the patients were treated surgically with plates and screws. Outcome was assessed radiologically and functionally, employing the Harris Hip Score. The mean follow‐up period of the patients in the postoperative period was 30 months (24–36 months). ResultsThe results were excellent in 60.86%, good in 21.73%, fair in 8.69%, and poor in 8.69%. Post‐operative complications of acetabular fracture such as heterotopic ossification were found in 2.17%, osteoarthritis in 6.52%, skin infections in 4.34%, nerve lesions in 2.17%, and vascular necrosis in 4.34% of patients. More than 80% of patients were satisfied with the results of acetabular surgeries. ConclusionThese results show that internal fixation of acetabular fractures leads to a good outcome in the majority of patients.

Complex fractures of the acetabulum: Should the enlarged iliofemoral approach be abandoned? Results at 20 years' follow-up.

Among the various options for internal fixation of acetabular fractures, the enlarged iliofemoral approach is less often used, being more invasive, although providing greater exposure enabling control of all components in complex fractures. Even so, the impact of its invasiveness has not been confirmed, and long-term results are not known. We therefore performed a retrospective study, aiming: to assess long-term functional outcome, and; to assess associated morbidity. The enlarged iliofemoral approach allows precise reduction, with favorable long-term outcome. Between 1992 and 1997, 15 patients were operated on for complex acetabular fracture by a single surgeon using an enlarged iliofemoral approach. Two patients were excluded due to lack of follow-up data, leaving 13 patients for analysis: 3 simple transverse fractures, 4 transverse+posterior wall fractures, 4 anterior column+posterior hemi-transverse fractures, one T-shaped fracture and one 2-column fracture. There were 4 cases of posterior dislocation of the hip, and 8 of intrapelvic protrusion. Surgical morbidity was assessed in terms of operative time, number of packed red blood cell transfusions, iatrogenic lesions or postoperative complications, rehabilitation time, and hospital stay. Functional assessment at follow-up used the WOMAC index and Harris score; radiologic assessment used the Kellgren-Lawrence score for osteoarthritis and Brooker score for ossification. Reduction was in all cases anatomic. There were no intra- or post-operative complications. Median number of packed red blood cell transfusions was 5 [range, 3-10]. Median operative time was 4hours [3-6]. Median hospital stay was 6 weeks [6-8], to allow systematic traction with early postoperative mobilization. Weight-bearing was resumed at a median 8 weeks [8-12]. At a median 22 years' follow-up [20-24], median Harris score was 83.5 [63-92] and median WOMAC index 24.5 [1-52]. All patients showed Brooker 1 or 2 ectopic ossification and moderate osteoarthritis. Two underwent subsequent arthroplasty (at 1 and 11 years after the index procedure). The enlarged iliofemoral approach allowed anatomic reduction of acetabular fracture. It provided very good long-term results, without excessive morbidity. IV, retrospective non-controlled study.

Outcome of surgical treatment for displaced acetabular fractures: a prospective study

ObjectiveThe aim of this study was to evaluate the functional outcome of surgically treated acetabular fractures. MethodsA prospective longitudinal study was undertaken in this hospital during the period from December 2010 to December 2014. A total number of 46 patients with the diagnosis of acetabular fracture were included in the study. The main cause of the acetabular injury was a road traffic accident. All the patients were treated surgically with plates and screws. Outcome was assessed radiologically and functionally, employing the Harris Hip Score. The mean follow-up period of the patients in the postoperative period was 30 months (24–36 months). ResultsThe results were excellent in 60.86%, good in 21.73%, fair in 8.69%, and poor in 8.69%. Post-operative complications of acetabular fracture such as heterotopic ossification were found in 2.17%, osteoarthritis in 6.52%, skin infections in 4.34%, nerve lesions in 2.17%, and vascular necrosis in 4.34% of patients. More than 80% of patients were satisfied with the results of acetabular surgeries. ConclusionThese results show that internal fixation of acetabular fractures leads to a good outcome in the majority of patients.

Effect of Tranexamic Acid on Transfusion: A Randomized Clinical Trial in Acetabular Fracture Surgery.

Given the increasing evidence that minimizing blood loss and limiting allogeneic transfusion can improve patient outcome, we are performing a randomized controlled trial of the use of tranexamic acid (TXA) during acetabular fracture surgery. Prospective, multicenter, and randomized. Two level I trauma centers. Eighty-eight patients underwent randomization, with 42 assigned to the TXA group and 46 assigned to the placebo group. The use of TXA during acetabular fracture surgery. The primary outcome was allogeneic blood transfusion. Secondary outcomes consisted of estimate blood loss (EBL) and venous thromboembolism (VTE). The overall transfusion rate was 40.9% (36 of 88), and the average estimated blood loss was 635 mL. There were no significant differences between groups for transfusion incidence, number of units transfused, EBL, or incidence of VTE. There was no difference in transfusion rate for the TXA group (0.097). Transfusion was significantly more likely in cases with low preoperative hemoglobin levels, higher rates of intraoperative blood loss, and longer surgical times. There was no significant difference in transfusion rate, EBL, or VTE for TXA versus placebo. Any potential benefit seems to be overwhelmed by other factors, specifically preoperative anemia and surgical time, which are highly variable in trauma surgery. These findings do not support the routine use of TXA in the setting of open reduction and internal fixation of acetabular fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures.

Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures. PubMed and MEDLINE were searched for posterior wall acetabular fracture studies that included weight-bearing protocols and Merle d'Aubigné functional scores. Twelve studies were identified. Each study was classified as either early or late weight bearing. Early weight bearing was defined as full, unrestricted weight bearing at or before 12 weeks postoperatively. Late weight bearing was defined as restricted weight bearing for greater than 12 weeks postoperatively. The 2 categories were then compared by functional score using a 2-tailed t test and by complication rate using chi-square analysis. Six studies (152 fractures) were placed in the early weight-bearing category. Six studies (302 fractures) were placed in the late weight-bearing category. No significant difference in Merle d'Aubigné functional scores was found between the 2 groups. No difference was found regarding heterotopic ossification, avascular necrosis, superficial infections, total infections, or osteoarthritis. This systematic review found no difference in functional outcome scores or complication rates between early and late weight-bearing protocols for surgically treated posterior wall fractures. [Orthopedics. 2017: 40(4):e652-e657.].

Total hip arthroplasty for post-traumatic arthritis after internal fixation of acetabular fracture

To study the clinical outcome of total hip arthroplasty(THA) for traumatic arthritis after acetabular fracture. From June 2010 to June 2014, 33 hips in 33 patients with traumatic arthritis after acetabular fracture were retrospective analyzed including 21 males and 12 females with a mean age of 44.6 years old. All the patients received THA with bio-prostheses. Harris score was used to evaluate the hip function of patients before and after operation, the X-ray was adopted for radiographic evaluation of the hip prosthesis. All patients were followed up for 7 to 38 months with an average of 21.6 months. The Harris score increased from preoperative 53.6±2.4 to 94.0±3.0 at the final follow-up, the difference was statistically significant(t=55.37, P<0.05). The X-ray evaluation showed the prosthesis was in good position, no loosening of the prosthesis, dislocation and periprosthetic osteolysis. THA is an effective treatment for the traumatic arthritis after acetabular fracture;internal fixation of acetabular fractures could not be removed if it shows difficult but does not affect the prosthesis placement.

Accurate fixation of plates and screws for the treatment of acetabular fractures using 3D-printed guiding templates: An experimental study

ObjectiveTo investigate the feasibility of the use of 3D-printed guiding templates for accurate placement of plates and screws for internal fixation of acetabular fractures. Methods3D models of the pelvises of 14 adult cadavers were reconstructed using computed tomography (CT). Twenty-eight acetabular fractures were simulated and placement positions for plates and screw trajectories were designed. Bending module was obtained by 3D cutting; guiding template was manufactured using 3D printing, and the plate was pre-bent according to the bending module. Plates and screws were placed in cadaveric pelvises using the guiding template, and 3D model was reconstructed using CT. The designed and real trajectories were matched using 3D registration including the coordinates (entry and exit points) of designed trajectory. The number of qualified points with different accuracy levels was compared using Chi-squared test. ResultsSixty-four plates and 339 screws were placed with no cortical breach. The absolute difference of the X, Y, and Z coordinates between the designed and real entry points were 0.52±0.45, 0.43±0.36, and 0.53±0.44mm, respectively. The corresponding values for the exit points were 0.83±0.67, 1.22±0.87, and 1.26±0.83mm, respectively. With an accuracy degree ≥1.9mm for the entry points and ≥3.8mm for the exit points, there was no significant difference between the designed and the real trajectories. ConclusionThe 3D-printed guiding template helped achieve accurate placement of plates and screws in the pelvis of adult cadavers.