Posterior Acetabular Fractures Research Articles

Prone or lateral patient positioning in KocherLangenbeck approach in acetabular fractures fixation: A systematic review and meta-analysis

The Kocher-Langenbeck (K-L) approach is the approach of choice to treat fractures involving the posterior acetabulum. It provides direct exposure to the acetabulum, adequate reduction, and access to treat associated hip fractures. However, there is no consensus on the positioning of the patient; prone or lateral. This review aimed to investigate the effect of patient positioning on the outcomes of the K-L approach in acetabular fracture fixation. Cochrane, Web of Science, Google Scholar, and PubMed were searched from inception until February 22, 2022. Inclusion criteria encompassed studies that investigated acetabular fracture fixation utilizing the K-L approach in relation to patient positioning (Prone and/or Lateral). Only English manuscripts that reported at least one of the outcomes of interest were included in the study. Studies that utilized both positions without specifying the outcomes in relation to the patient position were excluded from the study. The Newcastle–Ottawa Scale and the Joanna Briggs Institute tool were utilized to assess the quality of the included studies. This study included 521 patients from six articles. Of those patients, 46.1% were operated on in the lateral position and 53.9% in the prone position. The mean operative time of lateral and prone positions was 160.9 min (95% confidence intervals [CI]: 135.11–186.64) and 212.5 min (95% CI: 167.08–257.94), respectively. The mean blood loss in the lateral position was 502.mL (95% CI: 471.61–532.47) compared to 482.5 mL (95% CI: 396.77–568.28) in the prone position. The pooled complications in the lateral position were 29% (95% CI: 19–39%) compared to 37% (95% CI: 6–75%) in the prone position. The outcomes did not significantly differ when comparing lateral and prone patient positioning for posterior acetabular fracture fixation through the K-L approach. Further prospective randomized controlled studies are recommended to reach the best evidence.

Finite element analysis of posterior acetabular column plate and posterior acetabular wall prostheses in treating posterior acetabular fractures

BackgroundThe purpose of this study was to investigate the mechanical stability of the posterior acetabular column plate and different posterior acetabular wall prostheses used in treating posterior acetabular fractures with or without comminution.MethodsThe unilateral normal ilium was reconstructed, and a model of posterior acetabular wall fracture was established on this basis. The fracture fragment accounted for approximately 40% of the posterior acetabular wall. The posterior acetabular column plate and different posterior acetabular wall prostheses were also designed. Using static and dynamic analysis methods, we observed and compared the changes in the stress and displacement values of different models at different hip joint flexion angles under external forces.ResultsAt different hip flexion angles, the stress of each model mainly fluctuated between 37.98 MPa and 1129.00 MPa, and the displacement mainly fluctuated between 0.076 and 6.955 mm. In the dynamic analysis, the nodal stress‒time curves of the models were nonlinear, and the stress changed sharply during the action time. Most of the nodal displacement‒time curves of the models were relatively smooth, with no dramatic changes in displacement during the action time; additionally, most of the curves were relatively consistent in shape.ConclusionsFor simple posterior acetabular wall fractures, we recommend using a posterior acetabular column plate. In the case of comminuted posterior acetabular fractures, we recommend the use of a nonflanked posterior acetabular prosthesis or a biflanked posterior acetabular prosthesis. Regarding the method of acetabular prosthesis design, we propose the concept of “Break up to Make up” as a guide.

Risk of Postoperative Sciatic Nerve Palsy After Posterior Acetabular Fracture Fixation: Does Patient Position Matter?

To determine whether the prone or lateral position is associated with postoperative sciatic nerve palsy in posterior acetabular fracture fixation. Retrospective cohort study. Three Level I trauma centers. Patients with acetabular fractures treated with a posterior approach (n = 1045). Posterior acetabular fixation in the prone or lateral positions. The primary outcome was the prevalence of postoperative sciatic nerve palsy by position. Secondary outcomes were risk factors for nerve palsy, using multiple regression analysis and propensity scoring. The rate of postoperative sciatic nerve palsy was 9.5% (43/455) in the prone position and 1.5% (9/590) in the lateral position ( P < 0.001). Intraoperative blood loss and surgical duration were significantly higher for patients who developed a postoperative sciatic nerve palsy. Subgroup analysis showed that position did not influence palsy prevalence in posterior wall fractures. For other fracture patterns, propensity score analysis demonstrated a significantly increased odds ratio of palsy in the prone position [aOR 7.14 (2.22-23.00); P = 0.001]. With the exception of posterior wall fracture patterns, the results of this study suggest that factors associated with increased risk for postoperative sciatic nerve palsy after a posterior approach are fractures treated in the prone position, increased blood loss, and prolonged operative duration. These risks should be considered alongside the other goals (eg, reduction quality) of acetabular fracture surgery when choosing surgical positioning. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prone Versus Lateral Positioning for Posterior Acetabular Fracture Surgery.

Prone Versus Lateral Positioning for Posterior Acetabular Fracture Surgery.

Evaluation of the Results of Open Reduction and Internal Fixation of Posterior Wall and Posterior Column Fracture of Acetabulum by Reconstruction Plate and Screw by Kocher-Langenbeck Approach

Background: Historically, acetabular fracture therapy was generally insufficient, leaving many patients with incapacitating pain, mobility limitations, and joint failure. It's caused by high-velocity injuries and affects young, economically productive people. Proper treatment including optimum surgical care should be offered, especially in our uninformed and fiscally unstable society, to preserve lives and reduce long-term consequences and impairments. This research aims to examine and manage the posterior wall and column of acetabular fracture, focusing on aspects the treating physician may influence. Objectives: To assess the outcome of open reduction and internal fixation of posterior wall and column fracture of acetabulum which may help the orthopaedic surgeons to take appropriate measures as needed. Materials and Methods: 15 posterior acetabular fracture patients were studied. Cases were clinically and radiologically diagnosed in NITOR's emergency or outpatient departments (NITOR). All patients had open reduction and internal fixation by Kocher-Langenback technique. 1 hour 55 minutes was average operating time 21-day average hospital stay. Per- and post-op were uneventful. Patients were released with follow-up appointments. Patients were clinically and radiologically examined at each follow-up. Results: Most injuries were from RTAs (86.66 percent ). Most patients had left acetabular injuries (66.66 percent). Posterior wall acetabular fractures were more common (53.33%) than posterior column and wall fractures (33.33 percent). Most patients had surgery within 2 weeks after injury (60 percent ). 4 (26.66%) and 6 (40%) patients had good clinical and radiological outcomes following surgery. Most patients' clinical (46.66%) and radiological outcomes were favorable (53.33 percent). About 20% of patients were clinically and radiologically fair. 6.6% of patients had poor physical result, while none had poor radiological outcome. 20-40-year-olds had a largely ..........

Favorable Outcome Twenty-Two Months after Delbet Type Ib Capital Femoral Transepiphyseal Fracture and Posterior Column Acetabular Fracture in a Fifteen-Year-Old Male

Case A fifteen-year-old male patient sustained a posteriorly dislocated right capital femoral Delbet type Ib epiphyseal fracture-separation and a right acetabular posterior column fracture after a low-energy trip and fall. The capital femoral epiphysis was closed reduced and fixed with cannulated screws on an urgent basis. He underwent acetabular osteosynthesis via a Kocher-Langenbeck approach two days thereafter. Twenty-two months after injury, he was weight-bearing on the right lower extremity without radiologic evidence of avascular necrosis or clinical evidence of pain or functional deficit. Conclusion Fracture-separation of the capital femoral epiphysis comprises only 8% of skeletally immature femoral neck fractures in the Delbet and Colonna classification. Prognosis is worse with ipsilateral hip dislocation due to the risk of avascular necrosis from disruption of the medial femoral circumflex artery. Urgent referral to a trauma center and treatment by appropriate specialists enables good long-term results after this uncommon traumatic injury pattern.

Surgical treatment of acetabular fracture

The kocher -Langenbeck approach is the best suited approach for reduction and fixation of acetabular fracture that require fixation through posterior approach and provides sufficient access to the majority of posterior based acetabular fracture. Accuracy of fracture reduction is the strongest predictor of clinical outcome in acetabular fixation surgery.Twenty four patients with posteriorly based acetabular fracture were treated with open reduction and internal fixation using Kocher- Langenbeck incision. In our series, there were 11 posterior wall, 3 posterior column, 5 transverse, 2 posterior column and posterior wall and 3 transverse and posterior wall fractures. All the patients were in the age group of 30 to 45 years (mean age 38.5 years). Males dominated our series (n=18 i.e. 75%) and right side was more commonly involved in both the sexes (n=14 i.e. 58.33%). Road traffic accident was the leading cause (n=19 i.e. 79.16%). All the patients were operated achieving adequate stability and with utmost soft tissue care. Follow up radiograph were graded according to criteria developed by Matta J et al. A minimum follow up was two years. Patient with accurate reconstruction (n =21 i.e. 87.50%) had good or excellent functional outcome while two patients (08.33%) with inaccurate reduction and one patient (04.16%) with poor reduction had fair and poor outcome respectively. Despite relatively large number of possible complications Kocher–Langenbeck Approach is the best suited approach for posterior acetabular fracture.

Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study.

ObjectiveTo investigate the clinical and radiographic short‐term results of arthroscopic treatment for posterior labrum tears with an attached bony fragment after traumatic posterior hip dislocation.MethodsBetween July 2014 and May 2019, a consecutive series of nine patients diagnosed with a posterior labrum tear with an attached bony fragment after traumatic posterior hip dislocation were treated by hip arthroscopic techniques. The patients had been injured in traffic accidents (n = 6) or high falls (n = 3). All patients were provided primary treatment at the emergency department of our institution, and then were transferred to our department for arthroscopy. Demographic data (e.g. gender, age, etc), intraoperative findings, the preoperative and postoperative multiple clinical scores and radiological results were subsequently assessed. Visual analogue scale for pain (VAS) and modified Harris hip scores (mHHSs) were measured and compared before surgery, and at the last follow‐up.ResultsA total of nine patients were enrolled, all of them were male, with a mean age at surgery of 32.2 ± 5.6 years (range, 22–65 years). The patients were followed‐up for an average of 26.5 ± 4.1 (range, 24 to 50 years). During the arthroscopic surgery, all patients had labral tears with posterior acetabular rim fracture. All patients had loose osteochondral fragments. Five had partial or complete tears of ligamentum teres. Two patients had osteochondral damage. Two had capsular rupture. Postoperative X‐ray films and three dimension computed tomography (3D‐CT) showed satisfactory reduction of posterior acetabular wall fractures. The mHHS before surgery and at 1 year and 2 years after surgery were 51.8 ± 4.3, 81.8 ± 2.0 and 87.5 ± 1.9 respectively; VAS scores were 5.6 ± 0.5, 1.3 ± 0.3 and 0.7 ± 0.3 respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS and VAS scores at 1 year and 2 years after surgery (P < 0.01). There was no significant improvement in the mHHS and VAS scores between 1 year and 2 years after surgery (P < 0.05). At the final follow‐up, all patients had regained full range of motion (ROM) and were satisfied with the results. None of the patients showed signs of heterotopic ossification, avascular necrosis or progression of osteoarthritis of the hip joint.ConclusionTraumatic dislocation is accompanied by a variety of intra‐articular hip joint pathologies. Managing posterior acetabular rim fracture after traumatic posterior hip dislocation using arthroscopic reduction and fixation with anchors is a safe and minimally invasive option and delays the progression of traumatic osteoarthritis.

Polytraumatized patient with two columns fracture of the acetabulum and skin abrasion, which incision to use with soft tissue: A case report at 15 years follow-up

Posterior fractures of the acetabulum are the most frequent pattern of acetabular fractures. Based on the works of Judet and Letournel, accurate reduction and stable osteosynthesis with early mobilization have become the gold standard for the treatment of posterior acetabular fractures. Recently, a less invasive approach has been described to decrease Kocher-Langenbeck (K-L) approach complications. The clinical case describes a patient affected by two-column fractures of the acetabulum with skin abrasions of the gluteus. The clinical evaluation was based on Merle d’Aubigne and Postel scoring, which Matta has modified. The approach used is a modified, less invasive K-L: a straight skin incision from the midpoint between the posterior superior iliac spine and the posterior tip of the greater trochanter. We observed the essential advantages using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early postoperative rehabilitation, we examined the strength of the gluteus maximus, which was better than in patients treated with the typical Kocher–Langenbeck approach. The patient resumed after fifteen years after surgery; hip mobility is complete and painless.

Outcome of Open Reduction and Internal Fixation of Posterior Acetabular Fractures

Background:Acetabular fractures are a common clinical challenge. The posterior wall fractures represented 35% of all acetabular fractures and usually complexed. The curative treatment is surgical and depends on the fracture anatomy and surgeon preferences. Aim of the Work:The current study aimed to assess the short term results of posterior acetabular fractures management by open reduction and internal fixation. Patients and Methods:Thirty patients with displaced posterior wall acetabular fractures were included. They were treated by open reduction and internal fixation using neutralizing plates and screws. All patients were assessed by a pre-prepared trauma assessment sheet. Post-operative, active assisted and pain free passive range of motion exercises in all planes was advised. Functional outcome was evaluated using the Merle D'Aubinge and Postel score. Patients were followed up initially at 3 weeks intervals for first 2 months and thereafter at 6 weekly intervals for the next 6 months. Result:Patients were classified to two groups: Group [A] “70%” patients with isolated posterior wall fracture, and Group [B] “30%” of patients with posterior column plus posterior wall acetabular fracture. Both groups were comparable regarding age, gender, side and mode of trauma. The double plating fixation method was significantly increased in group B when compared to group A [77.8% vs. 0.0% respectively]. Group B was associated with significant increase of operative time than group A [164.44±13.33 vs. 128.57±27.80 minutes, respectively]. Blood loss significantly increased in group B than group A [1422.22±376.76 vs. 780.95±437.46 ml, respectively]. The excellent outcome was significantly associated with younger age, lower or absent complications, and anatomical [good quality] of direct postoperative radiological outcome. Conclusion: Most of our patients had an excellent and good outcome as a result to application of more strict selection criteria of patients and pattern.

Knee injuries concomitant to posterior acetabular fractures: an association to look for.

Acetabular fractures are frequently associated with other skeletal injuries, particularly knee injuries. This study aims to evaluate the relationship between posterior acetabular fractures and knee injury, analyzing its patterns and association with other injuries. This is a retrospective monocentric study in a tertiary referral centre. We reviewed the data (age, sex, type of fracture, and concomitant injury) of patients hospitalized for a posterior acetabular fracture. We recorded concomitant knee injury diagnosed up to oneyear following acetabular fracture. Two-hundred-seventeen patients (177 males/40 females) were included. The mean age was 40.5years. Eighty-five patients (39%) had a concomitant hip dislocation, nine (4.1%) had sciatic nerve palsy, 17 (7.8%) had upper extremity injury, and 18 (8.3%) had lower extremity injury (other than the knee). Eight (3.7%) patients had spine injury, 11 (5.1%) had severe thoracic injury, nine (4.1%) had an abdominal injury, and four (1.8%) had a head injury. There were 33 (15.21%, 95% CI 10.80-20.8%) patients (30 M/3 F) (group 1) with a concomitant knee injury and 184 patients without a concomitant knee injury(group 2). The mean age in group 1 was 34.3 compared to 45.4 in group 2(p = 0.021). The pattern analysis revealed five fractures, 14 ligamentous injuries (PCL injuries = 68%), and 14 soft tissue injuries. Sixteen (48.48%) injuries were identified during hospitalization and 17 (51.51%) during follow-up. There were an association between knee injury and upper extremity injury (OR = 3.49 95% CI 1.12-10.00,p = 0.022) and other lower extremity injury (OR = 3.18 95% CI 1.03-8.95,p = 0.032). Knee injury is the second most frequent lesion associated with posterior acetabular fractures. Being missed in half of cases, we recommend a systematic examination of ipsilateral knees under general anaesthesia, keeping a high index of suspicion and a low threshold for complementary knee imaging. Knee injury should be mainly looked for in patients younger than 60years and in those with upper and/or lower extremities injuries.

Comparison of clinical and radiological outcomes after posterior acetabular fractures in patients younger and older than 40 years old

Aim: This study aimed to evaluate and compare the clinical and radiological outcomes of patients aged >40 years and ≤40 years old, who underwent open reduction internal fixation for posterior fracture and/or fracture dislocation of the acetabulum.Material and Methods: A total of 52 patients who underwent surgical treatment for posterior acetabular fracture and/or fracture dislocation between June 2006 and October 2013 were included in this study. The patients were divided into the following 2 groups: group I, patients aged 40 years (n = 27; mean age, 53.3; mean follow-up period, 36.8 months). The Judet–Letournel classification system was used in the radiological classification of acetabular fractures. Clinical and radiological evaluations were performed using the modified Merle D’Aubigne evaluation score and the criteria developed by Matta, respectively. In addition, radiological evaluation for heterotopic ossification was performed according to the Brooker scoring system.Results: No significant difference in the quality of reduction and clinical and radiological findings was found between the two groups (p>0.05). The modified Merle D’Aubigne clinical outcome distribution and the distribution of Matta radiological results in groups I and II did not differ significantly (p>0.05 and p>0.05, respectively). Moreover, no significant difference in the development of postoperative heterotopic ossification was observed between the groups (p>0.05). Conclusion: Clinical and radiological outcomes are not significantly different between patients younger and those older than 40 years. Nevertheless, the clinical outcome scores are better in patients aged ≤40 years.

A prospective study to analyse the surgical outcome of posterior acetabular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of acetabulum are relatively uncommon, but because they involve major weight bearing joint in the lower extremity, they assume great clinical importance. Acetabular fractures are still difficult fractures to manage and are a major challenge to treating orthopaedic surgeon. The present study was aimed to study the surgical outcome of posterior acetabulum fractures and postoperative complications and failures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A one year prospective study was done after ethical approval. Patients with traumatic injury and posterior acetabular fracture was included and categorized according to the Letournel-Judet classification. Kocher-Langenbeck approach was used for all the cases and clinical follow-up and radiological evaluation was done up to 12 months. Evaluation of different demographic elements with reference to Harris hip score was also carried out. Statistical analysis was performed using the Statistical Package for the Social Sciences software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty cases with mean age 42.6 years and males 65% were included. Road traffic accident was cause in 65% of cases.50% of the cases had good, 20% excellent, 25% fair and 5% poor outcome in our study by Harris Hip scoring. Two cases of superficial infection, one deep infection, iatrogenic sciatic nerve injury in one, heterotopic ossification in one and one case of intra-articular screw penetration was observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Operative treatment of displaced acetabular fractures gives satisfactory functional results. Thorough evaluation of radiograph/ CT scan and a proper pre-operative planning is necessary for decision making regarding an appropriate surgical approach, the appropriate type of implant and fixation.&lt;/p&gt;

Study and results of reconstruction plating in fracture posterior column and posterior wall of acetabulum

Background: Posterior acetabulum fractures are the most common type of acetabular fractures. Acetabular fracture was an enormous orthopaedic problem in which the treatment was grossly inadequate and many patients were left with incapacitating pain. These fractures were often feared because of the poor outcome in many patients treated non- operatively. There are few published studies with a prolonged follow up. Thus this study was to review the displaced posterior acetabular fractures treated operatively in our hospital during last 3 years with regards to clinical, radiological results, the rate of surgical complication and the rate of successful fracture reduction. Methods: The patients with posterior acetabulum fractures were diagnosed on basis of clinical suspicion and confirmed on x-rays and CT scans. Displaced fractures were treated surgically in lateral position through Kocher- Langenbeck approach and fractures were fixed with reconstruction plates and cancellous screws and results studied. Results: Clinical grading was based on Merle d’Aubigne and Postel scoring which has been modified by Matta, According to this scale excellent to good results seen in 76.66% and fair results seen in 23.33% of cases. Radiological assessment grading according to the criteria developed by Matta, According to this criteria excellent to good radiological results are seen in 79.66% and poor results in 6.66% of cases. Conclusions: Displaced posterior acetabular fractures treated by open reduction and internal fixation with anatomical reduction allow early mobilisation and weight bearing and gives excellent results.

Surgically Treated Posterior Acetabular Fractures Via Iselin’s Modified Approach with A Short-Term Follow-Up

Objective: The main purpose of the surgical treatment of posterior acetabular fracture is to achieve anatomical reduction to attain a functional and stable hip joint without pain. Although Kocher-Langenbeck (K-L) approach is the most commonly used surgical exposure, various modified approaches have been described in the literature. The aim of this study to determine the early surgical results of the acetabulum posterior fractures surgery via Iselin's modified K-L approach. Methods: We reviewed the hospital records of patients who were operated for acetabulum posterior wall fractures via Iselin's modified approach between 2016 and 2018. All patients had detailed radiological, clinical evaluation and fractures were classified by AO/ASIF classification. All patients had radiological and clinical evaluation at the end of the postoperative 1st year. Results: There were 16 men and 4 women with an average age of 42.8±18.0 (range 18-77) years. The average follow-up was 14.8±6.1 (range 6-28) months. The right hip was involved in 12 (60%) patients and the left in 8 (40%) patients. The average operative time was 78.6±16.7 (range, 54–115) minutes. Average blood loss during the operation was 179.22±51.9 (range, 100–260) ml. The postoperative reduction was graded as anatomic (0–1 mm of displacement) for 17 hips and imperfect (2–3 mm of displacement) for 3 patients. No patient had a deep infection, implant loosening, recurrent dislocation, deep venous thrombosis (DVT), pulmonary embolism (PE) or revision fixation. Conclusion: The modified approach of Iselin is a successful approach with its ease in the surgery of displaced fractures that extending proximally and early radiological and functional results.

Direct posterior approach for the treatment of posterior acetabular fractures

Objective To explore surgical technique and clinical results of the direct posterior approach (DPA) for acetabular fractures involving posterior column, posterior wall, or posterior column and wall. Methods From January 2016 to June 2017, data of 10 cases (7 males, 3 females, an average age of 37 years, ranging from 17 to 54 years) with posterior acetabular fractures treated by the DPA were retrospectively analyzed. Fractures were caused by traffic accident in 6 cases and by falling in 4 cases. According to Letournel-Judet classification of acetabular fractures, there were 6 cases of posterior acetabular wall fractures, 4 cases of posterior wall fractures involving posterior column. A straight skin incision was made from the middle of the line between the posterior margin of the tip of the femoral greater trochanter and the posterior superior iliac spine, to the posterior margin of the femoral greater trochanter. The gluteus maximus muscle was cleaved longitudinally. A view of the area from hip capsule to the superior margin of the greater sciatic foramen was obtained by entering along the interspace of the gluteus medius and pyriformis muscle, and the superior gluteal neurovascular bundle was protected. Acetabular posterior column and posterior wall fractures were reduced and fixed under direct vision. The fracture reduction, fracture healing, femoral head necrosis, sciatic nerve injury, superior gluteal neurovascular injury and heterotopic ossification were evaluated by the postoperative X-ray and CT examination. The function of hip joint was assessed by the Merle d’Aubigne-Posteal score modified by Matta. Results The average operative incision length was 9.6 cm (range, 8-11 cm). The average operation time was 50 min (range, 35-80 min). The average blood loss was 310 ml (range, 200-440 ml). The time of follow-up was 12-30 months. All the patients were healed within 8-12 weeks without any complications such as superior gluteal nerve injury, superior gluteal vessel injury, or sciatic nerve injury. One case of acetabular posterior wall and posterior column fracture with posterior dislocation of hip joint, suffered from femoral head necrosis at the 9th months after surgery, which was treated by total hip arthroplasty and was recovered one year after surgery. In one case of actebular posterior wall and posterior column fracture, heterotopic ossification occurred 3 month after operation, without any special treatment and the hip joint activity was not affected at the follow-up of 15 months after surgery. During the 12-month follow-up after surgery, the Merle d’Aubigne-Postel score modified by Matta was 13-18, among which there were excellent in 6 cases, good in 2, acceptable in 2, with an overall excellent and good rate of 80% (8/10). Conclusion The direct posterior approach for posterior acetabular fractures can obtain satisfactory clinical results. The advantages of the DPA include decreasing trauma, shortening operation time, reduing blood loss and decreasing risks of iatrogenic injury to the gluteus medius muscle, the external rotators, the arteriae circumflexa femoris medialis and sciatic nerves as well as reducing and fixing the fractures under direct vision. Thus, the DPA is a relatively safe surgical approach for acetabular posterior wall/column fracture. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal

A novel approach for posterior acetabular fractures: Surgical technique.

This article describes a novel approach, the Direct Posterior Approach (DPA) for the treatment of posterior acetabular fractures (posterior column, posterior wall, or both posterior column and wall). This technique allows direct visualization of the entire posterior wall, part of the hip capsule and the posterior column between the space of the gluteus medius and the piriformis superiorly. The approach spares the division of short external rotators, abductors, and hip capsule, thus preventing iatrogenic damage to the medial femoral circumflex artery, sciatic nerve, and superior and inferior gluteal neurovascular bundles, as well as protecting the vascularity of the fracture fragments. In addition to the low blood loss, short operative time and low risk of iatrogenic injury, patients who are treated by the DPA approach exhibit positive functional recovery in follow-up. DPA is an effective, safe and minimally-invasive technique for the treatment of posterior acetabular fractures.

Study and results of reconstruction plating in fracture posterior column and posterior wall of acetabulum

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Posterior acetabulum fractures are the most common type of acetabular fractures. Acetabular fracture was an enormous orthopaedic problem in which the treatment was grossly inadequate and many patients were left with incapacitating pain. These fractures were often feared because of the poor outcome in many patients treated non-operatively. There are few published studies with a prolonged follow up. Thus this study was to review the displaced posterior acetabular fractures treated operatively in our hospital during last 5 years with regards to clinical, radiological results, the rate of surgical complication and the rate of successful fracture reduction.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The patients with posterior acetabulum fractures were diagnosed on basis of clinical suspicion and confirmed on x-rays and CT scans. Displaced fractures were treated surgically in lateral position through Kocher-Langenbeck approach and fractures were fixed with reconstruction plates and cancellous screws and results studied&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Clinical grading was based on Merle d’Aubigne and Postel scoring which has been modified by Matta, According to this scale excellent to good results seen in 76.66% and fair results seen in 23.33% of cases.&lt;strong&gt; &lt;/strong&gt;Radiological assessment grading according to the criteria developed by Matta, According to this criteria excellent to good radiological results are seen in 79.66% and poor results in 6.66% of cases. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Displaced posterior acetabular fractures treated by open reduction and internal fixation with anatomical reduction allow early mobilisation and weight bearing and gives excellent results.&lt;/span&gt;&lt;/p&gt;

Surgical Treatment of Unstable Posterior Wall Acetabular Fractures

: Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Aim: To evaluate the results of surgical treatment of unstable posterior wall fractures with open reduction and internal fixation. Patients and Methods: In this study, 16 patients with unstable posterior wall acetabular fractures. As regard age of the patients, it ranged from 20- 60 years with mean 32.8±9.12 years. They were 12 males and 4 females. The cause of trauma was road traffic accident (RTA) in all patients. All patients were operated upon with open reduction and internal fixation using reconstruction plates and cancellous screws for treatment posterior acetabular fracture in the period from March 2014 to March 2016 with follow up period ranging from 2 months to 2 years. Results: Satisfactory functional outcome was obtained in 12 cases, excellent in 5 and good in 7 cases, while unsatisfactory functional outcome was obtained in 4 cases, fair in 3 and poor in one. Conclusions: Open reduction and internal fixation is an effective method for treatment of unstable posterior acetabular wall fractures. Surgical treatment leads to early rehabilitation and avoiding complications as osteoarthritis

Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion.

BackgroundThe aim of this study was to provide valid data for a plate-screw fixation model for fractured posterior-anterior columns of the acetabulum.Material/MethodsNineteen cadaveric bony hemi-pelvis specimens were obtained and 50 healthy adults were enrolled. The modified Stoppa approach and computed tomography (CT) imaging were used to collect the measured parameter data of the module.ResultsThe measured parameter data were as follows: OP, 0.96±0.32 cm in females and 0.92±0.16 cm in males (P>0.05); PI, 0.98±0.28 cm in females, and 0.75±0.23 cm in males (P>0.05); ∠θ, 59.68°±6.28° in females and 56.75°±3.22° in males (P>0.05); and ∠ϕ, 41.27°±2.76° in females and 34.31°±2.78° in males (P<0.05). The corresponding CT image data were as follows: PI, 1.08±0.22 cm in females and 0.85±0.27 cm in males (P>0.05); OP, 1.06±0.29 cm in females and 1.12±0.24 cm in males (P>0.05); ∠θ, 55.33°±4.00° in females and 55. 50°±3.43° in males (P>0.05); and ∠ϕ was 39.21°±2.45°in females and 35.58°±2.31°in males (P<0.05). No significant difference with respect to sex and side existed between specimens and healthy adults (P>0.05).ConclusionsThe measured parameter data obtained in healthy adults and cadaveric specimens provided an anatomic basis for the designation of the guide module, and thus confirmed the accuracy and safety of screw placement in fractured columns of the acetabulum.