Traumatic Acetabular Fractures Research Articles

Outcome of primary fixation of traumatic acetabular fractures

Objectives; Traumatic acetabular fracture is a major injury with high association of mortality, morbidity and long recovery period. Surgical management of acetabular fracture is a technical challenge needing high level of skills and vigilance because of the complex anatomy and risk to surrounding structures. We aim to look at two surgical techniques for fixation of acetabular fracture and their outcome in this study. Methods; Between April 2018 and March 2023, a total of 26 patients (15 males and 11 females) were treated for acetabular fracture fixation. 10 were treated with minima invasive technique Close reduction and per-cutaneous fixation because of good reduction was achieved under image guidance and 16 patients had ORIF with use of various recon plates, screws and wires. Results; All patients were followed up for 12 months. Among all patients, the clinical outcomes were recorded as excellent in 17 patients (17/26, 65%), good in 5 (5/26, 19%), fair in 2 (2/26, 7.7%), and poor in 2 (2/26. 7.7%), according to the modified Merle d’Aubigné-Postel score. The average modified Merle d’Aubigné-Postel score was 15 ± 2.0 points (range, 10–18 points). The radio-logical healing was assessed according to the Matta score [22] and were reported excellent in 15 patients (15/26, 57.6%), good in 7 (7/26, 26.8%), fair in 1 (1/26, 3.8%),and poor in 3 (3/26, 11.5%). Conclusion; our study shows comparable clinical outcome for acetabular fracture fixation using either ORIF or CRPF technique. Right patient choice and good knowledge of anatomy is of paramount importance.

Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.

Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation.

The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation. All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008-18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline. Hemoglobin & hematocrit data were then used to calculate quantitative blood loss between pre- and post- operative blood counts for data analysis. 371 patients with unilateral traumatic acetabular fractures requiring fixation were reviewed; 99 of these had visible bladder outlines, complete blood count and transfusion data (2008-2018; 66% associated patterns). Median bladder shift (BS) was 13.3%. Every 10% of bladder shift was associated with 123mL greater IBL. Patients with full bladder shift to midline sustained a median 1.5L IBL (interquartile range [IQR] 0.8 to 1.6). Associated patterns had a threefold greater median BS (associated: 16.5% [15.4 to 45.9] vs. elementary: 5.6% [1.1 to 15.4], p < 0.05) and received intraoperative pRBC twice as frequently (57% vs. 24%, p < 0.01). Radiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions.

Hip Function after Surgically Treated Isolated Traumatic Acetabular Fracture: A Prospective Series of Consecutive Cases.

Isolated acetabular fractures can occur as a result of a high energy impact on the hip joint. Surgery is required for most patients with an isolated acetabular fracture in order to alleviate pain, restore joint stability, and regain hip function. This study was conducted in order to examine the course of hip function in patients after surgical treatment of an isolated traumatic acetabular fracture. This prospective series of consecutive cases included patients who underwent surgery for treatment of an isolated acetabular fracture in a European level one trauma center between 2016 and 2020. Patients with relevant concomitant injuries were excluded. Scoring of hip function was performed by a trauma surgeon using the Modified Merle d'Aubigné and Postel score at six-week, 12-week, six-month, and one-year follow-up. Scores between 3-11 indicate poor, 12-14 fair, 15-17 good, and 18 excellent hip function. Data on 46 patients were included. The mean score for hip function was 10 (95% confidence interval [CI] 7.09-12.91) at six-week follow-up (23 patients), 13.75 (95% CI 10.74-16.76) at 12-week follow-up (28 patients), 16 (95% CI 13.40-18.60) at six-month follow-up (25 patients), and 15.50 (95% CI 10.55-20.45) at one-year follow-up (17 patients). After one-year follow-up, the scores reflected an excellent outcome in 11 patients, good in five patients, and poor in one patient. This study reports on the course of hip function in patients who have undergone surgical treatment for isolated acetabular fractures. Restoration of excellent hip function takes six months.

Efficacy of Red Cell Salvage Systems in Open Acetabular Surgery.

Over the past 50 years, treatment of displaced acetabular fractures has moved away from conservative treatment with bedrest to operative intervention to achieve anatomic reduction, stable fixation, and allow early range of motion of the hip. However, operative fixation is not without complications. Internal fixation of traumatic acetabular fractures has been coupled with large volume of blood loss both at the time of injury and surgery. This often results in the need for allogenic blood products, which has been linked to increase morbidity (Vamvakas and Blajchman, 2009). In an attempt to avoid the risk associated with allogenic blood transfusion numerous techniques and methods have been devised. Red blood cell salvage (CS) is an intraoperative blood salvage tool where blood is harvested from the operative field. It is washed to remove the plasma, white blood cells, and platelets. The red cells are resuspended in a crystalloid solution. If the hematocrit of the resuspended red blood cells is sufficient, it is transfused to the patient intravenously. The benefits of CS in major spine surgery, bilateral knee replacement, and revision hip surgery are well established (Goulet et al. 1989, Gee et al. 2011, Canan et al. 2013). However, literature reviewing the use of cell saver in orthopedic trauma surgery, specifically acetabular surgery is limited. Our institute performed a retrospective review of 63 consecutive operative acetabular fractures at a level one trauma center. Our study revealed that patients with blood loss of less than 400 mL were 13 times less likely to receive autologous blood, and patients with hemoglobin less than 10.5 were 5 times less likely to receive autologous transfusion (p < 0.05). We also found that no patients with a hemoglobin level less than 10.5 and EBL less than 400 mL received autologous blood return. Autologous blood transfusion had no effect on volume or rate of allogenic blood transfusion. We believed that if a patient's preoperative hemoglobin is less than 10.5 or expected blood loss is less than 400 mL, then CS should have a very limited role, if any, in the preoperative blood conservation strategy. We found ASA greater than 2, BMI greater than 24 and associated fracture type to be a risk factor for high blood loss.

As an unusual traumatic presentation, acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture: a retrospective case series of 18 patients

BackgroundAcetabular fracture and concomitant ipsilateral intertrochanteric femur fracture has been suggested as an unusual traumatic presentation and rarely reported in the literature. The aims of this study were (1) to identify the etiological characteristics, (2) to summarize the treatment strategy, and (3) to present the mid- to long-term results of patients with this rare traumatic presentation.MethodsIn this retrospective study, 18 patients (15 males, 3 females; mean age = 42.77 ± 17.74 years, range = 16 to 87 years) who were diagnosed and treated for simultaneous acetabular fracture and ipsilateral intertrochanteric fracture were included. Injury mechanisms, fracture classifications, and treatment strategies were noted. To assess functional status, the Harris score was used. To evaluate pain intensity, visual analogous scale (VAS) was used. The reduction quality of acetabular fractures was examined as per Matta’s standard. Postoperative complications were also recorded.ResultsThe mean follow-up was 10.04 ± 3.38 (range = 6.2 to 16 years). The most common injury mechanism was traffic accident, followed by falling from a tall height. As per the Evans classification, intertrochanteric fractures were defined as type 3 in 13 patients, type 2 in one patient, and type 4 in 4 patients. In acetabular fracture site, the most common fractures were posterior wall fractures, followed by anterior column fractures. All patients received internal fixation for their intertrochanteric fractures. Ten out of 18 patients also received internal fixation for their acetabular fracture. However, for the remaining patients, acetabular fractures were treated conservatively or with fracture fragment resection. Bony healing was achieved in all but one patient who died postoperatively. Twelve patients achieved excellent and good results (Harris score ≥ 80 points) whereas five patients achieved fair and poor results (Harris score < 80 points). The proportion of patients who achieved an excellent-good Harris score was 70.6%. Dislocation of the hip was found to be an independent risk factor (HR = 9.194, 95% CI = 1.024-82.515) for the poor patient outcome.ConclusionTo sum up, high-impact trauma is the main cause of acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture. For patients who have undergone surgical treatment, fracture healing is usually achieved. However, the occurrence of complications, especially avascular necrosis, is the major cause of a poor prognosis. Dislocation of the hip joint at the time of injury is considered to be an important risk factor for a poor prognosis.

A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification

PurposeHeterotopic ossification (HO) is a potentially disabling disorder of ectopic bone formation secondary to orthopedic surgery or trauma. In this retrospective analysis we evaluated the outcomes of patients who received radiation therapy (RT) for HO prophylaxis. Methods and MaterialsA total of 287 patients who received RT for HO prophylaxis at a major trauma center from 2007 to 2018 were analyzed. Data collected included types of injury, surgery, time intervals between key events, development of postprophylaxis HO, and secondary malignancies. Associations between various factors and the risk of developing HO were analyzed. Kaplan-Meier analysis was used to estimate failure rates. ResultsThe most common indication for RT was traumatic acetabular fracture (83.3%). Twelve patients (4.2%) developed postprophylaxis HO with a median time to failure of 8.6 months (2.8-24.5). Kaplan-Meier 1-, 2-, and 5-year failure rates were 3.7%, 4.4%, and 7.4%, respectively. Injury type and timing of RT were not associated with the risk of failure, but we observed a trend of increased risk of failure in patients with longer time between surgery and RT (odd ration [OR] 1.68, P = .056). Current or former smokers (51.7%) were less likely to fail (OR 0.10, P = .03). There was no incidence of in-field secondary malignancy. ConclusionsThere was no significant association between injury and fracture type, surgical approach, or timing of RT and development of HO, contrary to published reports of increased HO risk with certain surgical approaches and longer time intervals between injury and surgery, suggesting that prophylactic RT might play a role in mitigating these effects. Decreased risk of postprophylaxis HO among former or current smokers was unexpected. No secondary malignancy in the RT field was identified, although the median follow-up was only 17 months. Compared with published HO incidences (17%-39%) in patients who receive no prophylaxis after traumatic acetabular fractures, our results are highly suggestive of the efficacy of prophylactic RT.

Results of Modified Ilioinguinal Approach in Management of Acetabular and Pelvic Fractures (A Systematic Review and meta-analysis of Literature)

Abstract Background Modified ilioinguinal approach was introduced to manage anterior acetabular fractures to reduce the morbidity &amp; complications of the classic ilioinguinal approach, a less invasive anterior approach consisting of a medial window combined with the lateral window of the ilioinguinal approach. Aim of the Work a systematic review to determine whether the modified ilioinguinal approach is better the classic ilioinguinal approach in managing traumatic acetabular fractures by comparing the results in each study. Materials and Methods 5 studies(from 2010-2017) were included &amp; reviewed the results of 147 patients operated by modified ilioinguinal approach in terms of: operative details, intraoperative &amp; postoperative complications, postoperative reduction quality &amp; final clinical outcome assessment, &amp; results was analyzed &amp; pooled together to reach a satisfactory outcome. Results Modified ilioinguinal approach showed operative time (123.2±6.83 minute), relatively small amount of blood loss (200-1000 ml) &amp; better quality of reduction (84.8% had anatomical reduction, 10.9% had fair reduction, and 4.3% had poor reduction). However there were no significant differences in terms of postoperative complications &amp; final clinical outcome assessment between different studies. Conclusion It was concluded that the modified ilioinguinal approach allowed reduction of anterior column and pelvic ring fractures without requiring dissection through the inguinal neurovascular structures. Results showed that its possible with this approach to reach safe reduction and stable fixation.

A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification

Abstract Purpose Heterotopic ossification (HO) is a potentially disabling disorder of ectopic bone formation secondary to orthopedic surgery or trauma. In this retrospective analysis we evaluated the outcomes of patients who received radiation therapy (RT) for HO prophylaxis. Methods and Materials A total of 287 patients who received RT for HO prophylaxis at a major trauma center from 2007 to 2018 were analyzed. Data collected included types of injury, surgery, time intervals between key events, development of postprophylaxis HO, and secondary malignancies. Associations between various factors and the risk of developing HO were analyzed. Kaplan-Meier analysis was used to estimate failure rates. Results The most common indication for RT was traumatic acetabular fracture (83.3%). Twelve patients (4.2%) developed postprophylaxis HO with a median time to failure of 8.6 months (2.8-24.5). Kaplan-Meier 1-, 2-, and 5-year failure rates were 3.7%, 4.4%, and 7.4%, respectively. Injury type and timing of RT were not associated with the risk of failure, but we observed a trend of increased risk of failure in patients with longer time between surgery and RT (odd ration [OR] 1.68, P = .056). Current or former smokers (51.7%) were less likely to fail (OR 0.10, P = .03). There was no incidence of in-field secondary malignancy. Conclusions There was no significant association between injury and fracture type, surgical approach, or timing of RT and development of HO, contrary to published reports of increased HO risk with certain surgical approaches and longer time intervals between injury and surgery, suggesting that prophylactic RT might play a role in mitigating these effects. Decreased risk of postprophylaxis HO among former or current smokers was unexpected. No secondary malignancy in the RT field was identified, although the median follow-up was only 17 months. Compared with published HO incidences (17%-39%) in patients who receive no prophylaxis after traumatic acetabular fractures, our results are highly suggestive of the efficacy of prophylactic RT.

Acetabular fractures: Is it possible to regain the same patient’s related quality of life before trauma?

Introductionacetabular fractures are difficult to treat with often an unsatisfactory results for patients. The aim of this study is to investigate about the health-related quality-of-life outcome of patients with a traumatic acetabular fracture, as recorded at least 24 months after their surgery. Methodsa cohort of patients underwent a dedicated acetabular surgical reconstruction for a pelvic trauma between November 2011 and May 2016, were enrolled to investigate, at least two years after injury, their midterm quality of life; SF-36 and LiSat-11 were used. Results35 patients were enrolled but only 28 patients were revisited, 20 males (714%) and 8 females (286%) with a mean age of 43 years (19–73). The most common cause was motor vehicle accident (655%). Lower score after trauma are reported in both tests, SF-36 and LiSat 11, for all items. Discussioncomparing the SF-36 score in the Italian normative sample with our SF-36 score before the trauma there is no statistically significant difference (p = 0.1661) underlining how the patients before the trauma were healthy and in good health. Both scores, SF-36 and LiSat-11, before and after trauma are statistically different with respectively p = 0,0002 and p = 0,049 which proves the lower quality of life after trauma in comparison to their life before trauma. ConclusionsAlthough the treatment protocols of acetabular fractures have greatly improved over the years, these continue to have disabling consequences that hardly allow to recover a good quality of life two years after the trauma.

Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification.

Scattered radiation during radiotherapy (RT) directed at the hip joint poses concerns about ovarian function in patients of reproductive age. Here, we report the impact of using a split-beam technique (SBT) and different photon energies on the total ovary dose during radiation prophylaxis of heterotopic ossification (HO). This was a single-institution, retrospective study of 32-patients with traumatic acetabular fractures (TAF). All underwent surgery followed by CT-based-RT within 72 h in a single fraction of 700 cGy. Ipsilateral (IL) and contralateral (CL) ovaries (OV) were contoured separately and dose volume histograms (DVH) generated. Additional planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6-18 MV) to investigate the difference in ovary dose among these maneuvers. The median Mean-dose delivered to ILOV was 59 cGy and the median Max-dose was 177 cGy. CLOV median Mean-dose was 6 cGy and median Max-dose was 10 cGy. SBT at the medial edge of the field led to a 27% and 22% dose reduction in the median Mean and Max. doses, respectively, to ILOV; 9% and 5% reduction was seen in the median Mean and Max. doses, respectively, to CLOV. Higher photon energies (10-18 MV) led to an additional 28% and 16 % reduction in median Mean and Max. doses, respectively, to ILOV when compared to those from 6 MV. The CLOV median Mean dose was reduced by 18% and the Max. dose was reduced by 12%. A biologically significant radiation dose is delivered to the ovaries during HO radiation prophylaxis at the hip joints. Ipsilateral ovarian dose could be reduced by half and contralateral by one-quarter by using CT-based treatment planning with a medial SBT and photon energies above 6 MV. We suggest using no more than 10 MV to minimize neutron contamination. Those techniques should be the standard of care as it provides a reliable method for minimizing the radiation dose to the ovaries, consequently, maximizing female fertility preservation during HO radiation prophylaxis. All female patients in childbearing age should be fully informed about ovarian radiation exposure and possible temporary alteration in ova production and morphology.

A Method to Improve the Safety and Tolerability of External Beam Radiation Therapy for Heterotopic Ossification Prophylaxis

Heterotopic ossification is a debilitating form of dystrophic calcification that occurs in 50-90% of patients with traumatic acetabular fractures. Radiation therapy in the peri-operative period is a proven intervention to reduce the incidence of heterotopic ossification. However, as many of the patients requiring radiation have suffered polytrauma and/or are clinically unstable, the treatment of these patients can be logistically challenging, uncomfortable for the patient and, at times, clinically unsafe. In this study, we describe the development and characterization of a clinical protocol in which the diagnostic images obtained on patients requiring radiation therapy for HO prophylaxis can be used for radiation treatment planning. This protocol allows for individualized patient treatment plans to be generated and transferred to the record and verify system prior to the patient being brought to the department for therapy. Using this method, these often times critically ill patients can be treated with improved efficiency and safety. We retrospectively identified 10 patients treated in 2015 in our department after traumatic hip fracture for heterotopic ossification prophylaxis who had undergone CT simulation for treatment planning. The diagnostic CT scans of the patients obtained by orthopedic surgery immediately post operatively to examine hardware placement were imported into the MIMvista system and corrected for orientation and then adjusted to a neutral pelvis alignment. These scans were then imported into the Pinnacle treatment planning system and plans were designed to treat the affected hip to 7.5 Gy in 1 fraction per institutional standard for HO prophylaxis. In order to determine the safety of this protocol, the treatment plans were then transferred without alteration onto the CT data set obtained at the time of CT simulation, and the dose distributions were compared. There were limited differences in the dose distributions in the plans generated on the diagnostic scans and dose distributions after transfer to the CT simulation data sets. The maximum point dose was within 1% (range -1% to 1%), and the volumes receiving 7.5 Gy and 7.0 Gy were within 25% (range, -25% to 20%) and 6% (range -3% to 6%) respectively. Additionally, the treatment plans after transfer to the CT simulation data sets were each reviewed by four physicians in the department not involved in the replanning portion of the study, and 100% of the plans were felt to be appropriate for treatment. This study demonstrates that diagnostic imaging scans can reasonably be used to plan patients requiring radiation for heterotopic ossification prophylaxis. As a result, patients can be treated efficiently, potentially reducing the time they will spend in the department and improving patient safety.

Testicular Dose During Prophylaxis of Heterotopic Ossification with Radiation Therapy

A single-institution, retrospective study was performed to investigate potential techniques to minimize radiation exposure to the testicles during heterotopic ossification (HO) prophylaxis. We report the impact of split-beam technique (SBT) and different photon energies on the total dose of radiation received by the testicles during prophylaxis of HO. Between 2008 and 2010, we identified 64 patients with traumatic acetabular fractures who underwent surgery followed by radiation therapy (RT) without testicular shielding. Postoperative RT was delivered within 72 h in a single fraction of 700 cGy using 6-18 MV photons, without testicular shielding due to patient refusal. All patients underwent 3-D RT planning in which the testicles were contoured as a region of interest and dose-volume histograms (DVH) were generated. Additional treatment planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6, 10 and 18 MV) to study the effects of these maneuvers on the delivered dose to the testicles. In reviewing the DVH, it was noted that the mean dose delivered to the testicles was 10 cGy (range=3-40). The maximum dose was 31 cGy (range=7-430). When SBT was utilized, a significant reduction in the mean (44%) and maximum (47%) doses delivered to the testicles was noted. Further reductions in the mean (26%) and maximum (14%) doses were achieved by using higher-energy (10-18 MV) beams. The radiation doses to the testicles from the CT simulation and the two portal images were estimated to be 4 and 1.5 cGy, respectively. Low-dose prophylactic RT to prevent HO around the hip causes a low, but likely biologically meaningful, radiation dose to be delivered to the testicles. This dose could be further reduced by using a medial SBT and photon energies above 6 MV. Testicular shielding should be offered to all male patients receiving such RT. In addition, all patients should be informed about the consequences of testicular radiation as part of their informed consent.

Outcomes of total hip replacement in limbs affected by poliomyelitis.

The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.

The Risk of Radiation-Induced Malignancy With Heterotopic Ossification Prophylaxis: A Case–Control Analysis

Heterotopic ossification (HO) is a debilitating complication following traumatic fracture or hip surgery. Prior research has shown that prophylactic RT given in a single fraction is more effective and more tolerable in the prevention of HO in the perioperative elderly population than six weeks of indomethacin. Given treatment efficacy, more cases of younger patients with traumatic fractures are being referred for prophylactic RT for HO. A recent case report documented the first incidence of radiation induced sarcoma in a 37 year old male following RT for a traumatic acetabular fracture.

Computerized tomography-based radiotherapy improves heterotopic ossification outcomes

PurposeTo report the impact of computerized tomography (CT) based radiotherapy (RT) on heterotopic ossification (HO) outcomes. MethodsThis is a single institution, retrospective study of 532 patients who were treated for traumatic acetabular fractures (TAF). All patients underwent open-reduction internal-fixation (ORIF) of the TAF followed by RT for HO prophylaxis. Postoperative RT was delivered within 72h, in a single fraction of 7Gy. The patients were divided into 2 groups based on RT planning: CT (A) vs. clinical setup (B). ResultsAt a median follow up of 8years the incidence of HO was 21.6%. Multivariate regression analysis revealed that group (A) vs. (B) had HO incidence of 6.6% vs. 24.6% (p<0.001), respectively. Furthermore, HO Brooker grade ≥3 was observed in 2.2% vs. 10.8% (p=0.007) in group (A) vs. (B), respectively. Thus, the odds of developing HO and Brooker grades ≥3 were 4.7 and 4.5 times higher, respectively, in patients who underwent clinical setup. ConclusionOur data suggest that using CT based RT allowed more accurate delineation of the tissues and better clinical outcomes. Although CT-based RT is associated with additional cost the efficacy of CT-based RT reduces the risk of HO, thereby decreasing the need for additional surgical interventions.

Ovarian Radiation Dose During Heterotopic Ossification Radiation Prophylaxis

To evaluate the impact of different photon energies and techniques in the total dose of radiation received by ovaries after radiation prophylaxis RT) of heterotopic ossification (HO) around the hip joint. This is a single-institution, retrospective study investigating the dose of radiation to the ovaries during RT for HO prophylaxis. From January (2008 - 2010), 32 patients, all had traumatic acetabular fractures (TAF) underwent surgery followed by RT. Postoperative RT was delivered within 72 hours in a single fraction of 700 cGy, prescribed to the mid-plane, using MV photons. The fields included the soft tissues around the proximal femur and acetabulum without bone shielding. All patients underwent CT simulation and 2 portal images prior to treatment. In all patients, the ipsilateral (IL OV) and contralateral (CL OV) ovaries were contoured separately as a region of interest and dose volume histograms (DVH) generated. Additional planning trials were created for each patient by utilizing a beam split technique medially and by using different photon energies (6 - 18 MV) to investigate the effects of these maneuvers on the delivered dose to the ovaries. 32 female patients, with median age 41 years (range 18 - 85). In reviewing the DVH for all patients, it was noted that the median Mean dose) delivered to the (IL OV) was 59 cGy (range 6 - 262) and the median Max.dose) was 177 cGy (range 7 - 650). (CL OV) median Mean dose) was 6 cGy (range 1 - 11) and median Max.dose) was 10 cGy (range 1 - 21). When a beam split was applied at the medial edge of the field, (27%, 22%) dose reduction in the mean and max.dose, respectively, delivered to the (IL OV) while (9%, 5%) reduction in the mean and maximum dose, respectively, to the (CL OV). When higher energies (10 - 18 MV) were compared to 6 MV, additional 28%, 16 % reduction in mean and max.doses, respectively, of the (IL OV) were achieved. The (CL OV) mean dose was reduced by 18% and the maximum dose was reduced by 12%. A biologically meaningful radiation dose is delivered to the ovaries during RT HO prophylaxis around the hip. This dose could be reduced to the IL Ov by half and the CL Ov by one-quarter by using simple technical adjustments (medial beam split technique and photon energies above 6 MV). All female patients especially those in the childbearing age should be informed and consented with ovarian radiation exposure and possible temporary alteration in ova production and morphology.Tabled 1ResultsBoth Ovaries DVHIL OV Mean DoseIL OV Max DoseCL OV Mean DoseCL OV Max DoseDelivered Median59 cGy177 cGy6 cGy10 cGyBeam Split Reduction27%22%9%5%10 - 18 MV Reduction28%16%18%12%Total Reduction65%38%27%17% Open table in a new tab

Prophylactic Radiation Therapy is Safe and Effective Treatment for the Prevention of Recurrent Heterotopic Ossification in Elbow and Knee Joints

Conclusions: Our data show there is a higher incidence of HO amongst Class III obese patients after open reduction and internal fixation of traumatic acetabular fractures followed by prophylactic radiation therapy ± Indomethacin. This information can be applied clinically by discussing the risks and benefits of radiation therapy with Class III obese patients undergoing operative repair of acetabular fractures.

Traumatic periprosthetic acetabular fracture treated by acute one-stage revision arthroplasty. A case report and review of the literature

Periprosthetic acetabular fractures are uncommon. Their management is difficult and postoperative complications such as nonunion and prosthetic loosening are common. Few reports concerning traumatic periprosthetic acetabular fractures and their management are available. We present a case of a traumatic, high-energy periprosthetic T-Type acetabular fracture without dislocation of the components of the arthroplasty, treated by an acute one-stage revision arthroplasty. To our knowledge, there have been no published cases with this type of injury pattern and this management algorithm.

Conservative treatment of a traumatic periprosthetic acetabular fracture in alumina–alumina THA

A 45-year-old male patient sustained a traumatic periprosthetic acetabular fracture involving the posterior column after a hybrid alumina-on-alumina total hip arthroplasty (THA) with cementless metal-backed acetabular cup. The fracture was classified as unstable type-2 and was managed conservatively. At 5-year follow-up, the patient had normal activity. The X-rays showed no signs of loosening or osteolysis and demonstrated complete remodeling with congruous contour of the osseous bed of the component. We believe that if the resistance of the alumina implants to trauma is considered a real breakthrough, the cementless cup could be another benefit to avoid THA revision in type-2 acetabular fractures.