Types Of Acetabular Fractures Research Articles

Clinical Management, Prognosis, and Outcomes of Bilateral Acetabular Fractures: A Case Report

Background: Bilateral acetabular fractures are a rare type of acetabular fracture, and due to the scarcity of information regarding these types of fractures, managing bilateral acetabular fractures presents significant challenges. We presented a 25-year-old man with bilateral acetabular fractures (left transverse fracture of the acetabulum and right posterior column fracture of the acetabulum) secondary to severe trauma following a road accident with no other pelvic damage. Case Report: Because the displacement was more on the patient's left side (although the patient's pain was more on the right side), the open reduction and internal fixation (ORIF) surgery was first performed on the left side, and secondary ORIF surgery was performed on the right side, under general anesthesia with Kocher-Langenbeck approach for both sides. Conclusion: Due to the increase in road traffic accidents (RTAs) and improper safety of cars, especially in developing countries, this type of fracture may be repeated in the future, and regarding the complexity and comorbidities associated with this type of fracture, the high experience of the surgeon and detailed investigations are required to achieve successful results.

Treatment of Geriatric Acetabular Fractures Using the Modified Stoppa Approach: A Review Article of Technique, Tips, and Pitfalls

The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to an increase in the frequency of anterior and combined anterior acetabular fractures. Surgery for geriatric acetabular fractures is very challenging, and surgeons need years of experience to be able to deal with the advantages and disadvantages of pelvic surgery. This is why a high level of surgical expertise is required. The aim of this article is to provide an insight into the topic of geriatric acetabular fractures with a critical narrative review of the current literature and a focus on minimally invasive surgical treatment using the modified Stoppa approach without patients’ own assessment. The modified Stoppa approach offers excellent visibility of the anterior structures of the acetabulum and can address the quadrilateral surface effectively. Pelvic surgery, in particular acetabular surgery, offers patients many advantages, such as rapid mobilization and the quick relief of pain symptoms. Total hip arthroplasty is currently being discussed as an alternative with good results for certain types of acetabular fractures in older patients, though it requires clarification of studies and recommendations.

Acetabular fracture in India: An epidemiological study

IntroductionAcetabular fractures, resulting from high-energy trauma, present significant orthopaedic challenges. Despite their rarity, the incidence of these fractures is rising, necessitating a comprehensive understanding of their epidemiological characteristics, especially in diverse populations like India. MethodsThis retrospective study analyzed data from 3643 patients across four level-1 trauma centers in India (North 1, North 2, West, and South) from January 2001 to December 2019. Prior ethical approval was obtained from the respective institutions. Data were collected using the computerized patient record system (CPRS) and included patients with complete clinical and radiological records. Only patients with full radiological data were included, comprising standard anteroposterior radiograph, Judet views on radiographs, and computed tomography scan of the pelvis. The study evaluated the demographic characteristics, fracture patterns and surgical approaches. ResultsThe majority of patients were males (84.05 %) and the fractures were mostly seen in young individuals between 19 and 40 years’ age group (44.9 %), followed by 41–60 years (42.3 %). Associated bony or other system injuries were seen in 53.42 % of patients, with pelvic injuries being the most common (9.8 %). Posterior wall fractures were the most frequent (20.7 %), while anterior wall fractures were the least common (0.8 %). Operative management was employed in 82 % of cases, with the Kocher-Langenbeck approach being the most commonly employed (42.5 %). ConclusionHigh-velocity trauma remains the commonest cause of acetabular trauma in India, primarily affecting young male individuals. Pelvic fractures are the most commonly associated injuries. Posterior wall fractures are the commonest type of acetabular fracture, and the Kocher-Langenbeck approach is the commonly adopted surgical approach.

Acetabular fractures in geriatric patients: epidemiology, pathomechanism, classification and treatment options.

The incidence of geriatric acetabular fractures has shown a sharp increase in the last decades. The majority of patients are male, which is different to other osteoporotic fractures. The typical pathomechanism generally differs from acetabular fractures in young patients regarding both the direction and the amount of force transmission to the acetabulum via the femoral head. Geriatric fractures very frequently involve anterior structures of the acetabulum, while the posterior wall is less frequently involved. The anterior column and posterior hemitransverse (ACPHT) fracture is the most common fracture type. Superomedial dome impactions (gull sign) are a frequent feature in geriatric acetabular fractures as well. Treatment options include nonoperative treatment, internal fixation and arthoplasty. Nonoperative treatment includes rapid mobilisation and full weighbearing under analgesia and is advisable in non- or minimally displaced fractures without subluxation of the hip joint and without positive gull sign. Open reduction and internal fixation of geriatric acetabular fractures leads to good or excellent results, if anatomic reduction is achieved intraoperatively and loss of reduction does not occur postoperatively. Primary arthroplasty of geriatric acetabular fractures is a treatment option, which does not require anatomic reduction, allows for immediate postoperative full weightbearing and obviates several complications, which are associated with internal fixation. The major issue is the fixation of the acetabular cup in the fractured bone. Primary cups, reinforcement rings or a combination of arthroplasty and internal fixation may be applied depending on the acetabular fracture type.

The use of a plate for fixation of the acetabulum.

This study aimed to share our experience of a self-developed plate for acetabular fracture fixation through the presentation of clinical cases. Eight patients with complex acetabular fractures (Letournel classification) underwent surgery using a modified Stoppa approach and the novel plate design between 2021 and 2023 at the National Scientific Center for Traumatology and Orthopedics. Criteria such as the mechanism of injury, type of fracture, surgical approach, intraoperative and postoperative complications, quality of reduction, and functional and radiological results were evaluated. All patients included in the study presented complex types of acetabular fractures according to the Letournel classification. In all cases, surgical interventions were performed using a modified Stoppa approach. The assessment of reduction quality was conducted based on the radiological standards established by Matta. The reduction in quality was excellent in two patients, good in four, and satisfactory in two. One patient developed a post-traumatic false joint requiring additional surgery. The remaining patients achieved fracture healing with satisfactory Harris Hip Score (HHS) scores, indicating good overall function. The results of the self-developed plate for acetabular fracture fixation in our series were satisfactory.

Functional Outcome of Acetabular Fracture Using Majeed Score: A Single-center Retrospective Study

ABSTRACT Introduction: Acetabular fractures make a challenge for orthopedic trauma surgeons. The published data on acetabular fracture in Indonesia are very limited and there is no study to assess the functional outcome of acetabular fracture using the Majeed score. This study aims to report the functional outcome of an acetabular fracture using the Majeed score in one tertiary referral hospital (single center), Dr. Moewardi General Hospital. Methods: This is a retrospective descriptive study with a cross-sectional design from patients who registered on January 1, 2017–December 31, 2021 (5 years) at Dr. Moewardi General Hospital, a referral Hospital in Surakarta, Indonesia. The inclusion criteria included all acetabular fracture patients who registered and had complete data. Results: The most common type of acetabular fracture based on Judet-Letournel classification in this study is both columns (59.1%), most commonly treated by surgery. The most common surgical approach to treating an acetabular fracture is the anterior approach. The Majeed score shows the total of good and excellent outcomes after surgery (57.2%) is higher than fair and poor outcomes (42.9%), and the total of good and excellent outcomes after nonsurgical treatment (66.7%) is higher than fair and poor outcomes (33.3%). Conclusion: Using the Majeed score in a single center, the functional outcomes of acetabular fracture patients treated both surgically and conservatively are good to excellent.

Finite element analysis of the use of two new types of internal fixation for acetabular fractures

BackgroundBoth-column fracture is a common type of acetabular fracture and is sometimes accompanied by a comminuted fracture of the quadrilateral area. Such fractures are difficult to anatomically reduce and securely fix. In this study, the authors compared the application value and mechanical properties of the Bespoke 3D-printed titanium alloy plates and Union Plate in acetabular both-column fractures.MethodsA both-column fracture model of the acetabulum was established, and the Bespoke 3D-printed titanium alloy plates, Union Plate and a common reconstruction plate were used for fixation. External loads were applied to the model at different angles, and the effects on the plates and the stress and displacement of the screws were determined.ResultsUnder different states of hip joint activity, the maximum stress experienced by the Bespoke 3D-printed titanium alloy plates and Union Plate was significantly smaller than the maximum stress experienced by the common reconstruction plate. The Bespoke 3D-printed titanium alloy plates experienced the lowest maximum stress under different hip joint motions. There was no statistically significant difference between the maximum displacement of the Bespoke 3D-printed titanium alloy plates and Union Plate and that of the common reconstructed plate.ConclusionsThe design of the Bespoke 3D-printed titanium alloy plates imparts a smaller maximum stress and better mechanical properties when repairing acetabular both-column fractures.

Transformation of transverse fractures of the acetabulum in T-shaped fractures and sequential approaches

Transverse acetabular fractures are difficult to reduce and generally associated with poorer clinical outcomes than other types of acetabular fractures. For these fractures affecting both columns, the surgical strategy is subject to controversy and there is currently no optimal method of management. The transformation of these transverse fractures in to a T-shaped fracture makes it possible to make the anterior and posterior components of the fracture independent and to reduce them sequentially. This technique has made it possible to obtain a satisfactory reduction of the fracture in certain cases and gives hope for good long-term functional results. Level of evidenceIV.

Systematic Review and Meta-Analysis of Sciatic Nerve Injury in Acetabular Fractures

Background: Acetabular fracture is a challenging orthopaedic injury, usually associated with post-traumatic arthritis, deep vein thrombosis, and sciatic nerve injury (SNI). Therefore, we assess the incidence and outcome of SNI associated with acetabular fractures in this study. Methodology: We applied search keywords across PubMed, clinicaltrail.gov, Scopus, and Cochrane library database from 2002 to March 2022 with the studies reporting SNI associated with acetabular fracture. Patient's demographic details, acetabular fracture type, recoveries rate and time, number of patients with acetabular fracture reporting SNI, and follow-up. Methodological Index for Observational Non-Randomized Studies (MINORS) criteria assessed the quality appraisal of each identified study. Results: This study includes twenty-one studies with a total of 682 patients, 19 iatrogenic SNI, and 44 post-traumatic injuries. Overall incidence of post-traumatic and iatrogenic SNI associated with acetabular fractures was 9% [95% CI: 6%-11%] and 5% [95% CI: 3%-7%] respectively. The overall recoveries rate from iatrogenic SNI and post-traumatic SNI associated with acetabular fracture were 55% (95% CI: 22%-83%) and 68% (95% CI: 53% -81%), respectively. The overall quality score of all included studies was 64.28± 7.43% (R: 56.25 % -81.25%), with seven studies below 60%. In most cases, Recoveries of sciatic nerve injury occur within 2-24 months after any open reduction and internal fixation (ORIF). Conclusion: This review estimates SNI incidence with acetabular fracture and recoveries rates. However, this study fails to report the association of SNI with specific acetabular fracture types due to insufficient reported data across eligible studies

Incidence of Traumatic Sciatic Nerve Injury in Association with Acetabular Fracture: A Retrospective Observational Single-Center Study.

PurposeTraumatic sciatic nerve injury is one of the most serious consequences of acetabular fracture. However, reports on this type of injury are rare. In this study, we investigated the demographics of acetabular fracture with traumatic sciatic nerve injury, the clinical characteristics of patients with these injuries, and potential risk factors.Patients and MethodsWe retrospectively reviewed patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of the acetabular fracture, whether or not sciatic nerve injury occurred, types of sciatic nerve injury, and risk factors were analyzed.ResultsA total of 195 patients met the diagnostic criteria for acetabular fractures. The average Injury Severity Score was 25.9 and the average Abbreviated Injury Scale score was 12.4. Road traffic accidents and falls from height were the main causes. Chest injuries and lower extremity fractures were the most common associated injuries. Posterior wall fractures were the most common fracture type. After exclusion of spinal cord and iatrogenic sciatic nerve injuries, 18 patients with acetabular fractures had traumatic sciatic nerve injury. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Logistic regression analysis identified a higher AIS score, posterior column fracture, and posterior hip dislocation to be predictors of traumatic sciatic nerve injury.ConclusionAcetabular fractures were mostly high-energy injuries. Posterior wall fractures were the most common acetabular fracture types. Most patients sustained injury to the sciatic nerve as well as injury to the common peroneal and tibial nerve divisions. A higher AIS score, posterior column fracture, and posterior hip dislocation were predictors of acetabular fracture combined with traumatic sciatic nerve injury.

Are screws enough? functional outcome in surgically treated posterior acetabular wall fracture using cannulated cancellous screws

Background: Posterior wall fractures of acetabulum are the commonest type of acetabular fractures 1,2. These fractures are usually associated with posterior dislocation of hip. Anatomical reduction and fixation are important to restore congruity and stability of joint, to decrease the risk of secondary arthritis and thus attain good functional outcome 3. Fixation modalities comprise of both recon plates in buttress mode, lag screw fixation or combination of both.In our study, we aimed to assess the functional outcome and complications following the use of only cannulated screws as fixation mo Material and methods: A total of 11 patients with a diagnosis of posterior acetabular wall fracture were treated with surgical fixation of posterior acetabular wall using only cannulated cancellous screws. The patients were followed up strictly for 6 weeks, 3 months, 6 months, as well as 1 year and thereafter at yearly intervals as long as possible. Functional and radiological assessment were done using Merle D’Aubigne and Postel grading system and Matta’s radiological criteria. Result:In our study, we noticed excellent outcome in 100% of the patients who had posterior wall fractures without hip dislocation.

Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes.

To investigate the incidence and the outcome of post-traumatic and iatrogenic sciatic nerve palsy (SNP) associated with fractures of the acetabulum. The results of sciatic nerve grafting for treatment were also investigated. PUBMED, SCOPUS and COCHRANE databases were searched for longitudinal observational studies reporting sciatic nerve palsy related to acetabular fractures in adult patients over the last 20years. Data regarding patients demographics, type of acetabular fracture, rate of post traumatic and iatrogenic sciatic nerve palsies as well as recovery rate are reported. Studies were assessed for their quality. Random effects meta-analyses were carried out to pool overall proportions of SNP incidence and complete recovery. Variations in SNP incidence by main study characteristics were assessed by subgroup analysis and meta-regression. A narrative review of sciatic nerve grafting was also conducted. Twenty studies reporting 44 post-operative and 18 iatrogenic SNPs in 651 patients were reviewed. The pooled incidence of posttraumatic SNP was 5.1% (95% CI 2.7-8.2%). The pooled incidence of iatrogenic SNP was 1.4% (95% CI 0.3-2.9%). Complete recovery of post-traumatic and iatrogenic SNP occurred in 64.7% (95% CI 41.7-85.4%) and 74.1% (95% CI 31.5-100%), respectively. A favorable outcome of both post-traumatic and iatrogenic SNP related to acetabular fractures has been found. Due to the poor results of sciatic nerve grafting, a "wait and see" approach may be the best option, in cases of a contused but anatomically intact sciatic nerve.

Effect of osteoporosis-related reduction in the mechanical properties of bone on the acetabular fracture during a sideways fall: A parametric finite element approach.

The incidence of acetabular fractures due to low-energy falls is increasing among the geriatric population. Studies have shown that several biomechanical factors such as body configuration, impact velocity, and trochanteric soft-tissue thickness contribute to the severity and type of acetabular fracture. The effect of reduction in apparent density and elastic modulus of bone as well as other bone mechanical properties due to osteoporosis on low-energy acetabular fractures has not been investigated. The current comprehensive finite element study aimed to study the effect of reduction in bone mechanical properties (trabecular, cortical, and trabecular + cortical) on the risk and type of acetabular fracture. Also, the effect of reduction in the mechanical properties of bone on the load-transferring mechanism within the pelvic girdle was examined. We observed that while the reduction in the mechanical properties of trabecular bone considerably affects the severity and area of trabecular bone failure, reduction in mechanical properties of cortical bone moderately influences both cortical and trabecular bone failure. The results also indicated that by reducing bone mechanical properties, the type of acetabular fracture turns from elementary to associated, which requires a more extensive intervention and rehabilitation period. Finally, we observed that the cortical bone plays a substantial role in load transfer, and by increasing reduction in the mechanical properties of cortical bone, a greater share of load is transmitted toward the pubic symphysis. This study increases our understanding of the effect of osteoporosis progression on the incidence of low-energy acetabular fractures. The osteoporosis-related reduction in the mechanical properties of cortical bone appears to affect both the cortical and trabecular bones. Also, during the extreme reduction in the mechanical properties of bone, the acetabular fracture type will be more complicated. Finally, during the final stages of osteoporosis (high reduction in mechanical properties of bone) a smaller share of impact load is transferred by impact-side hemipelvis to the sacrum, therefore, an osteoporotic pelvis might mitigate the risk of sacral fracture.

Management of anterior associated types of acetabular fractures utilizing the modified Stoppa and the pararectus approaches: a prospective cohort study and early experience from a level one Egyptian trauma centre.

This study aimed to report the early experience (radiographic, functional, and complications outcomes) from an Egyptian (North African) level one trauma centre after utilizing the modified Stoppa and the pararectus approaches to manage anterior-associated types of acetabular fractures. Between January 2014 and April 2018, 63 patients (40 males and 23 females) with a mean age of 33 ± 11.5 were included, 45 patients were treated through the modified Stoppa (group A), and 18 through the pararectus approach (group B). At a mean follow-up of 32.11 ± 15.36months (range 12 to 64), 56 patients (43 group A and 13 group B) were evaluated. The post-operative anatomical reduction was achieved in 44 (78.6%) patients. At the last follow-up, Matta radiological outcome grades were excellent and good in 50 (89.2%) patients, fair and poor in six (10.8%). The mean Harris Hip Score (HHS) was 92.6 ± 7.6; the mean modified Merle D'Aubigné (MMD) score was 16.5 ± 1.5. Excellent functional outcome was reported in 42 (75.0%) and 25 (44.6%) patients according to HHS and MMD scores, respectively. There are four (7.1%) intra-operative iatrogenic complications (two in each approach), three (5.3%) vascular injuries (two in group B and one in group A), and one (1.8%) bladder injury in group A. Employing less-invasive anterior approaches for managing anterior associated types of acetabular fractures proved efficiency and safety. Good to excellent radiological and functional outcomes were achieved, with no significant difference between both approaches.

Irreducible Posterior Hip Dislocation with Associated Isolated Comminuted Greater Trochanter Avulsion Fracture Treated with Universal Locking Trochanteric Stabilization Plate: A Rare Combination of Hip Injury

Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.

Acetabulum - Predictors of postoperative outcome for acetabular fracture

Introduction: The most prevalent type of acetabular fracture is posterior wall acetabular fracture. The conventional therapy for displaced posterior acetabular wall fractures is surgery. The clinical and radiologic results of open reduction and internal fixation in patients with posterior wall acetabular fractures are evaluated in this retrospective study. Methods: 50 patients with displaced acetabular fractures treated surgically were evaluated clinically with the Modified Postel Merle d'Aubigné score and radiologically using Matta's radiological outcome grading. The impact of age (≤ 55 or >55 years), gender, fracture displacement (≤ 20 mm or >20 mm), hip dislocation, surgical delay (≤ 2 weeks or >2 weeks), concomitant injury, and length of follow-up (≤ 2 years or >2 years) on functional outcome was studied. Results: There were 31 males (62%) and 19 females (38%), with a mean age of 38.75 years (16 to 65 years). The length of follow-up was 3 years. The Modified Postel Merle d'Aubigné score was 15.7 ± 2.2 on average (range, 8 to 18). The clinical outcome was excellent in 12 (24%) patients, good in 19 (38%), fair in 10 (20%), and poor in 9 (18%, including 10 patients who underwent THR for secondary arthritis). Initial fracture displacement >20 mm (P = 0.018), joint dislocation (P = 0.015), and surgery delay (P = 0.001), quality of reduction (P = 0.0001) and presence of related injuries (P = 0.0001) had a significant impact on the Modified Postel Merle d'Aubigné score. Age, gender, fracture type, and length of follow-up, on the other hand, had no effect on clinical outcome. Conclusion: Bad reduction, concomitant injuries, fracture displacement of more than 20 mm, joint dislocation, and late surgery all have a poor prognosis when it comes to predicting the fate of surgically treated acetabular fractures.

Outcome of Modified Stoppa Approach for Fixation of Acetabular Fractures

Objective: The purpose of this study is to determine the functional and radiological outcomes of modified stoppa approach for fixation of acetabular fractures. Study Design: Descriptive Study Place and Duration: Study was conducted at Orthopaedic department of Ayub Teaching Hospital Abbottabad, Fauji Foundation Hospital, Rawalpindi and Islamabad International Hospital E-11/4, Islamabad for duration of two years form July 2019 to June 2021. Methods: There were thirty patients of both genders who had acetabular fractures were presented. Included patients were aged between 18-55 years. Patients' age, sex, body mass index and cause of fractures were recorded after taking informed written consent. Types of acetabular fractures were also recorded. Modified stoppa approach was used to operate acetabular fractures. Outcomes were operative time, radiological and functional outcomes were assessed in terms of excellent, good, fair and poor results. Post-operative complications and patients' satisfaction was also calculated. We used SPSS 24.0 version to analyze complete data. Results: Among 30 cases, majority of the patients 20 (66.67%) were males and 10 (33.33%) were females with mean age 29.4±10.37 years. Mean body mass index of the presented patients was 23.7±7.25 kg/m2. RTA was the most common cause found in 17 (56.67%), followed by fall from height in 8 (26.67%) and 5 (16.67%) fractures had other causes. Anterior wall fracture was the most common type found in 14 (46.67%) cases. Mean operative time was 3.87±13.18 hours. As per radiological outcomes, frequency of anatomical reduction found in 21 (73.3%) cases, not perfect found in 5 (16.67%) cases and poor results found in 4 (13.3%) patients. Majority of the cases 18 (60%) had good results in functional outcomes, excellent results in 7 (23.3%), fairs results in 3 (10%) cases and poor in 2 (6.67%) cases. Post-operative complications found in 2 (6.67%) cases. Satisfaction rate among patients was 86.67%. Conclusion: We found in this study that the use of stoppa approach for fixation of acetabular fractures was effective and safe method in terms of good radiological and functional outcomes. Except this less operative time and less number of complications were calculated with high number of customer’s satisfaction. Keywords: Acetabular Fractures, MSA, Complications, RTA

The outcome of the uncemented acetabular component in delayed total hip arthroplasty following acetabular fractures.

AimsAfter failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients.MethodsA total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort.ResultsThe median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA.ConclusionDelayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA.Cite this article: Bone Jt Open 2021;2(12):1067–1074.

Хирургические доступы при лечении пациентов со свежими переломами вертлужной впадины

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average 3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures is the combined anterior and posterior approach.

Total hip arthroplasty following open reduction and internal fixation for displaced acetabular fractures

Fractures of the acetabulum are difficult to treat and even after fixation they can lead to posttraumatic arthritis and avascular necrosis of the femoral head. Total hip arthroplasty has been the most common surgery performed for the complications of posttraumatic arthritis and avascular necrosis of the femoral head. Aim: To evaluate the links between acetabular fracture type, radiological and clinical outcomes of open reduction and internal fixation, and clinical outcomes of total hip arthroplasty. Material and methods: One hundred thirty-two patients with acetabular fractures were treated surgically at the Trauma Department of “Sf. Spiridon” County Clinical Emergency Hospital from Iasi. Fifteen patients underwent THA for posttraumatic osteoarthritis or femoral head avascular necrosis following open reduction and internal fixation for acetabular fractures. Clinical and radiographic examinations were performed at 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. Patients were assessed clinically using the Harris Hip Score and radiologically with Matta outcome grading. Heterotopic ossification was classified according to Brooker grading. Results: Mean Harris Hip Score has improved from 55 before conversion to 90 at 6 months after THA. No dislocation, deep vein thrombosis or pulmonary thromboembolism, new nerve injury, and heterotopic ossification occurred. Conclusions: The conversion to total hip arthroplasty after posttraumatic arthritis and avascular necrosis of the femoral head in acetabular fracture can lead to reasonable pain relief and functional improvement.