ObjectiveTo explore the effectiveness of a new H-shaped anatomical titanium plate in treatment of posterior wall/posterior column acetabular fractures.MethodsBetween March 2012 and April 2019, 46 patients with acetabular fractures involving posterior wall/posterior column were treated with the new H-shaped anatomical titanium plates. There were 28 males and 18 females. The age ranged from 20 to 70 years, with an average of 45.5 years. Among the patients, 34 cases were injured by traffic accidents and 12 cases by falling from height. The time from injury to operation ranged from 2 to 14 days, with an average of 7 days. According to Letournel-Judet classification, there were 12 cases of posterior wall fractures, 1 case of posterior column fracture, 3 cases of transverse fractures, 9 cases of transverse fractures involving posterior walls, 8 cases of posterior column and posterior wall fractures, 2 cases of anterior column and posterior semi-transverse fractures, 3 cases of T-shaped fractures, and 8 cases of double column fractures. Matta reduction standard was used to evaluate fracture reduction and Merle d’Aubign-Postel score was used to evaluate hip joint function.ResultsAll operations were successfully completed. The time of posterior operation was 60-120 minutes, with an average of 80 minutes. The amount of intraoperative blood loss ranged from 200 to 600 mL, with an average of 300 mL. All the incisions healed by first intention and no infection, deep vein thrombosis, or sciatic nerve injury occurred. All 46 patients were followed up 6-72 months, with an average of 37 months. According to Matta reduction standard, 40 cases obtained anatomic reduction, 4 cases satisfactory reduction, 2 cases unsatisfactory reduction, and the satisfaction rate was 95.7% (44/46). All fractures healed, and the healing time was 3-6 months, with an average of 4.3 months. No internal fixation failure occurred during the follow-up. At last follow-up, the Merle d’Aubign-Postel score ranged from 6 to 18 (mean, 15.5), including 38 cases of excellent, 4 cases of good, 2 cases of fair, and 2 cases of poor, with an excellent and good rate of 91.3% (42/46). Heterotopic ossification occurred in 4 cases, traumatic arthritis in 4 cases, and osteonecrosis of femoral head in 2 cases after operation.ConclusionFor acetabular fractures involving posterior wall/posterior column, the new H-shaped anatomical titanium plate can provide stable fixation, satisfactory reduction, and good recovery of hip function.
ObjectiveTo study the experimental biomechanics of acetabular posterior wall fractures so as to provide theoretical basis for its clinical treatment.
MethodsSix formalin-preserved cadaveric pelvises were divided into groups A and B (n=3). The fracture models of superior-posterior wall and inferior-posterior wall of the acetabulum were created on both hips in group A;fractures were fixed with two interfragmentary screws and a locking reconstruction plate. The fracture models of superior-posterior wall of acetabulum were created on both hips in group B;fractures were fixed with two interfragmentary screws and a locking reconstruction plate at one side, and with acetabular tridimensional memory fixation system (ATMFS) at the other side. The biomechanical testing machine was used to load to 1 500 N at 10 mm/min speed for 30 seconds. The displacement of superior and inferior fracture sites was analyzed with the digital image correlation technology.
ResultsNo fracture or internal fixation breakage occurred during loading and measuring;the displacement valuess of the upper and lower fracture lines were below 2 mm (the clinically tolerable maximum value) in 2 groups. In group A, the displacement values of the upper and lower fracture lines at superior-posterior wall fracture site were significantly higher than those at inferior-posterior wall fracture site (P<0.01), and the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P<0.01) in two fracture types. In group B, the displacement values of the upper and lower fracture lines at the side fixed with screws and a locking reconstruction plate were similar to the values at the side fixed with ATMFS, all being close to 2 mm;the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P<0.05) in two fixation types.
ConclusionThe actual biomechanical effect of the superior-posterior wall of acetabulum is much greater than that of the inferior-posterior wall of acetabulum and they should be discriminated, which might be the reasons of reduction loss, femoral head subluxation, and traumatic arthritis during follow-up.
ObjectiveTo evaluate the surgical techniques, perioperative complications, clinical outcomes of the modified Stoppa approach in the treatment of acetabular anterior and posterior column fractures.
MethodsBetween March 2008 and October 2014, 42 cases of acetabular anterior and posterior column fractures were treated by modified Stoppa approach or modified Stoppa approach combined with iliac fossa approach, and the clinical data were retrospectively analyzed. There were 20 females and 22 males with an average age of 43.2 years (range, 19-68 years). Fractures were caused by traffic accident in 21 cases, by falling from height in 16 cases, and by heavy pound in 5 cases. The time from injury to operation was 3-15 days (mean, 6 days). According to fracture classification of Letournel-Judet, there were 20 cases of both column fractures, 15 cases of anterior and posterior hemi-transverse fractures and 7 cases of T-shaped fractures. The intraoperative blood loss, the amount of blood transfusion, the operation time, the volumn of drainage, and complication were recorded. Matta radiological standard was used to evaluate the reduction quality of fracture, and Merled'Aubigné-Postel system to evaluate hip function.
ResultsThe average intraoperative blood loss was 900 mL; the average amount of blood transfusion was 400 mL; the average volume of drainage was 110 mL; and the average operation time was 165 minutes. Intraoperative complications included 4 cases of tractive injury of obturator nerve and 2 cases of the external iliac vein injury, and postoperative complications included 2 cases of lateral femoral cutaneous nerve palsies and 1 case of deep vein embolism of lower extremity, which were improved after treatment. The patients were followed up 36 months on average (range, 12-48 months). There was no infection or heterotopic ossification. According to Matta radiological evaluation system, the reduction quality of fractures was rated as excellent in 21 cases, good in 16 cases, and poor in 5 cases, with an excellent and good rate of 88.1%. The healing time of fracture was 3.5-8.0 months (mean, 5.1 months). According to Merled'Aubigné-Postel system for hip function, 20 cases were graded as excellent, 15 cases as good, 4 cases as fair, and 3 cases as poor, with an excellent and good rate of 83.3% at last follow-up.
ConclusionModified Stoppa approach or with iliac fossa approach can get full exposure of quadrilateral area, good reduction, and firm internal fixation in the treatment of acetabular fractures associated with T-shaped fractures, both column fractures, anterior and posterior hemi-transverse fractures.
ObjectiveTo investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD).
MethodsBetween June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed.
ResultsThe hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case.
ConclusionTo pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.
Objective To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
This article aims to compare and analyze the biomechanical differences between wing-shaped titanium plates and traditional titanium plates in fixing acetabular anterior column and posterior hemi-transverse (ACPHT) fracture under multiple working conditions using the finite element method. Firstly, four sets of internal fixation models for acetabular ACPHT fractures were established, and the hip joint stress under standing, sitting, forward extension, and abduction conditions was calculated through analysis software. Then, the stress of screws and titanium plates, as well as the stress and displacement of the fracture end face, were analyzed. Research has found that when using wing-shaped titanium plates to fix acetabular ACPHT fractures, the peak stress of screws decreases under all working conditions, while the peak stress of wing-shaped titanium plates decreases under standing and sitting conditions and increases under forward and outward extension conditions. The relative displacement and mean stress of the fracture end face decrease under all working conditions, but the values are higher under forward and outward extension conditions. Wing-shaped titanium plates can reduce the probability of screw fatigue failure when fixing acetabular ACPHT fractures and can bear greater loads under forward and outward extension conditions, improving the mechanical stability of the pelvis. Moreover, the stress on the fracture end surface is more conducive to stimulating fracture healing and promoting bone tissue growth. However, premature forward and outward extension rehabilitation exercises should not be performed.
Objective
To discuss the short-term effectiveness of total hip arthroplasty (THA) for post-traumatic osteoarthritis secondary to acetabular fracture.
Methods
Between January 2004 and March 2012, the clinical data was analyzed retrospectively from 12 cases (13 hips) of post-traumatic osteoarthritis secondary to acetabular fracture undergoing THA. Of 12 patients, 6 were male and 6 were female, with an average age of 55.6 years (range, 40-68 years). The locations were the left hip in 5 cases, the right hip in 6 cases, and bilateral hips in 1 case. The interval between acetabular fracture and THA was 65.7 months on average (range, 12-240 months). The preoperative hip Harris score was 48.8 ± 9.5.
Results
The incisions healed by first intention. No deep vein thrombosis and infection occurred postoperatively. Ten cases were followed up 1-7 years (mean, 4.8 years). The hip Harris score was 86.5 ± 8.6 at last follow-up, showing significant difference when compared with preoperative score (t=10.520, P=0.006). X-ray films showed no acetabular prosthesis instability. Stem subsidence (2 mm) occurred in 1 case, peri-prosthetic osteolysis in 2 cases, and heterotopic ossification in 2 cases (Brooker type I and type II in 1 case, respectively).
Conclusion
THA has satisfactory short-term effectiveness for post-traumatic osteoarthritis secondary to acetabular fracture. The good effectiveness is based on strict case selection, pathological evaluation, and the proper acetabular reconstruction.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
ObjectiveTo investigate the clinical results of modified subinguinal approach without iliac osteotomy for anterior surgical treatment of acetabular fractures which involve the anterior wall and medial wall or in combination with femoral neck fracture.
MethodsThe subinguinal approach was modified after anatomical study on 12 adult cadavers. Between May 2010 and March 2012, 34 patients with acetabular fracture that involved the anterior wall and medial wall or in combination with femoral neck fracture were treated with open reduction and internal fixation through modified subinguinal approach in 15 cases and through modified subinguinal approach combined with Kocher-Langenbeck approach. There were 28 males and 6 females with an average age of 31.1 years (range, 20-64 years). According to the Letournel-Judet classification, there were 15 cases of anterior acetabular/column fractures, 8 cases of anterior acetabular/column fractures combined with trear half transverse fractures, 7 cases of double column fractures, and 4 cases of T shape fractures. The time between injury and operation was 5-16 days (mean, 7.4 days).
ResultsAnatomy results: the inguinal ligament was reflection and continuity from the aponeurosis of obliquus externus abdominis with a length of (11.09±0.24) cm, which form part of abdominal muscle. The conjugate of inguinal ligament and iliopsoas muscle on the anterosuperior iliac spine was (0.69±0.08) cm. The vertical distance from the saphenous vein to the inguinal ligament was (3.58±0.49) cm. Clinical results: all the cases were followed up 4-24 months (mean, 14.6 months). No complication was observed, such as wound infection, internal fixation loosening, and iatrogenic injury to the sciatic or femoral nerve. The bone union time was 12-16 weeks (mean, 14 weeks). According to Matta reduction criteria for acetabular fractures, anatomic reduction were achieved in 21 cases, satisfactory reduction in 10 cases, and unsatisfactory reduction in 3 cases at 1 week after operation. According to D'Aubigne and Postel criteria for hip function, the results were excellent in 25 cases, good in 4 cases, fair in 3 cases, and poor in 2 cases at last follow-up. Heterotopic ossification (Brooker's grade I) occurred in 8 cases.
ConclusionThe modified subinguinal approach can keep the inguinal ligament intact, provide broad visualization of anterior and medial wall of acetabulum and anterior hip capsule, which is a better modification and supplement for classic ilioinguinal approach.
ObjectiveTo compare the biomechanical difference of 4 kinds of internal fixations for acetabular fracture in quadrilateral area.
MethodsThe transverse fracture models were created in 16 hemipelves specimens from 8 adult males, and were randomly divided into 4 groups according to different internal fixation methods (n=4): infrapectineal buttress reconstruction plate (group A), infrapectineal buttress locking reconstruction plate (group B), reconstruction plate combined with trans-plate quadrilateral screws (group C), and anterior reconstruction plate-lag screw (group D). Then the horizontal displacement, longitudinal displacement of fractures, and axial stiffness were measured and counted to compare the stability after continuous vertical loading.
ResultsUnder the same loading, the horizontal and longitudinal displacements of groups A, B, C, and D were decreased gradually; when the loading reached 1 800 N, the longitudinal displacement of group A was more than 3.00 mm, indicating the failure criterion, while the axial stiffness increased gradually. Under 200 N loading, there was no significant difference (P>0.05) in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups. When the loading reached 600-1 800 N, significant differences were found in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups (P<0.05) except the horizontal displacement between groups C and D (P>0.05).
ConclusionFor acetabular fracture in the quadrilateral area, anterior reconstruction plate-lag screw for internal fixation has highest stability, followed by reconstruction plate combined with trans-plate quadrilateral screws, and they are better than infrapectineal buttress reconstruction plate and infrapectineal buttress locking reconstruction plate.
