Long term results after surgical management of posterior wall acetabular fractures

Background

Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.

Materials and methods

We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25–60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5–22 years) who met the inclusion criteria formed the study cohort. Matta’s criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d’Aubigné and Postel score.

Results

Anatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d’Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.

Conclusion

Anatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.

Level of evidence

(Level 4) Retrospective case series.     

Outcome of Porous Tantalum Acetabular Components for Paprosky Type 3 and 4 Acetabular Defects

Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4–71) to 88 ± 14 (range, 41–100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27–4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3–29 months). At a mean follow-up of 37 ± 14 months (range, 24–66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.     

螺旋CT三维成像对骨盆及髋臼骨折临床治疗的指导意义

目的 探讨用三维ＣＴ重建评价骨盆骨折及髋臼骨折的临床应用价值。方法 对２４例骨盆骨折及髋臼骨折患者的Ｘ线片、三维ＣＴ重建进行对比分析。对骨折进行分型,选择合适的方案。结果 通过Ｘ线平片确诊２１例,漏诊３例（１２．５％）。三维ＣＴ重建使２４例均明确诊断,确诊率１００％。并明确评价骨折形态和骨折移位方向,２１例均接受了手术治疗。结论 三维ＣＴ重建能多方位,立体显示骨盆及髋臼骨折的形态,帮助术者正确估计骨折类型及移位程度,选择合适的手术入径,准确复位,合理固定,取得较好的疗效。     

髋臼加深全髋置换治疗成人先天髋臼发育不良

目的：探索成人先天性髋臼发育不良伴髋关节半脱位的手术治疗方法。材料和方法：12例成人先天性髋臼发育不良伴髋关节半脱位患者采用髋臼加深髋关节置换的方法治疗。结果：经1－8年随访,段体稳定,髋关节疼痛症状消失,关节功能基本正常。结论：髋臼加深全髋关节置换是成人先天性髋臼发育不良伴髋关节半脱位的有效治疗方法。     

手术治疗18例复杂髋臼骨折

目的：探讨复杂髋臼骨折手术治疗的效果。方法：本组骨折切开复位采用前后联合入路12例,延伸髂腹股沟入路4例,改良S－P入路2例,结果：平均随访3年。11例解剖复位,疗效优,5例复位满意,4例优,1例良;2例陈旧性骨折复位不满意,疗效差,结论：手术可有效复合固定此类骨折,恢复髋关节的稳定性和正常的头臼关系。     

Acetabular bone loss: Accommodating a growing void

The burden of revision total hip arthroplasty continues to rise exponentially, which is a reflection of the increasing number of primary total hip arthroplasty (THA) procedures being performed, lower surgeon thresholds for THA due to excellent mid- to long-term success rates and improved survival of the general population. Acetabular bone loss encountered at the time of revision surgery can present a significant pre- and intra-operative surgical challenge. This review covers the causes, a classification system and surgical options for treatment of acetabular bone loss at revision surgery.     

Paediatric acetabular fractures

Paediatric acetabular fractures are rare entities commonly occurring in conjunction with pelvic ring injuries in the context of high-energy trauma. It is important to have a high index of suspicion for extra-pelvic injuries associated with acetabular fractures. Classification of these injuries can be difficult due to the transitional nature of the acetabulum in the immature skeleton and a variety of imaging modalities may be required for diagnosis. Paediatric acetabular fractures can cause significant long-term morbidity for the patient and a multi-disciplinary approach is required for management of these injuries. This article outlines the underlying anatomy of the paediatric acetabulum together with assessment and diagnosis of these rare injuries and discusses management of the various patterns of injury encountered in clinical practice.     

ISO-C^3D计算机辅助导航技术经皮微创内固定治疗髋臼骨折

背景：文献报道采用X射线透视下经皮空心螺钉治疗骨盆髋臼骨折,但其内固定时间长,且患者与医生的放射暴露量大。目的：评价ISO-C3D计算机辅助导航微创技术在髋臼骨折治疗中的应用效果。方法：采用计算机辅助导航下经皮微创内固定治疗骨盆髋臼骨折31例,患者伤后至内固定时间为4-13 d。所有患者随访满1年。结果与结论：患者内固定治疗中除1例伴有骶髂关节损伤行切开复位内固定患者出血量约300 mL,其余患者平均出血量18 mL。内固定中共置入螺钉42枚,髋臼前柱骨折螺钉24枚,后柱螺钉18枚,所有螺钉均一次性准确置入。平均内固定时间59 min,平均透视时间为39 s。31例患者治疗后1周疼痛明显减轻,均无感染、血管神经损伤、内固定物断裂等并发症发生。至随访结束,摄X射线片示骨折愈合,无螺钉断裂及松动,根据Matta临床评分标准,优23例,良8例,优良率100%。内固定后髋关节功能根据Majeed 评分系统：优22例,良6例,可3例,优良率90%。提示ISO-C3D计算机辅助导航技术经皮微创内固定治疗可实现坚强内固定,且治疗中创伤小,内固定后并发症较少。     

髋关节表面置换与全髋关节置换疗效的Meta分析

背景：髋关节表面置换近年来得到了越来越广泛的应用,其与传统的全髋关节置换相比哪种方式的效果更好仍有较大争议。目的：通过综合分析已发表的文献,探讨比较髋关节表面置换与传统的全髋关节置换的优缺点。方法：检索1900年1月至2012年7月关于髋关节表面置换和全髋关节置换的随机对照研究,严格评价纳入研究质量并提取资料。采用RevMan5．1．6进行统计学Meta分析。结果与结论：共纳入10个随机对照试验,Meta分析结果显示髋关节表面置换与全髋关节置换在平均手术时间、术中平均失血量、置换后1年Harris评分、置换后1年美国加州大学髋关节功能评分、置换后2年血清钻、铬离子水平方面均差异无显著性意义;髋关节表面置换组置换后平均髋臼倾斜角大于全髋关节置换组。结果说明髋关节表面置换和全髋关节置换的短期随访结果并无明显的差异,但二者远期效果如何需更多高质量、大样本临床随机对照试验进行评价。