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PubMed1985

[X-ray computed tomography in fractures of the acetabulum].

Radiographic assessment of these fractures remains difficult. Conventional techniques according to Letournel show the lesions but not to the best advantage, for instance the "congruency" of femoral head with acetabulum. 54 CT scan were performed (1982-1984) every time a doubt was persisting. Incarcerations of fragments, impactions of the acetabulum, sacro-iliac joint disjunctions, congruency and lesions of femoral head are much better seen with scanner. In planing the surgical therapy (or orthopedic), CT scan add a great deal to the information and dramatically improves the results.

Acetabulum↗
PubMedDate not supplied

[Surgical treatment of fractures of the acetabulum (personal experience)].

A hundred and thirty-five cases of fracture of the acetabulum seen from 1964 to date are analysed. Thirty-four were treated conservatively, a hundred-and-one by surgery. A clinical assessment of the cases treated was carried out. The different types of fracture (of the anterior column, of the posterior column, of the posterior wall and transverse fractures) are briefly described. In conclusion, treatment by surgery gives much better results because anatomical reconstruction of the acetabulum is possible or, at least, partial reconstruction which can be completed by the application of a hip-joint prosthesis at a later date.

Acetabulum↗
PubMedDate not supplied

[Rotational displacement of eccentric cups cemented in the acetabulum (author's transl)].

The authors have operated on 15 hips using a total prosthesis comprising a metallic head and plastic cup cemented in the acetabulum. The acetabular component is thicker at its upper part to accommodate eventual wear in the plastic. In all cases the cup rotated through 180 degrees so that, after several months, the thicker part was situated at the lower pole of the acetabulum. In two cases, a fracture of the cup was found. The cause of this abnormal rotation can be explained by a torque action taking place at each step because of the eccentric design of the cup. This was demonstrated by a prosthesis inserted into a cadaver and tested by simulated walking. 45 kilometres of walking were sufficient to provoke a rotation of 90 degrees. Conclusions are given on the use of such eccentric cups which should be avoided.

Acetabulum↗
PubMed1984

[Late and unexpected detection of a urinary complication of an intrapelvic fracture of the acetabulum].

This case concerns a 54 year old man presenting with septicemia, which was diagnosed as a fibrous ureteral stenosis consecutive to an intrapelvic dislocation of the acetabulum twenty years before. The unnoticed ureteral lesion consisted in a retraction through the acetabulum after the reduction of the dislocation. The lesion was treated by a ureterovesical reimplantation on a vesical psoas hitch, and led to partial recovery of renal function.

Acetabulum↗
PubMed1983

Cross-sectional anatomy of the adult bony acetabulum.

Cross-sectional cuts through the acetabulum of a cadaveric pelvis were obtained to evaluate the bony anatomy. There are six slices of 1 cm thickness which define the acetabulum. This information has been important to us primarily to assess acetabular fractures with computerized tomography.

Acetabulum↗
PubMed1982

Cross-sectional anatomy of the adult bony acetabulum.

Cross-sectional cuts through the acetabulum of a cadaveric pelvis were obtained to evaluate the bony anatomy. There are six slices of 1 cm thickness which define the acetabulum. This information has been important to us primarily to assess acetabular fractures with computerized tomography.

Acetabulum↗
PubMedDate not supplied

Histological study of the fetal development of the human acetabulum and labrum: significance in congenital hip disease.

Seventy-four acetabula from a total of 140 normal human fetuses, obtained from abortions and deaths in the prenatal period, were used. The fetuses ranged from 9.1 to 40 cm in crown-rump length and are believed to be between 12 weeks and term. Acetabula were decalcified embedded in paraffin or celloidin, sectioned, and stained using conventional histologic techniques. Sections from the superior one-quarter of the acetabulum were examined for the initial appearance and later spread of osseous tissue. Throughout the fetal period bone was present only in the floor of the acetabulum and did not extend into the socket walls. Ossification was detected initially more posteriorly in the socket floor, and at all ages, ossification was more prominent on the ischial side of the socket. Despite the lack of osseous tissue a well-formed hyaline cartilage socket was present. The fetal labrum was composed of fibrous tissue with the density of fibers increasing with age. Typical-appearing chondrocytes were detected at only the inner articular margin of the labrum. Contributing from one-fifth to one-half of the socket depth, the labrum may play a greater role in containing the femoral head at birth than it does in the mature joint. In seven acetabula, from joints that were neither subluxated nor dislocated, an area of areolar tissue with capillaries was detected at the hyaline cartilage-labrum junction. Such defects may weaken the labrum and contribute to neonatal hip instability.

Acetabulum↗
PubMed1980

[A histopathological study on aging process of the acetabulum with special reference to the pathogenesis of the acetabular cyst (author's transl)].

This is to report the aging process of the acetabula studied as an aid to the investigation of the pathogenesis and progression of osteoarthritis of the acetabulum. The material consisted of 45 acetabula obtained from 45 fresh cadavers. Regarding the morphological changes of the labrum-cartilage junction of middle and old age groups, marked degenerative changes such as tear, detachment, fissuring and scar formation were observed in many cases at the loaded part of the acetabulum. Among these, a loose connective tissue had invaded into the subchondral space through a fissure in one case, and infusion of the joint fluid into a fissure was observed in another. All of the 3 acetabular cysts were from the middle and old age groups and at the weight-bearing portions of the acetabula. All cysts were found to have communication with the joint cavities through the fissures. The trabeculae surrounding the cysts showed slight destructive changes apparently due to compression by the cysts. The above findings would suggest that the cyst formation as an aging process at the weight-bearing portions is probably due to infusion of the joint fluid into the subchondral space through the fissure at the labrum-cartilage junction or through the fissure at the junction resulting from subchondral plate fracture, although some additional causative factors might also play a role in the process.

Acetabulum↗
PubMed1980

Closure of the epiphysis of the femoral head and of the triradiate cartilage of the acetabulum following surgery for congenital hip dislocation.

Early closure of the epiphysis of the femoral head and of the triradiate cartilage of the acetabulum is reported in two young children following uneventful surgery for correction of deformities caused by congenital hip dislocation. Such epiphyseal arrests cause severe deformities, which frequently cannot be totally corrected. The reasons for epiphyseal arrest of the triradiate cartilage of the acetabulum following a Salter pelvic osteotomy and epiphyseal arrest of the femoral head following a subtrochanteric osteotomy are not known.

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PubMed1995

[Percutaneous cementoplasty for malignant osteolysis of the acetabulum].

The development of malignant lesions in the acetabulum can lead to painful and disabling bone destruction. In carefully selected patients where the cortical still provides a sufficient barrier protecting the joint, percutaneous injection of ciment (10-15 cc) can be a successful mean of countering both pain and functional impairment. This easy-to-perform technique requires only local anaesthesia and can be highly cost-effective. The antalgic effect is rapid. Most patients are able to walk again within 1 to 5 days (an effect which is particularly spectacular in bedridden subjects) probably due to the reduced pain and to better distribution of the mechanical forces. Hospitalization is usually shortened. In our experience with 18 patients, clinical improvement has been maintained for up to 18 months (mean follow-up 7 months) if the osteolytic process remains under control. Secondary effects are not rare but usually temporary. Recurrent pain, fever and/or inflammatory processes have been observed and usually resolve within 1 to 4 days. Intra-articular leakage can be avoided by careful patient selection. In association with radiotherapy, percutaneous injection of ciment appears to be an useful alternative to surgery for patients with destructive malignant lesions of the acetabulum, particularly in those with a poor clinical status and a short life expectancy. This technique has already been shown to be effective in lesions of the vertebral bodies. Several teams have made further attempts in other localizations.

Acetabulum↗
PubMedDate not supplied

The screwed acetabulum in acetabular reimplantations: long-term results.

The authors report the method used and long-term results for 61 acetabular reimplantations involving screwed truncated-conical acetabula and bone grafts. Mean follow-up was 6.3 years. From a clinical point of view the cases classified as excellent were 14 (24.1%), good 26 (44.8%), fair 12 (20.7%), and poor 6 (10.4%). As for radiographic evaluation, the acetabulum appeared to be stable in 37 cases (63.8%), there was fibrous stability in 13 cases (22.4%), the radiographic findings had shown uncertain stability in 5 cases (8.6%), and the acetabulum was unstable in 3 cases (5.2%). Long-term results show that the biological stabilization and, in particular, the implantation of screwed acetabula, when technically correct, may constitute a valid solution in revision surgery for the acetabular component.

Acetabulum↗
PubMed1995

Insufficiency fracture of acetabulum: a case report.

Most stress fractures of the hip joint occur on the femoral side. A review of the English literature showed that only eight cases of stress fracture of the acetabulum had been reported. Another insufficiency fracture of the acetabulum in an osteoporotic bone is reported.

Acetabulum↗
PubMed1994

[Experimental study of the deformations of the acetabulum in unipodal stance].

This work is based on an experimental simulation of unipodal stance using skeletons obtained from fresh nonembalmed cadavers, including pelvis, the two last lumbar vertebrae, and both femurs. Periacetabular deformations in unipodal stance were recorded in 10 pelves, which were bilaterally tested (20 acetabuli). Measurements concerned circumferential deformations (tangential to the periphery of the acetabulum), and normal deformations (perpendicular to the periphery of the acetabulum). Deformations of the medial wall and relative displacements between both acetabular walls were simultaneously recorded. A tridimensional interpretation of acetabular deformations is proposed based on the following classification: acetabuli in which the acetabular notch widens and acetabuli in which the acetabular notch closes itself with lateral displacement of the acetabular walls on the circumference of the femoral head. Acetabular deformations appeared dependent on the shape of the femoral head, but were not influenced by the action of the muscular model.

Acetabulum↗
PubMed1994

[Late results of acetabulum fractures].

Of 100 patients with acetabulum fractures treated from 1976 to 1985, 53 were followed up after a mean of 7.9 years. The results were predominantly good in patients with simple fractures, but mainly unsatisfactory in those with combination fractures. The poor results were mainly due to pain generally resulting from posttraumatic coxarthrosis (all grades 18/48) or from persistent nerve lesions (posttraumatic or postoperative 7/51) and functionally relevant ectopic ossifications (2/48). The mobility of the affected hip joint was predominantly good compared to the contralateral side. Results were best after rapid elimination of luxations in luxation fractures and early repositioning and elective internal fixation of fractures of the acetabulum to be operated on.

Acetabulum↗
PubMed1994

Osteoid osteoma of the acetabulum. A case report.

The acetabulum is a very rare location for osteoid osteoma. Reported herein is the case of a 21-year-old man who had nonspecific hip pain. Preoperative diagnosis was made 2 months after the first visit. Excisional biopsy was performed through the inner wall of the acetabulum. The patient reported complete relief from pain and there has been no evidence of recurrence in 8 years of followup.

Acetabulum↗
PubMed1994

Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures.

Management of displaced fractures of the acetabulum represents one of the greatest challenges in fracture surgery. This study reports intermediate term results for a single surgeon of 163 fractures in 161 patients treated by open reduction and internal fixation. The mean length of followup was 3.7 years. The most common fracture patterns treated were both column (67), transverse/posterior wall (32), posterior wall (14), and T shaped (12). The surgical approaches chosen were ilioinguinal (86), Kocher-Langenbeck (58), and extended iliofemoral (26) with 7 patients having sequential or simultaneous dual approaches. Reductions were rated by plain radiography and considered anatomic in 93 (56%) and near anatomic (< 2 mm displacement) in 40 (25%). There were 7 (4%) infections, 2 (1%) vascular injuries, 3 (2%) sciatic injuries, and 1 (1%) obturator nerve injury. Overall outcome was rated as excellent in 23 (14%), good in 101 (61%), fair in 25 (16%), and poor in 14 (9%). Nine patients have undergone hip salvage procedures. These results add to the growing body of clinical data which validates open reduction as the treatment of choice in most displaced fractures of the acetabulum.

Acetabulum↗
PubMed1996

[Reconstruction of the acetabulum after iterative surgery of the hip (report of 38 cases)].

UNLABELLED: The hip revision surgery like oncology surgery may need massive allografts to rebuilt the acetabulum or an hemi pelvis. Since 1982 we have chosen to use deep frozen massive allografts instead of massive metallic prosthesis, resection, or osteosynthesis of the femur to the iliac bone or the sacrum. These last proposal seems for our patients too heavy, the functional results being always bad. PATIENTS AND METHODS: --37 Acetabulum reconstruction has been performed. (18 hemi-pelvis). --The follow-up is from 1 to 12 years with a medical of 5 years and 2 months. --The tumoral pathology (14 cases) was for 50% chondrosarcomas [7]. 6 infections (1 massive echinococcosis and 5 osteomyelitis) --17 hip reconstruction for revision surgery. We use deep frozen allografts cryopreserved with Dimethylsulfoxide 10%. No secondary irradiation. The allografts were used after securisation (after the 6th month after the procurement). Most for the time we used 2 platres, one posterior outside the pelvis, one anterior inside the pelvis. Screwed on the contralateral pubis bone and the sacrum. A hip prosthesis was used in almost all the cases. In tumoral cases, the results were excellent with chondrosarcomas but in the other cases metastasis and death were usually seen in the 2 or 3 years following the surgery. --3 instability of the prosthesis. --2 fractures of the allograft. In the non tumoral cases, the integration of the graft was excellent. --1 instability of the prosthesis needed a antiluxent crescent. --1 fracture of the graft needed adjonction of autografts and new osteosynthesis. --1 superficial infection. Good functional results has been obtained with the use of massive allografts. The fracture of the allografts can heal without a new operation. In some cases we have had some liquid surrounding the grafts which can be a immunological response.

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