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PubMed2003

[Navigated reposition of transverse acetabulum fractures. A precision analysis].

Up to now navigated reduction control based on computed tomography (CT) image data could not be used commercially. With newly developed software, a transverse fracture of the acetabulum was reduced with navigation control in a laboratory test. The results were compared to visual and tactile control in a foam pelvis and specimen. Measurements were done with another magnet-based navigation system. The residual dislocation was measured with translation (mm) and rotation (degrees). Compared with visually controlled reduction, navigated reduction led to a residual dislocation of 0.7 mm and 0.9 degrees. Navigated reduction based on CT image data is also accurate for reduction of joint fractures under laboratory conditions. Further improvements of the software are planned for later in vivo use.

Acetabulum↗
PubMed1996

[Bilateral acetabulum fractures of the anterior column and vertebral body fracture after alcohol-induced seizure].

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

Acetabulum↗
PubMed1998

[Complex injuries of the pelvis and acetabulum].

Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological sequelae frequently persist. Complicated pelvic injuries, i.e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.

Acetabulum↗
PubMed1998

[Multiple surgical possibilities for the correction of acetabulum failure in rheumatoid arthritis].

Pronounced osteoporosis of and surrounding the acetabulum commonly leads to early loosening of endoprosthetic hip replacements following implantation. Large osseous defects in the subimplant bed are the result and the reason why multiple revisions of loosened acetabular cups have to be performed so often in rheumatic surgery. The defects extend from the cranial to the central; ventral and dorsal anchorage losses may occur in addition to this. The anchorage of a new implant must be adapted to the individual circumstances. The new implant must be selected in accordance with point of surgical access, the patient's general status and osseous regenerationability. In the optimum case, osseous buildup of lost anatomical structures is the preferred method. If this is not possible, special implants, mostly custom-made prostheses, have to be incorporated. However, the survival time of the implants is much shorter than in patients with degenerative diseases.

Acetabulum↗
PubMed1997

Avascular osteonecrosis of the acetabulum.

OBJECTIVE: To investigate the possible occurrence of osteonecrosis in the acetabulum in patients with non-traumatic necrosis of the femoral head. DESIGN AND PATIENTS: One hundred and seventy-nine patients with non-traumatic femoral head necrosis were assessed by MRI and radiography for the presence of acetabular necrosis. Three criteria were established to differentiate between osteonecrosis and osteoarthritic changes: (1) heterogeneous morphology and irregular contours of the lesion; (2) typical demarcation lines of osteonecrosis; (3) deficient accumulation of intravenous gadolinium in the affected regions. RESULTS: In four patients histological confirmation of acetabular necrosis was obtained. The MR analysis of 22 acetabula (9.5% of those examined) showed changes which suggested osteonecrosis. No cystic lesions were demonstrated in the subchondral bone of any patient. Two cases of acetabular necrosis were found without an ipsilateral femoral head necrosis. In two patients of the 14 who had undergone total hip replacement following necrosis of the femoral head, aseptic loosening of the acetabular component was found. CONCLUSION: The study suggests that acetabular necrosis may be an accompaniment to aseptic necrosis of the femoral head. Further work is required to assess its importance in premature loosening of the acetabular element of total hip arthroplasty.

Acetabulum↗
PubMed2006

Cement pressurisation in the acetabulum.

Cement pressurisation is an important step in total hip arthroplasty that determines the long-term integration at the cement-bone interface. Our aim was to evaluate the performance of a new pressuriser designed by us against the standard existing pressurisers in an in vitro experimental set-up using two parameters: cement penetration and cement pressurisation. A polypropylene cup model was designed to represent the acetabulum. DePuy's T-handle, Exeter and our own plunger type pressuriser were each tested for cement pressurisation in this acetabular model. Cement penetration and pressures were measured. The cement intrusion into the capillaries with the DePuy pressuriser was found to vary between 2 and 8 mm (mean: 5 mm at the pole and 4.6 mm at the rim), with the Exeter pressuriser it varied between 3 and 9 mm (mean: 5.8 mm at the pole and 7.8 mm at the rim) and with the plunger type pressuriser it varied between 4 and 6 mm (mean 5.2 mm at the pole and 4.8 mm at the rim). The peak pressure achieved with the DePuy pressuriser was 60 kPa whereas it was 70 kPa with the plunger type pressuriser. The mean penetration with the plunger type pressuriser was found to be better than the other types. The penetration was found to be more uniform with equal penetration at the rim as well as at the pole.

Acetabulum↗
PubMed1998

Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement.

The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief.

Acetabulum↗
PubMed2003

Improving reliability in the classification of fractures of the acetabulum.

BACKGROUND: Plain radiographs of the pelvis are routinely used in the initial assessment of patients with suspected fractures of the acetabulum. It is necessary for orthopaedic resident trainees, emergency physicians as well as orthopaedic surgeons who infrequently treat trauma patients to be able to describe these fracture patterns reliably to traumatologist orthopaedic surgeons who ultimately take over the patient care. Our purpose was two-fold: (1) to determine the reliability of the component parts of the Letournel classification of acetabular fractures involving six anteroposterior (AP) radiographic lines, and (2) to examine whether the addition of oblique radiograph views (Judet views) would improve the reliability. METHODS: Thirty sets of AP and oblique radiographs (Judet views) of the pelvis were selected from a hospital database to represent various types of acetabular fractures. Six reviewers (three orthopaedic trainees and three community orthopaedic surgeons) independently reviewed the radiographs. For each radiograph, the reviewer classified the acetabular fracture according to the Letournel classification. In addition, each reviewer utilized a simplified classification scheme using six radiographic lines on the AP pelvic radiograph. Interobserver reliabilities among reviewers were reported along with the intraclass correlation coefficient (ICC) and kappa values. RESULTS: Agreement for the Letournel classification increased with increasing physician experience (trainees ICC=-0.14 and community surgeons ICC=0.56). Interobserver reliability between trainees and community surgeons improved when the six radiographic lines were used (range kappa=0.09-0.89). The oblique pelvic radiographs (Judet views) did not significantly improve reliability among physicians. CONCLUSIONS: In this study we report the following: (1) the reliability of the Letournel classification improves with level of training, (2) physicians with less experience with acetabular fractures have significantly better agreement in identifying fractures using the six radiographic lines on the AP film than the Letournel classification, and (3) agreement among the reviewers for the AP pelvic radiograph is not improved with additional oblique (Judet) views.

Acetabulum↗
PubMed2004

Dysplasia epiphysealis hemimelica (Trevor's disease) of the acetabulum.

Unphysiological joint stress leads to problems and subsequently to joint destruction. We report a rare case of dysplasia epiphysialis hemimelica (DEH) of the triradiate cartilage of the acetabulum. In addition to clinical symptoms, we point out the specific therapy and outcome of the afflicted child.

Acetabulum↗
PubMed1976

Central fractures of the acetabulum.

A series of 26 patients with central fractures of the acetabulum is presented with a follow-up of 3-13 years. Three patients had undisplaced fractures. In the remaining 23, long-term results of treatment by traction in 15 and by primary open reduction in 8 have been compared. A numerical grading system has been used for assessment. Results in the non-operative group were generally poor, only 2 being satisfactory. Some of the poorest scores in this group were associated with initial roof damage. Three patients required secondary salvage procedures because of severe pain and disability approximately 2 years after injury. Of the open reduction patients, all with roof damage, 4 had satisfactory results. Reasons for failure is the remaining 4 patients are discussed. Galloping degeneration due presumably to irreversible intra-articular cartilage damage at the initial injury, developed in 2 patients in the non-operative group and in one in the operative group.

Acetabulum↗
PubMed1994

Bulk autograft for a deficient acetabulum in Charnley low-friction arthroplasty. A 2-9-year follow-up study.

The authors assessed 40 hips in 36 patients where a bulk femoral head autograft was used to supplement deficient acetabulum while performing Charnley low-friction arthroplasty. The majority of the hips were congenitally dysplastic or dislocated with secondary arthritis. The average age at surgery was 47.5 years and the average follow-up period was 4 years. The graft provided a cover between 10 and 42% (mean, 23%) of the socket hemisphere. Union of the graft was evident on the radiograph in 35 hips. There was no graft resorption in 28 hips. Mild graft resorption was seen in 11 cases, and moderate graft resorption was seen in 1 case. In 24 cases, there was no demarcation at the bone-cement interface of the socket. Asymptomatic demarcation of 1 mm thickness or less was seen in 16 hips, of which only 2 showed demarcation at the cement-graft interface. All 40 cases were clinically asymptomatic and successful thus far, with the mean d'Aubigne and Postel score improving from 3.1, 2.8, and 2.9 before surgery to 5.9, 5.4, and 4.9 after surgery for pain, function, and movement, respectively.

Acetabulum↗
PubMed1980

Intertrochanteric fracture of the femur with ipsilateral central fracture of the acetabulum.

The management of three patients each of whom sustained an intertrochanteric fracture of the femur with an ipsilateral central fracture of the acetabulum is described. Complications encountered in the first patient, using a standard nail and plate type of fixation, suggested that a screw compression system should be used for this combination of injuries. This method of internal fixation was successful in the treatment of the two other patients.

Acetabulum↗
PubMed1998

The role of the anterior column of the acetabulum on pelvic stability: a biomechanical study.

A study on the effects of the anterior and the posterior column of the acetabulum on pelvic ring stability was carried out by applying a lateral compression force to specially prepared specimens. In group 1, the continuity of the right anterior column was disrupted by removing the acetabulopubic part of the anterior column; the posterior column was left intact in order to measure the strength of the posterior column. In group 2 the continuity of the right posterior column was disrupted by removing the ischioacetabular part of the posterior column leaving the anterior column intact in order to measure strength of the anterior column. The posterior column provided an average maximum strength of 759.43 +/- 229.51 N and the stiffness was 113.19 +/- 22.40 N/nm. The anterior column provided an average maximum strength of 2015.40 +/- 352.31 N and the stiffness was 301.57 +/- 98.67 N/mm. Thus the anterior column provides 2.75 times greater strength to the pelvic ring than the posterior column (P < 0.05). This finding may be important in open reduction and internal fixation of double column acetabular fractures.

Acetabulum↗
PubMed2004

[Subacute osteomyelitis of the acetabulum].

A 15-months-old girl presented an excentration of the hip associated with a defect image of the acetabulum. Arthrography revealed a communication between the hip joint and the acetabular defect. Bacteriological specimens of the articular fluid were negative. The radiographic images were compatible with subacute osteomyelitis. Relative immobilization using an Atlanta abduction devise was undertaken. No medical treatment was prescribed for this adolescent who had received antibiotics for polymicrobial urinary tract infections and for pharyngitis prior to detection of the orthopedic disorder. Outcome was satisfactory with progressive filling of the acetabular defect but also with development of a subluxating coxa valga which required varus osteotomy of the femur. This case appears to illustrate a particular form of subacute osteomyelitis which is not described in earlier classifications.

Acetabulum↗
PubMed2000

The acetabulum: sex assessment of prehistoric New Zealand Polynesian innominates.

With increasing urban development in New Zealand, prehistoric Polynesian skeletal remains are frequently being recovered. Since such material must often be reinterred quickly, it has become important that the sex of individuals be determined from the remains in a relatively short time. For this purpose, discriminant function analysis was utilised for sex determination of prehistoric adult New Zealand Polynesian innominates (21 male and 35 female). Maximum diameter of the acetabulum was measured and subjected to SPSS direct discriminant function analysis. Accuracy of sex determination ranged from 85.2% to 86.2%. Reduction in error over random assignment by sex ranged from 70% to 72%. The two discriminant functions derived will provide a useful tool for the assessment of human remains in the forensic and archaeological context because they incorporate a single measurement which can be taken on incomplete bones.

Acetabulum↗
PubMed2000

Size and direction of hip joint forces associated with various positions of the acetabulum.

When total hip replacement is performed, the position of the acetabular component may affect wear and component survival time. We considered the questions: In what way does displacement of the hip joint center alter (1) the magnitude and (2) the direction of the resultant force? Biomechanical tests were carried out on a human multibody model. After displacement of the hip joint center, the resultant forces were calculated for the single leg stance. With the flexed single leg stance, maximum hip joint forces were observed with lateral, cranial, posterior displacement. The peak forces were affected by the modeling of a gluteus maximus wrapping point at the ischial tuberosity and were overestimated when this was removed. With the straight single leg stance, posterior displacement decreases the total load on the hip joint because of the increased leverage of the rectus femoris. With regard to the direction of the resultant force, medial displacement increases the angles in both planes, cranial displacement increases it in the sagittal plane (cranial, posterior-caudal, anterior), and anterior displacement decreases the angle in the sagittal plane and increases it in the frontal plane (medial, cranial-lateral, caudal). The direction of the force is relatively insensitive to displacement of the hip joint center. The results presented here indicate a marked increase in the force after lateral, cranial, posterior displacement of the center in the flexed single leg stance. To avoid extreme joint loading and to reduce the wear after total hip arthroplasty, the cranial and posterior regions of the acetabulum should be fully reconstructed. A high hip joint center has an adverse effect on the magnitude of the force, although the directions are hardly affected by it.

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