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PubMed1989

[Fractures of the acetabulum].

Fractures in the region of hip acetabulum are an ever more frequent and difficult orthopaedic problem. Not infrequently the choice of the therapeutic method is determined by associated injuries occurring in half the cases and affecting practically any part of the body. Of essential importance for the diagnosis and treatment of these fractures is the radiological examination as described by R. and J. Judet and Le Tournel. For prevention of femoral head necrosis the coexistent hip displacement must be corrected within 48 hours.

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PubMed1989

[Changes and progress in surgical treatment of fractures of the pelvic ring and acetabulum].

The diagnosis and treatment of pelvic fractures and dislocations demand that the pelvic girdle and the acetabulum be examined separately. Fractures of the pelvic girdle are present in more than 60% of cases but have to be stabilized only in 9%, in contrast to acetabular fractures, which need to be reduced and internally fixated in 55%. Combined fractures need surgical management in 66% of cases. Fractures of the pelvic girdle are best diagnosed by means of plain radiograms and computed tomograms to distinguish posterior instability. These techniques are the basis of the treatment plan for external or internal fixation. External fixation is an effective method from the aspect of hemorrhage control but not sufficient to avoid postoperative pain. Early open reduction and internal anterior and posterior fixation is the treatment of choice if good rehabilitation is to be achieved. Acetabular fractures occur mostly in young patients. Only accurate articular reduction of displaced fractures can bring about a good functional result, as this minimizes posttraumatic arthritis. Radiological evaluation is done with three standard views: 1. A. P. X-ray of the pelvis; 2. oblique view of the obturator; 3. oblique view of the ilium. When those are considered in combination with a CT scan, acetabular fractures can be classified. The Letournel classification is extremely important for reduction and fixation, as no one surgical approach has been found that is satisfactory for all acetabular fractures. Internal stabilization is provided with single screws and plates.

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PubMed1989

[An experimental study on the suitability of the prosthetic head to the acetabulum].

Central migration is a serious postoperative complication of the femoral head replacement and one of its causes is incongruity of the femoral head prosthesis. The present experiment was undertaken to investigate the influence of femoral head prostheses of varying size, constructed entirely of stainless steel, upon the acetabular cartilage. Dogs had their femoral head replaced with a smaller prosthesis (smaller prosthesis group), a larger prosthesis (larger prosthesis group) or a virtually congruous prosthesis (diameter discrepancy: less than 2 mm; congruous prosthesis group) and were examined both roentgenographically and histologically for subsequent changes in the acetabulum. As a result, acetabular changes were found to be more profound in both the smaller and larger prosthesis groups, especially the latter, than in the congruous prosthesis group. These results, even though not directly applicable to human clinical situations, may be interpreted as implicating incongruousness in diameter of the head of the prosthesis as one of factors causative of central migration of femoral head prostheses.

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PubMed1987

Major acetabulum reconstruction using autograft bone in cemented hip arthroplasty.

Acetabular wall deficiency is a relatively common problem in prosthetic hip arthroplasty. The authors have reviewed the results of acetabular reconstruction using autogenous bone grafts, either iliac wing or femoral head, in 49 cases in which a cemented acetabular component was employed. Thirty-one were primary cases, 15 revisions, and 3 ankylosed hips. The roof only was deficient in 20, the anterior wall in five, and the posterior wall in one. Fourteen had combined deficiencies and nine had total acetabular deficiency. Follow up ranged from three to eight years. The results have been reasonable with no graft absorption and no early acetabular component loosening. Failure of the femoral side in one case of total acetabular reconstruction at four years led to revision. The bone grafts were found to be united and had re-established a normal blood supply. It is concluded that autogenous bone grafting of the acetabulum is a reasonable procedure.

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PubMed1987

[A case of exostosis of the base of the acetabulum in a child with multiple exostoses].

The authors report a case of an exostosis of the base of the acetabulum seen at the age of four months in a routine radiograph of the pelvis in a child suffering from osteochondromatosis. The growth in size of this exostosis led to subluxation of the hip at the age of three years. Surgical removal resulted in reduction of the subluxation and restoration of joint stability three years after operation. An intra-acetabular site for an exostosis has rarely been described.

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PubMed1978

[Axial roentgenogram of the acetabulum (author's transl)].

The authors report the technical skills and diagnostic values of axial roentgenograms of the acetabulum. This procedure usefully completes the traditional method of examination of the hip joint and it is more informative in many cases. The method is advised in the modern examination and treatment of acetabular fractures, whether isolated or complicated by traumatic hip dislocation. Apart from its application in traumatology, this special technique is valuable in orthopedics as well.

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PubMed1986

The surgical treatment of inveterate fractures of the acetabulum.

Any fracture of the acetabulum which is not adequately treated within 3 weeks poses a considerable surgical problem. Reduction is difficult, callus has already begun to form between the displaced fragments, and the risks of complications are therefore increased. Our material consists of 35 cases, subdivided into 18 fractures submitted for treatment between 3 and 12 weeks after injury, and 17 fractures submitted for treatment beyond the 12 week limit. In the first group the incidence of complications (ischaemic necrosis, arthrosis, infection) was high; satisfactory results were obtained only when the fracture was of the simplest type. In the second group, malunion had to be accepted, and treatment was concerned solely with improving function by correcting malposition and relieving or eliminating pain. The surgical methods adopted depended on the circumstances: corrective osteotomy, arthrodesis or total prosthetic replacement.

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PubMed1987

The treatment of fractures of the acetabulum involving both anterior and posterior columns.

Over a period of 20 years, 35 cases of fracture of the acetabulum involving both columns were treated by operation in our unit. These were followed up after a minimum of 8 to a maximum of 20 years. The Iselin approach, even when extended forwards by partial disinsertion of the gluteal muscles, allowed good reduction only when there was little or no displacement of the ilio-pubic column. In the other cases, it was necessary to use a combined anterior and posterior approach, or the Letournel approach, but the latter was reserved for cases with very severe displacement or comminution of the fragments when it is essential to have access and control of the iliac and acetabular complex in its entirety. The clinical and radiographic results of fractures involving both columns are not unlike those observed in other complex fractures of the pelvis: good reduction and osteosynthesis is synonymous with good function even in the long term.

Acetabulum↗
PubMed1986

Fractures of the acetabulum. A retrospective analysis.

A roentgenographic analysis of 204 acetabular fractures is presented. In addition, 64 displaced fractures (43 treated surgically) are evaluated clinically and roentgenographically (average follow-up period, 3.7 years). Most fractures can be adequately evaluated from anteroposterior and oblique roentgenograms of the pelvis. The roentgenographic and clinical results correlate closely. Fractures must be reduced to a displacement of 3 mm or less, in addition to congruent reduction of the femoral head with the weight-bearing dome of the acetabulum, to achieve a satisfactory clinical result. Most displaced fractures involve the weight-bearing dome and require surgery. With an intact weight-bearing dome, nonoperative treatment is considered. Quantification of this dome with three measurements termed the medial, anterior, and posterior roof arc obtained from the standard roentgenograms is valuable in determination of appropriate treatment for displaced acetabular fractures.

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PubMed1986

Transverse fractures of the acetabulum.

From a total case material of 356 fractures of the acetabulum we have been able to analyse in depth 188 fractures treated surgically--77 transverse, 21 T-fractures and 90 transverse associated with posterior rim fractures. These lesions, although sharing certain anatomical and radiographic features, have peculiar characteristics which are important to define for purposes of treatment. Posterior dislocation of the femoral head is frequently associated with posterior rim fractures and central dislocation with transverse and T-fractures. Traumatic arthritis as a late complication was studied with particular reference to the quality of reduction of the fracture. When this results in an irregular articular surface early arthritis is the usual outcome; when it results in an acetabular cavity wider than the diameter of the femoral head, arthritis is delayed usually for more than 10 years, and subsequently progresses very slowly.

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PubMed1986

[Mixed fractures of the posterior wall of the acetabulum. Value of x-ray computed tomography].

The authors have studied three cases of fracture of the posterior wall of the acetabulum in which one fragment was separated and another was impacted. The nature of the lesions were not able to be appreciated on standard radiographs but was visualised by means of tomodensitometric studies. The patients were treated surgically to obtain an accurate reconstruction of the articular surface. The importance of tomodensitometry in the diagnosis of such lesions is stressed.

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PubMed1986

Three-dimensional computed tomography of the acetabulum.

Acetabular fractures represent a complex variety that are classified in different types. Conventional radiology is often inadequate to demonstrate and classify the fractures. Computed tomography (CT) has already been shown to be superior in this field. A further advantage of CT is represented by the recent availability of three-dimensional (3D) images that are realized from axial CT scans by means of a new software. The Authors report the applications of this new software to the study of the normal acetabulum and in patients with fractures. 3D images allows an effective demonstration of the fracture, its irradiation and the dislocation of bone fragments. The information is contained in one or few images rather than many axial images. Therefore the role of 3D images may be considered complementary to axial CT scans.

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PubMed1986

[Repair of the acetabulum using a bone homograft preserved at the time of revision of total hip prostheses].

Between 1973 and 1982 the authors have used the preserved femoral head to allograft the affected acetabulum in 80 patients with loose total hip arthroplasties. The problems of reconstruction were various and several techniques were used. 65 cases have been reviewed with more than one year follow-up. No complication relating to the graft was found. All patients but 6 had dramatic relief of pain. Four new loosenings were encountered. The quality of the functional result was related to the pre-operative condition of the hip and the adequacy of the repair.

Acetabulum↗
PubMed1986

Revision of total hip arthroplasty for aseptic loosening: the acetabulum.

Very predictable results can be obtained from revision of the aseptically loose acetabular prosthesis by using cement fixation if: the hip is taken apart completely so that complete access to the acetabulum is obtained, a bed of bone of adequate strength completely devoid of soft tissue is prepared, a new prosthesis, backed with a metal shell, is selected to distribute the applied load as evenly as possible and thus minimize peak stresses in cement or bone, and this prosthesis is inserted as far medially, inferiorly, and anteriorly as possible to create a new anatomic geometry that, during function, will place as little load on the hip as possible.

Acetabulum↗
PubMed1986

[Osteoid osteoma of the floor of the acetabulum in children. Apropos of a case].

The authors report a case of osteoid osteoma of the acetabulum in a 5 year old child. It was resected after arthrotomy by an anterior approach. The upper end of the femur was deformed and this was related to impaired growth. After the operation, the pain subsided but the deformity was still noticeable two years later.

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PubMed1979

[Above acetabulum aneurismal cyst. One case (author's transl)].

One case of above acetabulum aneurismal cyst is presented and the authors insist on the main features of this benign tumor supplied with radiology, clinic and evolution. Location of such cyst are uncommon: 4 cases upon 137. Medical team has to resolve two problems: on one hand, positive diagnosis of this benign tumor, on the other hand, treatment of this particular location.

Acetabulum↗
PubMed1979

[Morphometry of the femoral head in the rabbit. Surface appearance of the acetabulum after femoral prosthesis].

An anatomical study has been achieved on 42 upper extremities of adult rabbit's thigh bones. Three types of prostheses have been perfected in order to analyse the reactions of the cartilage and of the subchondral bone when confronted with these implants. The animals were sacrificed at different intervals. The state of the acetabulum surface has been studied according to macroscopic and microscopic criteria. Three methods converge and agree in showing an arthrosis type of reaction with regard to the non operated controlateral articulation.

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