Subperiosteal osteoid osteoma of the right acetabulum.
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Unstable Fractures of the pelvic girdle should be stabilized as soon as possible. Use of standardized protocols for primary assessment and operative procedures can minimize complications and help to optimize clinical results after pelvic or acetabular fractures. The different methods of internal stabilization are not yet ideal but new developments are under way. A trend towards screw fixation can be seen in both pelvic and acetabular surgery, as well as a tendency to "localized" stabilization using small fragment implants to avoid unnecessary transfixations of pelvic joints.
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In a study of 40 young adults the pelvic inclination measured by a specially constructed inclinometer was found to be the same in the supine and standing positions when related to the horizontal and frontal planes, respectively. Consequently supine CT measurements of the hip are also representative of corresponding standing angles. The variations of the acetabular anterversion and the sector angles on CT of the hips in 5 adult corpses were measured by angulating the gantry in increments of 5 degrees to +/- 20 degrees. An approximate linear relationship was found for all parameters, the acetabular anteversion varied 0.5 degree with 1 degree pelvic rotation, and the sector angles 0.7 degree. A theoretic mathematical model for the variation of the acetabular anteversion outside the measured range employing a sine curve is introduced.
Proximal displacement of the femoral head can been seen sometimes after Chiari pelvic osteotomy. In order to clarify the causes of the displacement, a quantification analysis was performed to evaluate the factors of this osteotomy. The statistical analysis showed that 54% of the causes could be explained as being due to the angle of osteotomy, obesity ratio, the variation of the acetabular trochanteric distance, and other three factors. Paying attention to get good results: 1) making the angle of osteotomy from 11 degrees to 20 degrees, 2) keeping the variation of the acetabular trochanteric distance within 20mm, 3) the improvement of the lever arm ratio within 15%, and 4) the approximate acetabular index above 30%. In a case with the greater trochanter pulled down, a computer simulation showed that the centripetal force of the femoral head was decreased, and the displacement was increased.
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After several disappointing experiences related to the positioning of self-threading acetabulae, a new model is presented. This consists of a Titanium conical external ring and a conical insert in Biolox bioceramic. The design of the threading produces considerable stability of implantation.
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