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PubMed1993

Osteoid osteoma of the acetabulum.

Osteoid osteoma of the acetabulum can be expected to cause nonspecific symptoms of hip inflammation. In a sixteen year old girl, investigation by routine radiographs and a bone scan suggested a focus of inflammation with a nidus and sclerosis of the acetabulum and overgrowth of the head and neck of the femur. Removal of the lesion by an anterior approach with dislocation of the hip gave excellent results when seen after three years with a normal gait and normal hip motion.

Acetabulum↗
PubMed1978

[Principles of growth in the acetabulum. Consequences for the shelf operations (author's transl)].

Not unlike a Mercedesstar the arms of the Y-growthzone divide the cup of the acetabulum into three equal segments. The three branches of the Y-zone are spheroid. So the socket can expand evenly and conform to the head by feed back. Otherwise the socket would fill up. For the cartilage of the concave acetabulum proliferates by apposition to its uppermost layers, exactly as the hyaline cartilage does in the convex condyles. The trend of the socket during growth goes outwards, forwards and downwards. It moves away from a metal mark, set into the ileum flush with the shelf. It is precisely this increasing distance, that happens to a surgical shelf in a child. Failure will be inevitable. 614 shelf operations checked.

Acetabulum↗
PubMed1978

[Subchondral cysts of the iliac acetabulum (author's transl)].

Subchondral solitary bone cysts occur, as well as in numerous other places in the skeletal system, also in the roof of the acetabulum. These cysts differ from typical arthrosis growelcysts in form, position and X-ray appearances. They can be found in hips otherwise normal on X-ray examination (Group I), or in the presence of prearthrosis or arthrosis (Group II). The clinical features and the pathological anatomy of this form of bone cysts are discussed, as well as its aetiology. The pain precipitated by these cysts is very favorably affected by operative filling of the cyst with autologous spongiosa, as shown by follow up of the 19 operations done by the authors. These operations were done on an average 7 years previously. The result was good or satisfactory in 17 out of these 19 cases. The 2 treatment failures were due to wrong indication for operation--the simultaneous arthrosis was already too advanced. The authors prefer for this operation the Watson-Jones approach and recommend, if a large acetabulum-roof-cyst is present, immediate filling of the cyst also if an intertrochanteric osteotomy is done at the same time because of prearthrosis or arthrosis.

Acetabulum↗
PubMed1996

Fractures of posterior wall of acetabulum.

Fractures of the posterior wall of the acetabulum form a special group in acetabular fractures. This study aims to evaluate the results in the management of such fractures. Thirty-two patients with fractures of posterior wall of acetabulum were reviewed retrospectively. The follow-up period was 7 (range 3-10) years. Twenty-four were associated with initial posterior dislocations. Twenty-seven were managed with open reduction and internal fixation, while the remainder were managed conservatively. Reductions were rated as congruent in 30 cases and as noncongruent in 2. The functional results were excellent in 16 cases, good in 10, fair in 2, and poor in 4. Two early complications were met, namely 1 iatrogenic sciatic nerve injury and 1 superficial wound infection. Sixteen late complications were noted, including 10 heterotopic ossifications, 3 avascular necroses of femoral head, and 3 symptomatic arthritides. The incidence of late complications was high, but the functional results were generally satisfactory. Congruent reduction was the key in obtaining satisfactory results in the management of these fractures.

Acetabulum↗
PubMed1987

Anatomic basis of a superior approach to the acetabulum with osteotomy of the ala of the ilium.

This study demonstrates the importance of a superior approach to acetabulum with intrapelvic osteotomy of the iliac ala in certain fractures of the acetabulum. This study is based on the dissection of 15 formolized and 5 frozen subjects, the surgical treatment of 17 acetabular fractures, and the performances of 2 Chiari-type osteotomies and 2 Salter-type osteotomies. We investigated the gluteus medius muscle and its pedicle in relation to the iliac ala. Landmarks for the osteotomy lines and the gluteal pedicles are defined in terms of the requirements of different surgical approaches. The superior approach for acetabular fractures was made using a skin incision of Smith-Petersen type. The underlying principle is the performance of an intrapelvic osteotomy of the iliac ala, the anterosuperior part of the ala being tilted outward and backward and pedicled on the gluteal muscles. This provides intra- and extrapelvic exposure of the acetabular walls. The advantages and drawbacks of this route of approach in surgery of the pelvic girdle are discussed in terms of the types of fracture treated and tumoral locations. The anatomic findings are illustrated from traumatology and tumoralpathology. This approach seems particularly suitable for acetabular fractures interrupting the pelvic ring.

Acetabulum↗
PubMed1982

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

The results of conservative and operative treatment of dislocated fractures of the acetabulum are compared. The types of fracture are described where surgical stabilisation is indicated. Depending of the type of fracture, the causes of unsatisfactory results following operative treatment are: primary lesions of the cartilage, difficulties with reduction and retention, septic complications. The aim of surgery is first of all the anatomic reconstruction of the supporting area of the acetabulum. 2/3 of our patients were operated between the 2nd and the 14th day. The lateral position with the extremity freely movable is recommended for dorsal and lateral approach. A trochanter traction screw with extension facilitates the operative reduction. It was possible to re-examine 45 of 64 cases after a period of between 2 and 13 years. Results were evaluated according to the scheme by Merle d'Aubigné. 35 patients had very good or good results, in 3 cases secondary arthrodesis was necessary and in one case a total hip prosthesis was implanted. Dislocated acetabular fractures should be be operated as soon as possible if conservative methods fail. Late reconstruction may also be successful. The lesion of the sciatic nerve is an absolute indication for operation. Satisfactory results can be achieved by anatomic reconstruction even in cases with multiple fragmentation.

Acetabulum↗
PubMed1985

[Surgical and conservative therapy of fractures of the acetabulum--indications and results].

Between 1975 and 1983 38 patients with a fracture of the acetabulum were treated - 28 patients were operated upon, 10 patients were treated conservatively. 26 in 28 patients treated operatively and 8 in 10 patients treated conservatively could be checked up. 3 of the cases treated operatively could not be evaluated, as the operation had been realized less than two years before. Following an accurate indication for the operative treatment 14 in 23 patients proved an efficient osteosynthesis. In 5 in 8 cases treated conservatively good results were obtained. In aged patients and in certain types of fractures of the acetabulum, especially in comminuted fractures, conservative treatment is still justified.

Acetabulum↗
PubMed1980

[Complications after total hip endoprosthesis: fracture of the femur and simultaneous fracture of the cement mount of the acetabulum (author's transl)].

Report about a rare complication after total hip endoprosthesis with a simultaneous rupture of the cement mount in the acetabulum (due to a trauma) and a fracture of the femur. The x-rays and the intraoperative findings were interpreted erroneously; therefore the diagnosis was delayed. A second operation was needed to reimplant the acetabulum. During the same operation a wrong position of the prosthesis (outward rotation) had to be corrected.

Acetabulum↗
PubMed2003

[The postoperative control CT after a fracture of the acetabulum. A useful quality control measure or an unnecessary exposure to radiation?].

Fractures of the acetabulum are severe injuries of the hip joint. Exact preoperative management is necessary to make possible an anatomical reconstruction. Postoperative quality control is done best with computed tomography. Is the higher radiation exposure caused by this routine examination justified?During the 5 years from 1995 to 1999, a total of 154 patients with fractures of the acetabulum were examined postoperatively at our clinic using CT to control reconstruction, implant position and the remaining free fragments in the joint. Thirteen of these patients (8.4%) had to be re-operated after postoperative CT control. The causes of the re-operation were four cases of an intra-articular implant position, three of free fragments remaining in the joint, and in 6 patients showed inadequate reconstruction. The mean radiation exposure was 25 mGy per patient. The low mean age of the patients and the long lasting consequences of a probably unrecognised complication, justify routine, postoperative CT control, even though the radiation exposure is about 10 mGy higher than the conventional radiological diagnosis. The use of CT diagnosis as a routine postoperative measure is an appropriate control procedure that allows an objective assessment of the quality of the result for the patient as well as for the surgeon.

Acetabulum↗
PubMed1996

Bone cement penetration of the acetabulum in total hip replacement. An experimental study.

Cones of cement passing through, or below, the acetabulum may be seen after total hip replacement and are due either to iatrogenic perforation of the wall or to substantial bony defects. An experimental study was undertaken to establish which structures might be affected by these cones. In 20 cadaveric specimens, the acetabula were divided into 4 quadrants and, after the cement was set, the structures within the pelvis were dissected. In the antero-inferior quadrant the cement impinged on either the obturator nerve or vein, or the external iliac vein. Anterosuperiorly, these structures and the external iliac artery were impinged. In the posterior quadrants, the obturator muscle and nerve, and vessels, were affected, and inferiorly the external obturator muscle was also involved. The size of the cones depended on the bony depth of the acetabulum. Compared with screws, the cement can cause late complications through heat necrosis and continuous friction. The posterosuperior quadrant is the safest area to make holes for anchoring the cup.

Acetabulum↗
PubMed1995

Lateral extension of the ilioinguinal incision in the operative treatment of acetabulum fractures.

The choice of which decision to use for open reduction and internal fixation of complex acetabulum fractures depends on several variables. We report on 26 patients in whom a lateral extension of the ilioinguinal incision was used to achieve fracture reduction and stabilization. The lateral extension allowed visualization of the lateral ilium, in some cases passage of cerclage wires around the anterior and posterior columns, and in some cases placement of lateral to medial lag screws above the dome of the acetabulum. Reduction with a step of 1 mm or less and a gap of 3 mm or less with joint congruence was achieved in 21 patients (81 per cent). No patients had clinically significant heterotopic ossification. One patient had a transient postoperative femoral neuropathy, one a superficial infection, and one a deep infection. We recommend this lateral extension as an option during surgery of complex acetabular fractures through the ilioinguinal incision.

Acetabulum↗
PubMed1994

Prestresses around the acetabulum generated by screwed cups.

Screwed acetabular cups, applied in total hip replacements, generate stresses in the surrounding bone during implantation (prestresses). The effect of these prestresses on the endurance of the hip replacement are unknown. The prestresses in the acetabulum were examined both experimentally, using strain gauge techniques, and numerically, using the finite element method. It was found that the prestresses were of the same order of magnitude, if not larger, than the stresses due to the hip reaction force during one-legged stance. In some cases, the prestresses even approximated the ultimate tensile strength of cortical bone. The prestresses seemed to have a strong dependence on the outer shape of the cup, rather than on the flexibility of the cup or whether the cup had a self-cutting thread or not. Furthermore, it was found that the prestresses are not very susceptible to stress relaxation due to the visco-elastic behaviour of bone. This means that prestresses will remain present over long periods of time. So even when a patient has resumed normal daily activities, the prestresses will still play an important role in the overall stress distributions around the acetabulum. Due to the interaction of prestresses and stresses due to normal loading, the primary stability of a metal-backed screwed cup is better guaranteed than the primary stability of an all-polyethylene screwed cup.

Acetabulum↗
PubMed2004

Neurovascular injury during primary total hip arthroplasty caused by a threaded acetabulum cup.

We report an iatrogenic neurovascular injury during hip arthroplasty surgery. During insertion of a threaded titanium cup into a dysplastic acetabulum (lack of anterior wall), both the common femoral artery and nerve were crushed. It is therefore recommended that, if the soft tissues are exposed and can interfere with the instruments, inserts that require rotation should not be selected to be placed in the acetabulum. To the best of our knowledge, such a mechanism of injury has never been reported.

Acetabulum↗
PubMed2003

Arthroscopic removal of a bullet embedded in the acetabulum.

A unique case is described involving the arthroscopic removal of a bullet in the wall of the acetabulum from a low-velocity gunshot wound. The projectile entered the abdomen anteriorly and penetrated the urinary bladder and the inner wall of the acetabulum before becoming embedded intra-articularly in the subchondral bone of the hip joint. After surgical repair of the viscus, the bullet was retrieved from the hip joint using standard arthroscopic portals and a fracture table. Postoperatively, the patient immediately resumed full weightbearing with minimal discomfort and no formal rehabilitation. No complications were encountered. Arthroscopy allowed adequate inspection of the articular surface, irrigation of the joint, and removal of the foreign body while avoiding an invasive arthrotomy with its associated morbidity and soft tissue disruption.

Acetabulum↗
PubMed2005

Arthroscopic bullet removal from the acetabulum.

Hip arthroscopy has been shown to offer minimally invasive access to the hip joint compared with standard open arthrotomy. The use of arthroscopy for diagnosing and treating disorders about the hip continues to evolve. The authors describe an arthroscopically assisted technique for the removal of a bullet lodged in the acetabulum of a patient who sustained a gunshot wound that entered the abdomen and traversed the rectum before ending up in the weight-bearing dome of the acetabulum. A number of issues led to the decision to use both arthroscopy and this specific technique. Most importantly was our desire to limit the amount of surrounding articular cartilage and local bone damage on removal. Minimizing the soft tissue dissection needed to access the bullet and keeping down our operative time also played a role in deciding to use this technique. We considered the risks of potential bullet fragmentation and migration, as well as a possible abdominal compartment syndrome before proceeding. This surgical technique afforded a very satisfactory outcome for this patient and serves as a model for others when encountering a similar injury pattern in a trauma patient. It is a procedure that can be performed safely, quickly, and with minimal complications for surgeons who have experience with arthroscopy of the hip joint.

Acetabulum↗
PubMed2004

Surgical treatment of displaced fractures of posterior column and posterior wall of the acetabulum.

We evaluated the results of open reduction and internal fixation of displaced posterior wall and posterior column fractures of the acetabulum. This was a prospective clinical evaluation of such cases where the main surgical strategy was open reduction and internal fixation with interfragmentary screws and reconstruction plates. Data on 11 patients treated by open reduction (all via Kocher-Langenbech approach)/internal fixation with interfragmentary screws and reconstruction plates were collected. The follow-up period was 61 (18-102) months. Reduction with a fracture gap of less than 2mm without articular stepping was achieved in all 11 cases. Postoperative complications developed in five patients, including subcutaneous haematoma in one, avascular necrosis of the femoral head (AVNFH) in one and heterotopic ossification (HO) in three. All but the patient with AVNFH, had anatomic radiological reduction, and good to excellent functional results. Open reduction and internal fixation with interfragmentary screws and reconstruction plates is the treatment of choice in displaced posterior wall and posterior column fractures of the acetabulum.

Accidents, Traffic↗
PubMed2004

Fractures of the posterior wall of the acetabulum: treatment using cannulated screws.

A total of 19 patients (16 males, 3 females) who had fractures of the posterior wall of the acetabulum were treated by open reduction and internal fixation. Their mean age was 40 years. There were five single-fragment fractures and 14 comminuted. Fifteen patients were treated by fixation with cannulated screws only and four were treated with cannulated screws and reconstruction plates. Reduction and fixation of fragments was facilitated, and soft tissue dissection minimized, by the use of cannulated screws. Clinical results were excellent in nine hips, very good in one, good in six, and poor in three after follow-up of more than 2 years. We think that preservation of the blood supply to the fracture fragments and careful placement of the fixation components is as important as rigid fixation of the fragments for the successful treatment of posterior-wall fractures of the acetabulum. The use of cannulated screws may be helpful for this purpose.

Acetabulum↗
PubMed2001

Cerclage wiring in displaced both-column fractures of the acetabulum.

We evaluated the effect of cerclage wiring in the open reduction and internal fixation of displaced both-column fractures of the acetabulum. This was a prospective clinical evaluation of such cases where the main surgical strategy was open reduction and internal fixation with cerclage wire and supplemental reconstruction plates. Data on 35 cases treated by open reduction (all via the triradiate approach)/internal fixations with cerclage wire and reconstruction plates were collected. The follow-up period was 40 months (18-69). Reduction with a fracture gap of less than 2 mm without articular stepping was achieved in all 35 cases. Postoperative complications developed in seven cases, including subcutaneous haematoma in two, wound infection in two and heterotopic ossification in three. All the complications had no adverse effect on the clinical outcome, and all the cases had good to excellent final results. Cerclage wiring is very useful and effective in the reduction and fixation of displaced both-column fractures of the acetabulum, and supplemental fixation with reconstruction plates and screws is necessary.

Acetabulum↗