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PubMed1992

[Diagnosis, classification and surgical indications in acetabulum fractures].

Displaced acetabular fractures may lead to posttraumatic arthritis. Consequently, joint congruency must be restored by either conservative or operative measures. Standardized radiographs of the pelvis are prerequisites for the correct evaluation of the hip-joint. The a. p.-pelvis projection and the Judet views (obturator and iliac oblique) showing the whole pelvis are indispensable and demonstrate radiological landmarks typical of anatomical relationships and fracture characteristics. The two dimensional computertomogram is an adjunctive diagnostic measure and facilitates the evaluation of the hip joint itself. The 3DCT allows the imaging of old acetabular fractures and aids in the planning of reconstructive surgery. With the basic three projections of the hemipelvis, Letournel and Judet developed the acetabular fracture classification now accepted world-wide. Assuming the notion that the acetabulum is supported by two columns, five fracture types and five fracture type combinations are described according to involvement of the anterior or posterior columns respectively. The correct classification precedes the choice of surgical approach and is the basis for preoperative planning. The indications for surgery adhere to the principles of joint surgery. Conservative treatment may be considered only if the weight bearing joint surface of the acetabulum is congruent. Otherwise open reduction and internal fixation are indicated.

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PubMed1991

[Reconstruction of an acetabulum by implantation of a reconstruction prosthesis].

The problem of the "missing acetabulum" in central dislocation of the hip was solved in the case under report by means of a bone transplant from the ala of the ilium. After the bone had healed, a vital and solid acetabulum had been obtained, so that a repeated central dislocation is most unlikely--both as a result of this fact and because of the insertion of an Eichler ring.

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PubMed1975

[The anatomic and radiologic picture of the acetabulum (author's transl)].

The basic shape of the facies lunata shows at the inner margin of each of the three participating bones a dell into which the floor of the acetabulum progresses. These dells originate in nutritive vessels which enter the bone and claim this place. There always are groups of vessels and wide channels which may be visible on radiographs. The so far unexplained picture of a vascular canal in the roof of the acetabulum corresponds to the canal leading into the body of the ilium. Due to its position there is often restructuring leading to filling or covering of the canal. The entrance to this canal is shown as a gap in the arc of the acetabular cavity which would have to be added to that of the "tear figure" known so far. The closed arc, as always drawn, reults only when this entry has been filled up.

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PubMed1991

Total hip replacement after central fracture dislocation of the acetabulum.

We performed total hip replacement (THR) for traumatic arthritis following central fracture dislocation of the acetabulum in 19 patients (15 men and four women). This situation is significantly challenging, as most patients have scarring, contractures, and unequal leg length. The average age was 49 years, and all patients were followed for a minimum of 2 years. A two-piece cementless acetabular component and a cemented or cementless femoral component were utilized. In each patient, prophylactic low-dose irradiation was administered to discourage heterotopic ossification, and gentamicin with either cefazolin or vancomycin were given as prophylaxis for infection. Overall, the results were excellent. The mean Harris hip score after surgery was 84. No infections, dislocations, or significant heterotopic ossification occurred. Limb length was within 1 cm in each patient. No revision surgeries were performed, and no components were roentgenographically loose. There was one case of transient nerve palsy. We conclude that THR after central fracture dislocation of the acetabulum is a safe and effective procedure.

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PubMed1990

Prophylaxis with indomethacin for heterotopic bone. After open reduction of fractures of the acetabulum.

Forty-four fractures of the acetabulum that had been treated with open reduction and internal fixation necessitating dissection of the gluteal muscles were reviewed radiographically for the development of heterotopic bone. Grade-2 (Brooker classification) or more severe heterotopic ossification was seen in thirteen (50 per cent) of twenty-six patients who did not receive indomethacin but in only one (5.5 per cent) of eighteen patients who received indomethacin for six weeks postoperatively. In the patients who did not receive indomethacin, the maximum amount and extent of the heterotopic bone was evident in twelve weeks. In the patients who did receive indomethacin, the heterotopic ossification did not progress after the administration of indomethacin was discontinued. We concluded that, in patients who have a fracture of the acetabulum, indomethacin provides effective prophylaxis for heterotopic bone after operative reduction with gluteal dissection.

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PubMed1990

[Fractures of the acetabulum operated on by the Sénégas approach. Apropos of 33 cases].

Thirty-three fractures of the acetabulum were operated on through an extended lateral approach described by Sénégas. Exposition of the posterior column was similar to that obtained through a classic Kocher-Langenbeck approach. The anterior column can be simultaneously exposed even though the exposition is relatively limited. Intraarticular control of the fracture through this approach is excellent, allowing de visu reconstruction of the acetabulum. Clinical results were excellent in 28 patients with an average follow-up of 3 1/2 years. Complications were relatively rare. The Sénégas approach is indicated in "T" fractures and in transverse fractures without an associated fracture of the posterior wall. In bicolumnar fractures, the Sénégas approach allows joint reconstruction even in the absence of peripheral control of the fragments.

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PubMed1990

[Plastic surgery of post-traumatic marginal defects of the acetabulum].

A method of plasty of the hip joint with the perforated metallic implant fixed with plastics is proposed. The method was approbated in experiment with 10 adult dogs and used in 3 patients with long-standing marginal fractures of the acetabulum. Morphological and roentgenological examinations have found restored integrity of the acetabulum, the supporting ability of the extremity and sufficient amplitude of movements.

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PubMed1990

Recent developments in imaging diagnosis in fractures of the acetabulum: the role of CAT and tridimensional reconstruction.

The authors report their experience in a radiographic study of the treatment of 22 cases of fractures of the acetabulum. All the patients were studied using both traditional radiography and CAT, and the results were then compared. In 17 cases (77%) the CAT images were integrated with a tridimensional reconstruction (3D). The diagnostic aid provided by CAT was of crucial importance in planning treatment and selecting the most suitable surgical approach. Furthermore, 3D reconstruction may provide a valuable link between traditional radiography and CAT in evaluating complex fractures. The authors conclude that a comprehensive radio-diagnostic study should be a routine preoperative procedure in complex fractures of the acetabulum, and in all cases where traditional radiography yields doubtful results.

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PubMed1989

[The computer-assisted spatial reconstruction of the hip acetabulum].

Computer aided design is a useful method in presenting graphics. By 2 simple computer programs written in BASIC and running on most home computers very clear plots of the 3-dimensional (3D) structure of joints like the acetabulum can be drawn quickly. By orthogonal transformations the 3D-body may be easily regarded from every possible point of view. The surface of the acetabulum may be emphasized by an optional automatic hatching between adjacent cutting bows. Further methods of automatic data entering from given joints are discussed.

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PubMed1989

[Long-term results of primary hip total prosthesis with acetabulum reinforcement ring].

The Müller acetabular reinforcement ring has proven very useful, especially in total hip revision when the bone of the acetabulum is of poor quality or deficient. However, the acetabular reinforcement ring may also be indicated in primary total hip replacement, especially in the case of poor quality bone in the acetabular bone stock, e.g. in chronic polyarthritis or protrusio acetabuli, or of deficient morphology of the acetabulum, e.g. in hip dysplasia. We analysed the results recorded in 145 patients operated on between 1977 and April 1983. Each of these patients had received a total hip prosthesis for the first time, with the polyethylene cup supplemented by an acetabular reinforcement ring. This patient group cannot be compared with the usual patient populations reported on in connection with primary hip replacement, since most of our 145 patients had several risk factors and had undergone previous surgery on up to seven occasions on the hip ultimately replaced by a prosthesis. Radiological analysis did not show a significant correlation between malposition of the acetabular reinforcement ring and signs of loosening, except when the acetabular component had been implanted in a most atypical manner. The infection rate was 4.8%, but it must be borne in mind that from 1977 to 1983 there was no routine prophylaxis with antibiotics. The incidence of aseptic loosening of the acetabular reinforcement ring necessitating revision was 0.7% after a mean follow-up of 7.7 years (range 5.5-11 years).(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1989

[Surgical treatment of metastases of the acetabulum].

The lytic metastasis of the acetabulum are frequent, causing pathologic fractures, pain and disability. The authors analyze 42 acetabular metastases operated on between 1976 and 1986. Thirty-nine total hip replacements were made, 9 conventional arthroplasties for minor lesions, and 30 metallo-acrylic reconstructive surgery of the acetabulum combined in 8 cases to bone grafting of more extensive lesions. These arthroplasties allowed immediate weight-bearing. In three cases of very extensive acetabular destructions, hip resections were only possible. The complications were essentially: 3 early deaths, 2 acetabular loosening by tumor osteolysis, and one deep infection. Mean follow-up was 15 months. Results were assessed by pain and walking which are in the whole satisfactory in these patients with limited life expectancy. Surgical indications should be wide in disable patients. It is a palliative surgery aiming to improve the quality of life, giving the patient a functional autonomy.

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PubMed1989

[Treatment of fractures of the posterior border of the acetabulum].

The author presents the results of the treatment of 30 patients (21 males and 9 females) with fractures of the posterior border of the acetabulum. In 25 patients there were injuries of other parts of the skeleton and of the inner organs. 20 patients were urgently transported to the institute and 10 patients were admitted at remote terms after the injury. The indications for conservative and surgical treatment are given. 12 of the 20 urgent patients have been operated on. In cases of late admission arthrodesis or total replacement of the joint has been made. Successive reconstructive interventions may be achieved when the fragments of the acetabulum are precisely adapted.

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PubMed1988

[Fracture of the acetabulum].

Severe trauma of the acetabulum is uncommon in children. However, it must be remembered that these apparently benign lesions can be responsible for serious complications. In a group of 31 children under the age of 16 years presenting with such lesions, 12 already had an adult type skeleton. Amongst the remaining children, 15 presented with fractures or fracture-dislocations of the acetabulum and 4 presented with marginal avulsions of the acetabular ridge. Two epiphysiodeses of the Y cartilage were observed, one in a 2 year old child, revealed by acetabular dysplasia at the age of 8 years, and the other in a 10 year old child which did not have any serious consequences. Three of the 4 cases of marginal avulsion were complicated by intra-articular incarceration, 2 of which were initially missed. Secondary surgical treatment achieved good functional recovery, but left radiological sequelae in the form of coxa magna.

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PubMedDate not supplied

Conservative treatment of fractures of the acetabulum. Results after longtime follow-up.

In a retrospective study the long-term results of conservative treatment of acetabular fractures has been evaluated. From 1967 through 1983, 79 patients with 81 fractures of the acetabulum were treated. The fractures were classified according to Judet and Letournel (1). Out of these 79 patients 83% had multiple injuries. The mean Injury Severity Score was 34 (9-75). Follow-up examination was performed in 55 patients. Partial avascular necrosis of the femoral head appeared in 11%. Fractures without dislocation had all a good prognosis. Fractures with dislocation, where the anterior column was involved, had a relative similar prognosis. In 79% of patients, where the dorsal column or roof of the acetabulum was involved, had a moderate or bad result. We conclude that no optimal result can be expected, when in dorsal column or acetabular roof fractures the reposition achieved by conservative treatment is insufficient. In these cases operative reposition and fixation should be considered.

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PubMed1987

Fractures of the acetabulum: conservative treatment and results.

The treatment of fractures of the acetabulum is still a controversial subject. There has in recent years been a tendency towards surgical rather than conservative treatment but more recently it has been observed that the long-term results of both types of treatment are not dissimilar. The classification of these fractures is important in relation to both conservative and surgical treatment. With the objective of rationalising the choice of treatment, 72 comminuted fractures of the acetabulum treated conservatively at the Orthopaedic Clinic in Perugia between 1959 and 1980 were reviewed. Both the clinical and radiographic features of these cases were analysed. The overall results were 70% successes and 30% failures. Several correlations indicating which features of the fracture had most influence on the final results were established; the involvement of the support surfaces (acetabular dome) and joint congruency were found to be the most important. In addition to these major factors, the age of the patient, presence or absence of dislocation, the degree of displacement and topography of the fragments collectively define the "type" of fracture and the criteria which are indispensable for the choice of treatment.

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PubMed1987

The surgical treatment of fractures of the acetabulum. Results after five years and proposed new classification.

Thirty-seven fractures of the acetabulum treated surgically at the Orthopaedic Institute in Milan were reviewed 5 years after operation. The overall clinical and radiographic results over this period of time were considered to be satisfactory, but a detailed study of each case enabled us to determine some of the factors which may negatively influence the outcome of this type of fracture. These negative factors were used to devise a new classification based on whether or not there was involvement of the load bearing segment of the acetabulum and on the complexity and comminution of the fracture.

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PubMed1987

[Bone dynamics of the acetabulum in experimental subluxation of the hip joint and its repair process].

Subluxation of the hip and subsequent acetabular dysplasia were experimentally produced by fixing the knee of young rabbits in extension position. Changes of the acetabulum during the repair process after reduction were investigated radiologically, histologically and histomorphometrically. Radiologically, subluxation and acetabular dysplasia appeared two weeks after fixation and disappeared as the knee became flexible after removal of fixation. Histologically, abnormalities of growth cartilage and hypertrophy of trabeculae in the secondary spongiosa were prominent two weeks after fixation. Histomorphometrically, the bone area, osteoid surface and mineral appositional rate increased at this time. The above findings, however, were normalized as concentric reduction of the hip was achieved. Abnormal stress acting on the acetabulum caused hypertrophy of trabeculae, and this may result in the development of osteoarthritis. In order to prevent such a pathologic process, it is important to normalize the hip mechanically from the view point of bone dynamics.

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PubMed1986

Fractures of the acetabulum. Early results of a prospective study.

One hundred two patients with 105 displaced fractures of the acetabulum were treated for fractures involving at least one column of the acetabulum and displaced at least 5 mm (rim fractures were excluded). The patients were primarily young adults with multiple injuries secondary to motor-vehicle-associated trauma. Fractures were classified according to the classification of Letournel. The most common fractures were the complex associated types with 44 complete both column, 19 T-shaped, and 18 associated transverse and posterior wall. Seventeen fractures were treated closed, and 88 were treated operatively. Closed treatment with skeletal traction was undertaken if roof arc measurements demonstrated a satisfactory remaining acetabular dome following fracture and in some cases of apparent congruence following complete both column fractures. Fractures not meeting these criteria were operated upon through the Kocher-Langenbeck, extended iliofemoral, or ilioinguinal approach. Ninety percent of the operations produced a satisfactory reduction of the fracture (3 mm or less displacement). A follow-up study longer than one year was obtained for 50 fractures. Clinical results were 80% satisfactory overall. Operative complications included 3% infection, 5% nerve palsy, and 7% significant ectopic bone. Operative treatment can produce satisfactory fracture reductions and clinical results with an acceptably low complication rate.

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