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In 1996 the quality of the early management of 100 consecutive patients referred to the SW Thames regional pelvic and acetabular unit between 1989 and 1992 was studied. The management of these patients was assessed in four specific areas, and guidelines were laid down. It was found that in 56% of patients the early management did not meet these suggested standards, with 34% having deficiencies in...
To evaluate the results of retrograde percutaneous screw fixation (PSF) in minimally or undisplaced acetabular fractures in a geriatric population.Between July 1998 and July 2001, 21 consecutive patients with an acetabular fracture underwent fluoroscopic guided percutaneous fixation. The mean age was 81 years (range 67–90 years). In all cases, the fracture was minimally or undisplaced (<2mm). Two...
Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbancy. We have performed a postal questionnaire to establish the current clinical practice in the specialist pelvic and acetabular units throughout the UK, with respect to time to surgery from injury, thromboprophylaxis,...
We have established a nationwide directory of the specialist surgical units and their Lead Consultants with expertise in acetabular fracture surgery throughout the UK. Our directory has facilitated an estimation of the total numbers of operative acetabular fracture cases managed annually in the UK, as reported by those actually providing this specialist service. Previously the total number of acetabular...
The classic ilioinguinal approach is a gold standard in acetabular surgery. We developed a modification, a minimally invasive method that entails a median lower abdominal approach with extraperitoneal dissection and exposure of the pubic symphysis. The second incision is lateral, next to the iliac crest. This allows an easy, safe and quick exposure of the anterior iliac ring as well as easy access...
Total hip replacement has an important role in the treatment of acetabular fractures. Immediate total hip arthroplasty is only indicated for some rare cases but late reconstruction is performed more frequently and may follow failed non-operative or operative treatment of the original acetabular fracture.The purpose of this study is to determine the results of the use of total hip replacement for the...
Pelvic and acetabular injury may occur in isolation, or, in two-thirds of cases be associated with other significant injuries to the skeleton or other body systems.Most unstable pelvic and acetabular injuries require specialist surgical treatment which often means transfer to a specialist centre. The associated injuries also require assessment and treatment by appropriate specialists. It is believed...
Four hundred and fifty acetabular fractures in a prospectively recorded cohort were studied. Forty-one patients had died, 201 had a follow-up of more than 2 years and 25 were excluded which left a study population of 176 patients. Harris Hip Score (HHS) and modified HHS were used as outcome instruments. Acetabular fracture displacement and roof arc angles converted into a Roof Arc Score were assessed...
Unreduced fracture crossing the weight-bearing dome of the acetabulum leads to arthritis. Thus the integrity of the weight-bearing dome is considered to be an important prognostic indicator for acetabular fracture. The decision of whether or not to operate is based on the location of the fracture relative to the weight-bearing dome. A displaced fracture crossing the weight-bearing dome is an indication...
Postoperative surgical site infection (SSI) in orthopaedic trauma surgery is uncommon, but can present serious complications. This study was designed to assess the prevalence of, and to identify the risk factors for, SSI following acetabular fracture open reduction and internal fixation. A total of 326 consecutive patients who underwent acetabular fracture surgery were retrospectively reviewed. There...
The tremendous increase of acetabular fractures in the elderly provides new challenges for their surgical treatment. The aim of this study was to evaluate the biomechanical properties of conventional and newly developed implants for the stabilisation of an anterior column combined with posterior hemitransverse fracture (ACPHTF), which represents the typical acetabular fracture in the elderly.Using...
We present the first directory of the specialist acetabular surgical units throughout the United Kingdom. Previously there has not been any directory of acetabular surgeons in the UK as held by any governmental or healthcare agency. We have established that acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in 2003–2004. The total number of cases performed at each centre...
Epidemiological, clinical and radiological data of 1266 patients with a unilateral acetabular fracture of up to 29 hospitals was reviewed. Three time periods, 1991–1993 (Registry I; n=359), 1998–2000 (Registry II; n=503), and 2005–2006 (Registry III; n=404) were compared with regard to injury pattern and severity, fracture type, and chosen nonoperative vs. operative treatment to elucidate changes...
Acetabular both-column fractures are challenging articular injuries. They usually require operative treatment. We report on fundamental elements of pathoanatomy and radiology that are reviewed as far as they may influence treatment planning and surgical intervention. Surgical strategy, choice of the most suitable approach, reduction manoeuvres and fixation techniques are presented, together with some...
To develop and evaluate a computer-assisted virtual surgical procedure for preoperative planning that simulates the reduction and plate fixation for acetabular fractures based on real computed tomography (CT) data using computer softwares on personal computers.Virtual preoperative planning for reduction and plate fixation for seven acetabular fractures was performed. Three-dimensional (3D) models...
Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically,...
The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment...
The aim of this study was the direct comparison of the static fixation strength of two common plate systems: MPS (Matta Pelvic System) and LPPS (Low Profile Plate System). Furthermore the role of a modified screw placement with addressing the infra-acetabular corridor and the use of locking screws were evaluated.Custom made anterior column fractures in artificial SYNBONE pelves were fixed with different...
The effects of cerclage wiring in the open reduction and internal fixation of displaced associated anterior column and posterior hemi-transverse acetabular fractures were evaluated.This is a retrospectively clinical study of such cases where the main surgical strategy was open reduction and internal fixation with cerclage wire and reconstruction plates. Data on 12 cases treated between 1992 and 2011...
The purpose of this study was to assess the natural history of bone bruise and bone mineral density (BMD) after traumatic hip dislocations and conservatively treated acetabular fractures. Our hypothesis was that poor bone quality can influence degree of bone bruise and, in time, cause degenerative changes.Eight consecutive patients with traumatic hip dislocations and five patients with conservatively...
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