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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...
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...
Non-unions of acetabulum are rare. Seven cases of acetabular non-unions are reported in this retrospective study. Five out of our seven patients had either transverse or associated transverse with posterior wall fractures. All patients had surgical stabilisation of their index fractures. A diagnosis of non-union was made at an average of 5.8 months from the original injury based on clinical and radiological...
Between June 1994 and December 2000, 80 displaced acetabular fractures were treated by open reduction and internal fixation, where possible by a single surgical approach. We report our results in 72 patients (73 fractures) who completed a minimum follow-up of 2 years. The average age of patients was 39.5 years (range 15–76 years). Thirty-four fractures were classified as simple and the remaining 39...
The results of operative treatment of acetabular fractures as well as its role in the occurrence of post-traumatic osteoarthritis (OA) are presented. From 1990 to 2000, 50 patients (32 male and 18 female), aging from 18 to 71 years (mean: 37.8 years) underwent an open reduction and internal fixation of their displaced acetabular fracture. They were reviewed at a mean of 5.8 years (2–10 years). A typical...
The aim of this study was to adjust the Harris Hip Score for evaluation of acetabular fracture treatment. The discriminating quality of the score was assessed. As there was low discriminating capacity at the upper end of the scale, with a high ceiling effect and the 60th percentile showing top points, the score was modified and re-evaluated. The discrimination of the modified score was improved, with...
The primary goal in the treatment of pelvic fractures is the restoration of haemodynamic stability. The secondary goal is the reconstruction of stability and symmetry of the pelvic ring. Percutaneous reconstruction can only be accepted if these goals are met. The type of definitive surgery is dependent of the degree of instability of the anterior and posterior pelvic ring. Retrograde transpubic screw...
The incidence of pelvic ring and acetabular fractures in the elderly is climbing relentlessly. This increase is attributed to a greater longevity and a decrease in the incidence of alcohol-related trauma in younger adults. Often, the elderly trauma patient has compromised physiological reserve and healing capacity due to concomitant morbidities, resulting in a less favourable clinical outcome. The...
Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction...
Advances in systemic treatment of cancer have improved patients’ survival and increased the number of patients presenting with metastases of the pelvic ring. Pelvic metastatic lesions may cause severe pain and functional disability. A multidisciplinary approach is fundamental for the management of these lesions. Lesions of the pelvis not directly involving the hip joint such as the ischium, pubis...
To evaluate the use of rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures.The complex three-dimensional anatomy of the pelvis and acetabulum make assessment, classification and treatment of fractures of these structures notoriously difficult. Conventional imaging only provides two-dimensional images of these fractures. While interpretation of traditional...
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...
Posterior wall fractures are the commonest type of acetabular fracture. Nonoperative management is associated with significant complications and poor outcome. Consequently, open reduction and internal fixation has become increasingly common. In this article, inaugurating the new section of “how do I do it”, we present our current approach to the treatment of posterior wall fractures of the acetabulum,...
The aim of this study was to improve the reliability of Letournel classification system using a guideline algorithm protocol. The study was conducted upon two groups of orthopaedic surgeons with different experience and was consisted of two observation sessions (A and B). In session A, every observer studied, with no instructions or guidelines, a particular set of acetabular fractures on AP and Judet...
Knowledge of the bony thickness of the acetabular columns is one requisite for safe execution of percutaneous fixation of acetabular fractures. We performed a cadaveric study to determine anatomical dimensions of the columns of acetabulum with reference to percutaneous screw fixation. Twenty-two hemipelves (11 pairs) from 6 male and 5 female cadavers were measured and statistically analysed.In the...
The goal of treatment in intra-articular fractures is to obtain anatomical restoration of the articular surface and stable internal fixation. Studies have attempted to specify how accurately an articular fracture needs to be reduced to minimise the chances of a poor clinical outcome. In this study, the current evidence with regard to articular step-offs and risk of post-traumatic osteoarthritis (POA)...
The current gold standard for operatively treated acetabular fractures is open reduction and internal fixation. Fractures with minimal displacement may be stabilised by minimally invasive methods such as percutaneous periacetabular screws. However, their placement is a demanding procedure due to the complex pelvic anatomy. The aim of this study was to evaluate the accuracy of periacetabular screw...
We reviewed 77 patients with an acetabular fracture, treated operatively through a non-extensile approach after an average time of 45 months. The ilioinguinal approach was chosen in 41, the Kocher–Langenbeck approach in 36 patients. Following the Letournel classification, the most frequent lesions were posterior wall (26%), two-column (22.1%) and anterior column (14.3%) fractures. Subchondral impaction,...
Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994...
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...
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