Functional Outcomes and Their Influencing Factors for the Surgical Management of T-type Acetabulum Fractures: A Prospective Single-Centre Study of 73 Patients.

Introduction T-type fractures of the acetabulum are uncommon injuries, typically resulting in poorer long-term outcomes compared to other patterns of acetabular fractures. Our main purpose is to analyse the epidemiology, functional outcomes, and factors affecting the functional outcomes of patients with T-type acetabular fractures. Methods This prospective, single-centre study included 73 patients with T-type and T with posterior wall acetabular fractures. They underwent treatment with open reduction internal fixation using plating through the modified Stoppa, Kocher-Langenbeck (KL), or dual approach. The post-operative reduction was assessed according to Matta's criteria, and functional outcomes were evaluated using the modified Harris hip score. Results Between September 2017 and January 2023, 53 patients underwent surgery for T-type fractures (72.6%), and 20 patients were treated for T with posterior wall acetabular fractures (27.4%). The minimum follow-up period was one year, with a mean follow-up of 3.5 years. Anatomical reduction emerged as the major contributing factor towards good functional outcomes compared to satisfactory reduction according to Matta's criteria (P value: 0.006). Overall, 65 patients (89%) achieved excellent to good modified Harris hip scores, while eight patients (11%) obtained fair to poor scores. Patients with T-type fractures demonstrated better functional outcomes compared to T with posterior wall fractures (P value: 0.031). Conclusion Anatomical reduction, as assessed by Matta's reduction criteria, serves as a predictor of favourable functional outcomes. T with posterior wall fractures exhibit poor outcomes in comparison to T-type fractures. The surgical approach employed does not influence the reduction or the final functional outcome of the patient.

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments.

PURPOSE: The results after acetabular fracture are primarily related to the quality of articular reduction. Using the AO large femoral distractor, incarcerated fragments can be easily removed, and marginally impacted fragments can be elevated under direct visualization without further re-dislocating the joint. The current study aimed to evaluate our early results of using the AO large femoral distractor as an assisting tool during ORIF of acetabular fractures associated with marginal impaction or intraarticular incarcerated fragments. METHODS: Eighteen patients were included in this retrospective case series study diagnosed with an acetabular fracture associated with either marginal impaction injury or an intraarticular incarcerated fragment. On a usual operative table, all patients were operated upon in a prone position through the Kocher Langenbeck approach. The AO large femoral distractor was used to facilitate hip joint distraction. Postoperative fracture reduction and joint clearance were assessed in the immediate postoperative CT scans. RESULTS: The average age of the patients was 30 ± 8.2 years; 13 (72.2%) were males. All cases had a posterior wall fracture, and it was associated with transverse fractures, posterior column fractures, and T-type fractures in five (27.8%), two (11.1%), and one (5.6%) patients, respectively. Intraarticular incarcerated fragments were present in 13 (72.2%) cases and marginal impaction in five (27.8%). Fracture reduction measured on the postoperative CT scans showed an anatomical reduction in 14 (77.8%) patients, imperfect in four (22.2%), and complete clearance of the hip joint of any incarcerated fragments. CONCLUSION: The use of the AO large femoral distractor is a reliable and reproducible technique that can be applied to assist in the removal of incarcerated intraarticular fragments and to ease the reduction of marginally impacted injuries associated with acetabular fractures.

Clinical and Radiological Outcomes of Patients With Anterior Acetabulum Fractures Treated by the Modified Stoppa Approach.

Introduction Acetabular fractures are intra-articular fractures involving the lower extremity's weight-bearing dome. These fractures require an anatomical reduction of the fracture fragments. This aim can be accomplished by the selection of an appropriate surgical approach. This study aimed to analyze the clinical and radiological outcomes of patients with fractures in the anterior part of the acetabulum who were treated by the modified Stoppa approach. Methods This prospective observational study was conducted from April 2022 to September 2023. The inclusion criteria were: (i) age between 18 and 70 years, (ii) displaced acetabular fracture (displacement > 3 mm), (iii) within three weeks of trauma (iv) acetabular fractures with involvement of anterior column. Exclusion criteria included: (i) patients with visceral injuries requiring colostomy, (ii) pathological fracture, (iii) open fractures of the acetabulum, and (iv) neglected fracture (more than three weeks). Intraoperative data regarding surgical time, amount of blood loss, and incidence of intraoperative complications were recorded. In the postoperative period, anteroposterior X-ray and Judet views of the pelvis X-ray were obtained. Matta criteria were used to judge the quality of Fracture reduction and fixation. All the patients to be included in this study had undergone a minimum follow-up duration of six months. At the last follow-up, an assessment of the functional outcome of the affected hip by Merle d'Aubigné Hip Score and Harris Hip Score was done. Results Twenty-four patients were included in the study. The mean patient age was 36.08±11.65 years. Eighteen patients were male (75%) and six patients were female in this study. All acetabular fractures were due to high-energy trauma: road traffic accidents in 22 cases (91%) and fall from height in two cases (9%). According to Judet & Letournel's classification, there were 13 T-type fractures, five transverse fractures, and six associated both column fractures. The mean duration of surgery was 152.08 ±29.19 minutes, and the mean intraoperative blood loss was 277.08±85.95 ml. Intraoperatively one unit of blood transfusion was done in most cases. There were intraoperative complications of rent in the external iliac vein in two patients. Postoperative X-rays showed anatomical reduction in 17 cases, imperfect reduction in five cases, and poor reduction in two cases. Functional outcome of the hip by Merle d'Aubigné Hip Score was very good in 15, good in four, fair in three, and poor in two patients. Similar functional outcomes were obtained with the Harris Hip Score. Conclusion The results of the current study demonstrated that the modified Stoppa approach allows good visualization of the pelvic brim, quadrilateral surface, and posterior column. Lesser experienced orthopedic surgeons should utilize this approach to get good radiological and functional outcomes.

Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures- A case series.

Introduction: The operative fixation of pelvic ring injuries and associated acetabulum fractures presents a challenging scenario to most of the orthopaedic trauma surgeons. Current development of anatomically contoured reconstruction (ACR) plates gained popularity in fixing complex pelvic ring fractures. This study was done to assess the functional and radiological outcomes using of lateral wall stainless steel (LWSS) calcaneal plates in posterior pelvic ring injuries and displaced iliac blade fractures. Materials and methods: Retrospectively selected eight cases of pelvic ring injuries planned for fixing posterior pelvic instability and iliac blade fractures using LWSS plates. Mean follow-up was 18 months (Range 12-26 months). Results: Average time for radiological bony union achieved in 18 weeks (Range 13-22). Seven patients returned to their normal work. Average Majeed score was 60 (Range 50-68). Mean duration of surgery was 160 min (Range 120-200). Conclusion: This technique can be routinely used as supplementary fixation for posterior pelvic ring instability and iliac blade fractures. LWSS calcaneal plates showed no screw breakage or implant failure. Further this technique was cost effective in developing countries with limited resources.

OUTCOMES OF SURGICAL TREATMENT FOR DISPLACED BOTH-COLUMN ACETABULAR FRACTURES.

Complex both-column acetabulum fractures are severe injuries, often with associated injuries and complications with uncertain clinical and functional outcome. Modern traumatological protocols point to early surgical treatment, with anatomical reduction and stable internal fixation of fragments as a prerequisite for achieving a good treatment outcome. This retrospective-prospective multicenter cohort study was conducted during the 2014-2020 period and included 24 cases that met the input parameters, using the Letournel and Judet classification, and application of a combined surgical approach, a modified Stoppa and Kocher-Langenbeck approach. The results of treatment with complications, associated injuries and functional outcome are described. Fractures were caused by high kinetic energy trauma, and the cause was traffic accident in 17/24 (70.84%), fall from a height in 5/24 (20.83%) and crash injuries in 2/24 (8.33%) cases. The sample included 18 (75.00%) male and 6 (25.00%) female, with 10/24 (41.67%) right sided and 14/24 (58.33%) left sided fractures. Their mean age was 45.06 (range, 24-62) years. The mean follow-up time was 2.8 (range, 1-5) years. Postoperative complications were detected in 14/24 (58.33%) cases, including wound infection in 4/24 (16.67%), deep vein thrombosis in 2/24 (8.33%), heterotopic ossification in 2/24 (8.33%), hip osteoarthrosis in 3/24 (12.50%), avascular necrosis of femoral head in 2/24 (8.33%), total hip arthroplasty procedures in 3/24 (12.50%), abdominal complications in 2/24 (8.33%), urologic complications in 2/24 (8.33%), iatrogenic nerve lesion in 3/24 (12.50%), and fatal pulmonary embolism in 2/24 (8.33%) cases; there was no loss of reduction or non-union acetabular fracture. Associated injuries that we recorded as major trauma were presented in 13/24 (54.17%) study patients. The final functional results according to the Harris Hip Score (HHS) were excellent in 7/22 (31.82%), good in 10/22 (45.45%), moderate in 4/22 (18.18%) patients, and poor in 1/22 (4.55%) patient. The mean HHS was 84 (range 34-98). Complications and results have led us to a conclusion that primary injuries significantly affect the clinical and functional results. A good diagnostic procedure, assessment of the general condition and application of the trauma scoring system, surgical treatment that includes early hip reduction, open reduction internal fixation and physical rehabilitation are necessary.

Screw Impingement Causing Massive Swelling of the Sciatic Nerve: A Case Report.

Sciatic nerve (SN) injuries after hip fracture dislocation are described and are not uncommon. Several factors can lead to SN injury after hip surgery; among other factors, screw plates of synthesis materials can immigrate and lead to nerve impingement. We report a case of a 22-year-old male with a history of posterior wall fracture and hip dislocation after a motorway accident. Ultrasonography showed massive swelling of the SN with a cross-sectional area measured at 1.50 cm2 upstream to screw impingement. The reoperation option was judged too risky by the orthopedic surgeons; currently, the patient is undergoing platelet-rich plasma (PRP) injections around the nerve swelling and to the lifter muscles of the foot.

How to improve the performance of acetabulum fracture diagnoses: investigating the use of three-dimensional CT-scan reconstructions.

PURPOSE: The classification of acetabular fractures remains a challenge for the junior radiologist, although he is the first line of diagnosis in Emergency Department. The advantages of three-dimensional reconstructions have yet to be evaluated on a large scale. METHOD: A total of 212 fractures were classified according to Letournel and Judet by a senior orthopaedic surgeon, a senior radiologist, and a resident radiologist. The CT scans were first analysed in 2D and then a second time using 2D + 3D reconstructions of the acetabulum excluding the femoral head. RESULTS: 3D reconstructions improved correct classification not only for the radiologist resident (+ 5%) but also for senior radiologist and orthopaedist (+ 2 and + 3%). 3D reconstructions also more significantly improved the diagnoses of complex fractures (+ 8.3%) compared to simple fractures (+ 0.4%). CONCLUSIONS: 3D reconstructions have improved the routine diagnosis of acetabular fractures, especially for junior radiologist or in cases of complex fractures.

Algorithm Improves Acetabular Fracture Radiograph Interpretation Among Inexperienced Practitioners.

Acetabular fractures are often first evaluated in the emergency department, where physicians with little experience reading pelvic radiographs may be required to make an accurate diagnosis and early management decisions. In this study, medical students classified radiographs of 20 acetabular fractures and repeated the exercise three weeks later with the aid of a previously described algorithm; half the students were given a lesson prior to using the algorithm. The pre-algorithm accuracy was 4/20 and the post-algorithm accuracy was 8.3/20 (p<0.01). The lesson provided no difference (p=0.5). This algorithm is therefore a useful reference to help classify and triage acetabular fractures.

Radiological and Functional Assessment of Treatment Outcomes in Patients after Open Reduction with Internal Fixation (ORIF) of Acetabular Fractures.

(1) Fracture of the pelvis usually happens in young men and results from high-energy trauma. It generates high social and economic costs and results in further health problems. It is therefore important to assess long-term treatment results. (2) The study (NCT04902209) involved 31 patients (mean age 43.6 ± 14.8 years). We conducted fixation assessment on the basis of radiographs and CT scans and functional assessment based on functional scales. (3) We observed more degenerative changes in the less precise reconstruction of the acetabulum (p = 0.075). We did not find statistically significant relationships between the area of surgical approach, the gravity of fracture, and the development of degenerative changes. We did not find statistically significant relationships between patients' functional states and the type of surgical approach or the complexity of the fracture. We found a positive correlation between the time of surgical treatment and patients' functional state (p = 0.04). Patients whose joint surfaces were reconstructed anatomically had significantly higher scores in functional scales (HHS p = 0.05, Merle p = 0.03). (4) Patients after surgical fixation of the acetabulum have low functional abilities. The quality of reconstruction of the loaded surface as well as the length of time post-surgery seems to be essential for the patients' functional state.

Thromboelastography is predictive of mortality, blood transfusions, and blood loss in patients with traumatic pelvic fractures: a retrospective cohort study.

PURPOSE: In patients with traumatic pelvic fractures, thromboelastography (TEG) is a useful tool to rapidly evaluate and identify coagulation disturbances. The purpose of this study was to examine the coagulation kinetics of patients with traumatic pelvic fractures (pelvic ring and/or acetabulum) by analyzing the TEG results at initial presentation and its relationship with mortality and blood loss. METHODS: A retrospective review at our Level-1 trauma center was conducted to identify Full Trauma Team activations (FTTa) with traumatic pelvic and/or acetabular fractures who were evaluated with a TEG on initial presentation between 2012 and 2016. In-hospital mortality, product transfusion, and hemoglobin changes were analyzed. Subgroup analysis was performed based on pelvic fracture type. RESULTS: 141 patients with a mean age of 49.0 ± 20.8 years and mean Injury Severity Score (ISS) of 25.18 ± 12.8 met inclusion criteria. PRBC transfusion occurred in 78.0% of patients; a total of 1486 blood products were transfused. A total of 65 patients (46.1%) underwent operative treatment for the pelvic injuries, and 18 patients (12.7%) required embolization. The overall in-hospital mortality rate was 14.9%. The degree of clot lysis at 30 min (LY30) was significantly associated with blood loss (p < 0.0001), units of packed red blood cells (PRBCs) transfused (p < 0.0001), and mortality rate (p = 0.0002). CONCLUSION: Increased fibrinolysis evidenced by an elevated LY30 on initial TEG in patients with traumatic pelvic fractures is associated with increased blood loss, blood product transfusions, and mortality. Future studies should evaluate the clinical utility of reversing hyperfibrinolysis on initial TEG. LEVEL OF EVIDENCE: Prognostic level III.

Size and location of posterior wall fragment on CT can predict hip instability in a cadaveric model.

PURPOSE: Previous research has been unable to elucidate the exact factors that contribute to hip instability in the setting of posterior wall acetabular fractures. The purpose of this study was to determine the influence of posterior wall fracture fragment size and fracture angle on the stability of the hip joint in a cadaveric model. METHODS: Six fresh human cadavers (12 hips) were used. Specimens underwent pre-procedure CT evaluation and were then randomized to one of three groups: posterior wall fragment size (FS) of 15%, 20% and 25%. Osteotomies were performed starting at a fracture angle (FA) of 40°. The specimens underwent an exam under anesthesia (EUA). If the hip remained stable, the fracture angle was increased in 20° increments and re-tested until it became unstable. RESULTS: In the group with a FS of 15%, all hips were stable with a FA of 40°. Increasing the FA to 60° caused all hips to be unstable (subluxation or dislocation). In the group with a FS of 20% and 25%, all hips were unstable with a FA of 40°. CONCLUSION: In all specimens, a FS of 15% and FA of 40° were stable on EUA. Varying combinations of increasing FS size and increasing FA were all unstable. This study provides data for a CT-based measurement to predict hip instability in the setting of posterior wall acetabular fractures based on FS and FA. More research is required to validate this data in a clinical setting.

Fractures around the hip: inducing life-like fractures as a basis for enhanced surgical training.

INTRODUCTION: In this study we investigated if realistic fracture patterns around the hip can be produced on human cadaveric specimens with intact soft tissue envelope. Possible applications of such fractured specimens would be in surgical training. MATERIALS AND METHODS: 7 cadaveric specimens (2 male, 5 female, 2 formalin-fixed, 5 fresh-frozen) were fractured. 2 specimens were fractured on both femurs, 5 only on one side, resulting in 9 fractures total. 5 fractures were set in our custom-made drop-test bench, 2 fractures by inducing axial force using a hammer, and the remaining 2 fractures by a direct dorsal approach and a chisel. AO/OTA and Pauwels classification were used to classify the fractures on the specimens by two independent trauma surgeons. RESULTS: In our drop-test bench, axial load with the femur adducted by 10° resulted in an intertrochanteric fracture (AO type A1.3), adducted by 20° resulted in a femoral neck fracture (Pauwels type III). Fracture induction using a hammer resulted in two intertrochanteric fractures (AO type A2.2 right, A3.3 left). The use of a chisel resulted in both cases in a femoral neck fracture. The acetabulum could be fractured multifragmentarily through use of a hemiprosthesis as a stamp. CONCLUSION: A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic proximal femur and acetabular fractures in cadaveric specimens with intact soft tissue. Furthermore, axial load using a hammer as well as using a chisel through a direct dorsal approach represent additional methods for fracture induction. These pre-fractured specimens can be utilized in surgical education to provide a realistic teaching experience for specialized trauma education courses.

Management of acetabular fractures in elderly patients.

Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.

Clinico-Radiological Evaluation of Modified Stoppa Approach in Treatment of Acetabulum Fractures.

Background The aim of our study was to evaluate the efficacy of Modified Stoppa approach for surgical treatment of acetabulum fractures by analyzing clinical and radiological outcomes. Also, we assess intraoperative and postoperative complications of fracture treated by using Modified Stoppa approach. Objectives To evaluate clinical outcomes of Modified Stoppa approach by using Merle d'Aubigne hip score. To evaluate the radiological reduction quality of Modified Stoppa approach by using the criteria of Matta, and to assess complications of Modified Stoppa approach.  Method Thirty-two patients participated in this study (mean age 40 years; range 18-60 years) and the male to female ratio was 4:1, patients who underwent surgical intervention for acetabular fracture by using Modified Stoppa approach from Oct 2017 to April 2019 were included. Out of 32 patients, two were lost in follow up, leaving 30 of 32 patients for clinico-radiological analysis. We classified the fracture pattern according to Judet and Letournel classification based on preoperative X-ray AP view, Judet View, and 3D-CT pelvis. Operative time, blood loss, reduction quality, and perioperative complications were assessed in each patient. Clinical outcomes were assessed by Merle d'Aubigne hip score and radiological outcomes by criteria of Matta.  Results Out of 30 acetabulum fractures in 30 patients, three (10%) were categorized as anterior column fracture, one (3.3%) as transverse with posterior wall, one (3.33%) as T-type, six (20%) as anterior column with posterior hemi-transverse and 19 (63.33%) as both column fractures. In our study, most patients have trauma due to road traffic accident (RTA) in 25 (83.3%) and fall from stairs in three (10%) patients. Timing of surgery after trauma was average 5.83 days (range three to 15 days), Mean surgical time determined to be 214.66 min (range 150-350 min) and mean intraoperative loss 683.33 ml (range 230-1250 ml). Clinical outcomes by Merle d'Aubigne hip score was excellent in 13 (43.33%), good in 15 (50%), fair in two (6.66%) patients whereas poor results in 0 (0%) patient (p=0.001). Quality of reduction by Matta criteria was found to be an anatomical reduction in 26 (86.6%), imperfect reduction in three (10%), and poor reduction in one patient (3.33%) (p<0.001). Radiological grading by Matta criteria was excellent in 24 (80%), good in five (16.66%), and fair in one (3.33%) patient, and no patients met criteria for poor results (p<0.001). In operative complications one patient developed an external iliac vein injury which was repaired by a vascular surgeon, one patient had a superficial infection for which debridement, regular dressing, and IV antibiotics given and resolve in one month, obturator nerve injury in one patient which was resolve in five to six months, lateral femoral cutaneous nerve injury in one patient which resolved within three months and one patient urinary bladder injury which was repaired by a general surgeon.  Conclusion Our experience with Modified Stoppa approach for surgical treatment of acetabulum fracture in 30 patients is excellent and effective for better visualization to anterior column, quadrilateral plate, and up to sacroiliac joint. This approach provides better visibility of the fracture site which allows for good to an excellent reduction of fracture and fixation. Although Stoppa approach is cosmetic surgery in terms of scar size, there is less complication rate than the ilioinguinal approach.

Complications in patients of acetabular fractures and the factors affecting the quality of reduction in surgically treated cases.

INTRODUCTION: Acetabulum fractures, though relatively uncommon, are associated with significant morbidity and mortality. These involve high energy trauma and due to their complex nature, the management requires understanding the relevant surgical anatomy, defining the injury via appropriate radiographic assessment and determining a suitable treatment plan. Literature is scarce for the demographic data, fracture patterns, associated injuries, management and early complications in the Indian scenario. These factors play a pivotal role in the ultimate recovery of the patients. Therefore this study was conceptualised to assess the epidemiology and evaluate the complications of these fractures. Furthermore the effects of various factors determining the quality of reduction in surgically treated patients were also assessed. METHODOLOGY: This was a prospective observational study in which patients presenting to the advance trauma centre of our institute with acetabulum fractures were included. Demographical data of the patients, mechanisms of injuries, fractures morphologies, complications and radiological outcomes were recorded prospectively. RESULTS: 116 patients with acetabular fractures were included in the study. 81% of these were males, with average age of 39.95 ±â€¯15.87 years; with road traffic accidents being the predominant mode of injuries. Mortality was reported in 5 patients; 4 patients had deep venous thrombosis and sciatic nerve injuries were seen in 12 patients of which 4 were iatrogenic. 8 patients had some form of infection, out of which 4 required multiple debridements. 4 cases developed heterotrophic ossification while 2 cases had loss of reduction. The timing of surgery and other associated fractures had significant effect on the quality of reduction (p < 0.05); while age, gender, mode of injury or individual fracture patterns had no such effect. CONCLUSIONS: Proper radiological assessment and evaluation of fracture configuration is important for management of acetabulum fractures. When indicated, this should be followed by early open reduction and internal fixation to achieve anatomical reduction, with management of associated injuries for better outcomes.

Effects of the incision preference in acetabular surgery on the postoperative functional outcomes.

BACKGROUND: Many factors are known to affect the functional outcomes of the acetabular surgery. The aim of this study is to evaluate the effects of incision preferences and number of incision on scores and clinical functional outcomes. PATIENTS AND METHODS: Forty-seven adult patients who had undergone acetabular surgery and had been followed up for at least 1 year in our clinic were included in the study. Demographic data, trauma type, acetabular fracture type based on the Judet ve Letournel classification, presence of any additional traumatic fractures, time to surgery, operation duration, surgical technique, and postoperative complications were recorded. Range of motion measurements, SF-36 and Harris Hip function scale score, and full weight-bearing times were evaluated on the postoperative first year follow-up and reviewed retrospectively. RESULTS: Our study suggests that use of double incisions in the surgery of associated fractures shortens the full weight-bearing time. The localization and the number of incisions were found to be unrelated with the Harris Functional Hip scale, SF-36 (PCS, physical component score), and SF-36 (mental component score, MCS) scores. CONCLUSION: Incision type and number of incisions must be determined based on the fracture type and fracture localization for better functional outcomes. The factors that have the most effects on the functional outcomes are the type and the localization. In associated fractures, performing multiple incisions reduces the time for full weight bearing and enables patients to return to their daily routine early but have no effect on the functional outcomes.

Total hip arthroplasty for arthritis following acetabular fractures-evaluation of radiological, functional and quality of life parameters.

INTRODUCTION: Total hip arthroplasty (THA) has been termed as 'operation of the century' as it provides a stable and mobile hip to patients who are debilitated by pathologies affecting the hip. Acetabular fractures pose a challenge for their initial management as well for the management of secondary osteoarthritis which is often the outcome of these fractures. The study attempts to evaluate the short term radiological, functional and quality of life outcomes of THA done in patients with prior acetabular fractures and to find a correlation between various factors. MATERIALS AND METHODS: 47 patients who provided consent for this retrospective study were clinically and radiologically evaluated at their latest follow up. Ratios of horizontal offset, vertical offset, body lever arm and cup inclination were calculated with respect to the opposite normal hip on a radiograph. Questionnaires were filled up for Harris Hip Score (HHS), Short form -12, Short Musculoskeletal functional assessment (SMFA) and WHO-quality of life (WHO-QoL). RESULTS: HHS and quality of life scores had a tendency to improve over time. A statistically significant difference (p < 0.05) was noted between scores of patients having less than 2 years follow up and more than 4 years follow-up. The HHS, radiological and quality of life parameters were not statistically significantly different when analysed based on acetabular fracture pattern, their primary management and aetiology necessitating the THA. CONCLUSION: The short term radiological, functional and quality of life parameters are dependent on the accuracy of the THA performed and are not significantly affected by the fracture type, initial management and outcomes of that management. However, longer follow up is necessary to evaluate these parameters even more accurately.

Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration.

The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes.

BACKGROUND: The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there is no clinical evidence to confirm its efficiency. Therefore this study was designed to ascertain: (1) if the Stoppa approach versus ilioinguinal allows less blood loss, (2) if functional and radiological results are superior to that of the ilioinguinal approach, (3) if the rate of complication was different. HYPOTHESIS: The modified Stoppa approach allows less blood loss than the ilioinguinal in management of fractures of the anterior column of the acetabulum. PATIENTS AND METHODS: Nineteen patients who were treated with the ilioinguinal approach (Group A) at a mean follow-up of 33 months and 17 patients who were treated with the modified Stoppa approach (Group B) at a mean follow-up of 28.9 months were retrospectively reviewed. Patients were called to the final follow-up examination, mean follow-up durations were set and the functional evaluation of patients was made with measurement of range of motion, Harris Hip Scores (HHS), and Merle D'Aubigné score. RESULTS: Average blood loss was determined at a mean 1170 mL (range, 750-2150 mL) in Group A and at a mean 1110 mL (range, 450-2000 mL) in Group B (P=0.168). The mean HHS (group A=89.4 [73-99] and group B=88.4 [75-97]) and Merle D'Aubigné scores (group A=16.8 [13-18] and group B=16.5 [13-18]) showed no significant difference between the groups (P=0.169). At the final follow-up, the mean hip flexion was found to be 106.83 ± 12.47 and the hip extension was 10.33 ± 6.12 in Group A, while these values were 103.71 ± 14.32 and 10.69 ± 8.17 in Group B (NS between groups regarding flexion [P=0.678] and extension [P=0.445]). The complication rate was 31% in Group A (6 patients) and 23% in Group B (4 patients) (P>0.05). DISCUSSION: Both surgical approaches give successful results in the treatment of acetabular fractures. Contrary to expectations, there was no difference in the amount of bleeding at the wound site from the Stoppa technique, even though it is minimally invasive, compared to the ilioinguinal approach. LEVEL OF EVIDENCE: Level III retrospective case control study.