Fix and replace: Simultaneous fracture fixation and hip replacement for acetabular fractures in older patients.

INTRODUCTION: Displaced acetabular fractures in the elderly present significant treatment challenges. The 'fix and replace' concept involves open reduction and internal fixation of the acetabulum, providing bony stability to accept the press-fit of an acetabular cup, with a cemented femoral stem. This allows early mobilisation and the advantages this confers. This study of 57 patients treated with fix and replace describes our technique, outcomes, and survival analysis. METHODS: A retrospective review of 57 'fix and replace' procedures in patients aged over 60 was performed. Data was collected on mechanism, fracture type, demographics, time to surgery, comorbidity index, complications, EQ-5D and Oxford hip scores (OHS). Radiographs were reviewed for fracture healing, implant loosening, cup migration, and heterotopic ossification. RESULTS: 57 patients aged 60 to 95 had fix and replace surgery. The median ASA score was 3. The mean Charlson Index was 4.8. 45 patients had a low-energy fall, 6 had a road traffic accident, 3 fell off a bicycle, and 1 mechanism was unclear. The fracture patterns were anterior column posterior hemitransverse (67%), associated both columns (9%), posterior column (9%), posterior column and posterior wall (9%), and transverse (2%). The mean time to surgery was 8.4 days (0-14). 26 out of 57 (46%) received a blood transfusion. Mean length of stay was 17.6 days (7-86). The mean follow-up was 35.5 months. 4 dislocations were treated with closed reduction, whilst 1 required excision arthroplasty. 2 infections resolved with debridement, antibiotics, and implant retention (DAIR), whilst 1 required a two-stage revision. 1 acetabular component had migrated requiring revision. The median pre-injury OHS was 44 (26-48) compared to 37.3 (28-48) at 1 year. There were no deaths at 30-days, whilst at 1 year 7 patients had died. Kaplan Meier survival analysis showed mean survival was 1984.5 days. Implant survival was 90% at 1 year. CONCLUSION: While fix and replace is conceptually attractive, this medically complex patient group requires considerable support peri­ and post-operatively. Further studies are required to provide clinicians with more information to decide on how best to provide a holistic management strategy for such injuries in this frail patient cohort.

Acetabular avascular necrosis following high-dose steroid treatment and chemotherapy for leukemia : Computer tomography analysis of treatment with impaction bone grafting.

Avascular necrosis (AVN) of the bone is thought to be a serious complication of treatment for acute lymphoblastic leukemia (ALL). The acetabulum is an unusual area to be affected by AVN, and there are currently no reports of successful joint salvage procedures found in the literature. We present a case of a 20-year-old man with ALL who was diagnosed with debilitating AVN of both acetabula 2 years following initial diagnosis of ALL and treatment with a multi-agent chemotherapy regimen including high-dose corticosteroids. After unsuccessful treatment with bisphosphonate therapy, the acetabular AVN underwent bilateral curettage and impaction bone grafting to prevent collapse of subchondral fractures with the hope of salvaging both hip joints. Computer tomography (CT) of the AVN affected areas, pre- and post-bone impaction grafting, demonstrated healing of the subchondral fractures and a doubling of bone density that was maintained at 2 years after surgery. The patient resumed full weight-bearing at 3 months after first surgery, continues to ambulate unrestricted, and remains pain free 3 years post-surgery.

Assessment of risk factors for occurrence or worsening of acetabular fracture following percutaneous cementoplasty of acetabulum malignancies.

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.

Modified Stoppa approach for operative treatment of acetabular fractures: 10-year experience and mid-term follow-up.

INTRODUCTION: The (modified) Stoppa approach for acetabular fracture surgery has gained significant popularity and early results have been encouraging but clinical outcome at extensive follow-up is scarce. The purpose of this study is to provide an update on our experience with this approach for operative treatment of acetabular fractures and to assess clinical outcome at mid-term follow-up. METHODS: In this retrospective study, all patients treated operatively for an acetabular fracture using the Stoppa approach over a 10-year period were included. Surgery details were reviewed and patients were contacted and requested to return for follow-up. Primary outcome was native hip survivorship, secondary outcome measures included; functional outcome (Merle d'Aubiginé, Harris hip) scores, health-related quality of life (short-form 36) and radiographic outcome (heterotopic ossification, hip osteoarthritis). RESULTS: Forty-five patients received operative fixation for 47 acetabular fractures using the Stoppa approach. Complications requiring surgical intervention were found in one patient (with a vascular lesion) intra-operatively and 3 patients (with wound infections (2) and diffuse bleeding (1)) post-operatively. Follow-up was 83% and 29/39 (74%) native hips survived at mean 59 months (SD 49) postoperatively. Excellent-good functional scores were found in 88% (Merle d'Aubiginé) and 76% (Harris hip) of patients who had retained their native hip. Most (6/8) short-form 36 indices in these patients were comparable to population norms. Of 29 native hips with radiographic follow-up (mean 59 months (SD 49), 4 (86%) had no-minimal radiographic abnormalities. CONCLUSION: This study confirms that the Stoppa approach is a safe and effective technique for acetabular fracture fixation. Moreover, at mid-term follow-up, this approach is associated with satisfactory results in terms of hip survivorship as well as functional and radiographic outcome. As such, our findings reinforce the notion that this less invasive technique presents a valuable alternative to the ilioinguinal approach for the surgical treatment of acetabular fractures.

Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures.

BACKGROUND: Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. METHODS: We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. RESULTS: Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. CONCLUSION: Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present.

Internal fixation of acetabular fractures in an older population using the TIMI approach - Midterm results of a prospective study.

INTRODUCTION: The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures. METHODS: From July 2007 to April 2014, 47 patients aged over 55 years were treated via the TIMI approach; these patients were included in the present prospective study. The patients' characteristics, data, and early phase of care were assessed during acute care. A radiological evaluation comprised pre- and postoperative CT scans and x-rays, including Judet views at follow-up. Follow-up examinations were performed after 6 and 24 months and comprised a clinical and radiological examination and an evaluation of hip function (Harris Hip Score) and health-related quality of life (EQ-5D). RESULTS: The mean age of the patients was 74±11years, with a gender ratio of 35/12 (m/f). The average operation time was 93±30min, and perioperative blood loss amounted to 858±463ml. In total, five (11%) complications associated with the operative procedure occurred, and revision surgery was necessary in three patients. We observed no wound infections, abdominal wall hernias or cases of heterotopic ossification in our sample. The Harris Hip Score at six months after surgery was 81, and it slightly improved to 84 after 24 months. The mean EQ5D index was 0.91 at six months after surgery and 0.92 at 24 months after surgery. CONCLUSION: The TIMI approach represents a valuable alternative to the ilioinguinal and modified Stoppa approach for the treatment of acetabular fractures located in the anterior column, which are often observed in geriatric patients. LEVEL OF EVIDENCE: Therapeutic Level II (Prospective cohort study).

Simultaneous bilateral shoulder and bilateral central acetabular fracture dislocation: What to do?

Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.

The use of manual therapy post-hip arthroscopy when an exercise-based therapy approach has failed: a case report.

STUDY DESIGN: Case report. BACKGROUND: Although there is a growing body of literature on both surgical intervention and postsurgical rehabilitation of acetabular labral repairs and femoroacetabular impingement, there is a paucity of information on how to manage individuals who show a lack of progress postsurgery. CASE DESCRIPTION: A 30-year-old woman underwent surgical labral repair with femoroacetabular impingement osteochondroplasty. Postsurgery, she was initially treated with an exercise-based approach, but experienced an increase in hip pain and further decline in function. Her primary functional deficits were difficulty standing and pain (6/10) with ambulation. A combination of soft tissue mobilization and trigger point dry needling was used to address perceived muscle dysfunction, and nonthrust manipulation was used to address perceived hip joint hypomobility. OUTCOMES: Following 12 therapy sessions over 120 days, the patient returned to her demanding occupation with minimal residual symptoms. By the end of the period of care, the patient's Harris hip score had improved from 56 to 96 and her Lower Extremity Functional Scale score had improved from 26 to 70. DISCUSSION: This case describes a multimodal manual therapy approach and the health outcomes of a patient following labral repair with femoroacetabular impingement decompression who did not respond to an initial exercise-based postsurgical rehabilitation approach. Level of Evidence Therapy, level 4.

Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

STUDY DESIGN: Single-subject research design using 4 consecutive patients. OBJECTIVE: To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. BACKGROUND: Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. METHODS: This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. RESULTS: All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. CONCLUSION: Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

Thromboprophylaxis in patients with pelvic and acetabular fractures: A short review and recommendations.

The management of thromboprophylaxis in patients with pelvic and acetabular fractures remains a highly controversial topic within the trauma community. Despite anticoagulation, venous thromboembolism (VTE) remains the most common cause of surgical morbidity and mortality in this high-risk patient group. Although various thromboprophylactic regimes are employed, evidence relating to the most effective method remains unclear. Controversies surrounding screening, the use of prophylactic inferior vena cava filters (IVCF) and chemothromboprophylaxis in polytraumatised patients, particularly those with pelvic and acetabular fractures, form the basis of considerable debate. With the absence of a well-designed clinical trial and the presence of ongoing controversies within the literature, this review will explore current treatment options available to trauma surgeons and highlight differing scientific opinions, providing an update on the role of screening and current available preventative measures. We cover existing as well as recent advances in chemical thromboprophylactic agents and discuss external mechanical compression devices, the usefulness of serial duplex ultrasonography and the role of extended chemothromboprophylaxis on discharge. The evidence behind prophylactic IVCF is also considered, along with reported complication profiles. We conclude with a proposed protocol for use in major trauma centres, which can form the basis of local policy for the prevention of VTE in trauma patients with pelvic and acetabular fractures.

Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery.

INTRODUCTION: Pelvic acetabular injuries are associated with significant blood loss. This is compounded by multiple surgical interventions including definitive fracture fixation, which put patients at further risk of postoperative transfusion. We use intraoperative cell salvage routinely as a blood conservation strategy to address this issue. This is a prospective evaluation of the clinical efficacy and cost effectiveness of using intraoperative cell salvage in patients with pelvic acetabular injuries. METHODS: Data were collected prospectively for all the patients who underwent pelvic acetabular fracture fixation at our institution. A total of 30 patients (25 men, 5 women) with a mean age of 41 years (range: 31-79 years) were assessed over a period of 10 months. RESULTS: The mean preoperative and postoperative haemoglobin levels were 11.8g/dl and 9.9g/dl respectively. The mean intraoperative blood loss was 1,232.5ml (range: 150-2,693ml). The mean amount of blood salvaged and retransfused through a cell saver was 388ml. Of the 30 patients, 14 (47%) required transfusion after surgery and 26 units of blood were transfused. In terms of cost effectiveness, a total of £2,572 in 30 patients or £86 per patient were saved. CONCLUSIONS: We found intraoperative cell salvage to be clinically efficacious and cost effective in patients with pelvic acetabular injuries.

The use of blood cell salvage in acetabular fracture internal fixation surgery.

OBJECTIVES: To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. DESIGN: A retrospective study. SETTING: Tertiary pelvic and acetabular reconstructive center. PATIENTS/PARTICIPANTS: Patients undergoing internal fixation for acetabular fractures. RESULTS: Eighty consecutive patients were reviewed, comprising 26 elementary fracture (EF) and 54 associated fracture (AF) types. The mean volume of autologous blood transfused was 484 mL. The mean volume of 561 mL of autologous blood transfused in patients with AF types was significantly greater than the mean volume of 325 mL transfused in the EF group (P = 0.007). Additional allogenic blood transfusion was required in 5 (19%) patients with EFs and 15 (28%) patients with AFs (P = 0.418). The mean cost of the blood cell salvage and additional blood products in our study was $223 (£135) for all fracture types ($174/£105 for EF and $246/£149 for AF).When treating AF types, the mean cost of using blood cell salvage was $246 (£149) as compared with the mean predicted cost of not using blood cell salvage and transfusing the equivalent of 1.7 units of allogenic blood instead, which was $463 (£281). These distributions are significantly different (P = 0.01). CONCLUSIONS: The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion.

Tratamiento artroscópico de las lesiones del labrum acetabular: estudio prospectivo de 68 casos con un seguimiento máximo de 9 años / Arthroscopic treatment of labral injuries: prospective study of 68 cases with 9-years follow-up

Introducción: Durante los últimos años las lesiones del labrum acetabular se han convertido en la fuente de dolor encontrada más frecuentemente en los adultos jóvenes y deportistas. Los métodos de diagnóstico modernos y la artroscopia nos han permitido poder identificarlas y así tratarlas con mayor precisión. La artroscopia es la herramienta más adecuada para reparar estas lesiones. La reparación del labrum y sus trastornos asociados es fundamental para la preservación de la cadera en pacientes activos y deportistas. Numerosos estudios han demostrado que las lesiones labrales generan cambios degenerativos precoces en la cadera. El propósito de este trabajo es mostrar el seguimiento a largo plazo de pacientes con lesiones labrales tratados mediante debridamiento simple, tal cual como se describió hace más de una década, y proponer un punto de partida frente a los conceptos actuales sobre el tratamiento de las lesiones labrales de la cadera. Material y método: Entre julio de 2000 y julio del 2005, se realizaron 235 procedimientos artroscópicos de cadera en 233 pacientes, que presentaban dolor e impotencia funcional de un mínimo de 4 meses de evolución. 68 casos tratados con debridamiento simple del labrum fueron estudiados de manera prospectiva con un seguimiento máximo de 9 años. Usamos el score de Harris modificado en preoperatorio y post operatorio para la evaluación y seguimiento de los resultados. Los procedimientos fueron realizados con la técnica en decúbito dorsal con mesa de tracción y control con intensificador de imágenes intraoperatorio. El protocolo de terapia física incluyo marcha protegida con muletas 15 días y movilización rápida asistida y magnetoterapia. Resultados: Los resultados obtenidos fueron: buenos (73,5 por ciento), pobres y malos (26,4 por ciento). Dependieron fundamentalmente de dos parámetros principales asociados a las variables ambientales: grado de lesión del cartílago (Outerbridge), presencia de signos degenerativos (Osteofitos cefálico superior o inferior); estos asociados a edad, sexo, peso y respuesta biológica de los pacientes. Conclusiones: El desbridamiento artroscópico simple de las lesiones del labrun acetabular tiene resultados satisfactorios en el largo plazo siempre que no estén asociados a otras patologías, especialmente lesiones de cartílago en cualquiera de sus formas o presencia de cambios degenerativos articulares. Así como también se debe tener en cuenta a la hora de indicar este procedimiento la edad y el nivel de actividad de los pacientes.

Tratamiento artroscópico de las lesiones del labrum acetabular. Estudio prospectivo de 68 casos con un seguimiento máximo de 9 años / Arthroscopic treatment of labral injuries. Prospective study of 68 cases with 9-years follow-up

Introducción: Durante los últimos años las lesiones del labrum acetabular se han convertido en la fuente de dolor encontrada más frecuentemente en los adultos jóvenes y deportistas. Los métodos de diagnóstico modernos y la artroscopia nos han permitido poder identificarlas y así tratarlas con mayor precisión. La artroscopia es la herramienta más adecuada para reparar estas lesiones. La reparación del labrum y sus trastornos asociados es fundamental para la preservación de la cadera en pacientes activos y deportistas. Numerosos estudios han demostrado que las lesiones labrales generan cambios degenerativos precoces en la cadera. El propósito de este trabajo es mostrar el seguimiento a largo plazo de pacientes con lesiones labrales tratados mediante debridamiento simple, tal cual como se describió hace más de una década, y proponer un punto de partida frente a los conceptos actuales sobre el tratamiento de las lesiones labrales de la cadera. Material y método: Entre julio de 2000 y julio del 2005, se realizaron 235 procedimientos artroscópicos de cadera en 233 pacientes, que presentaban dolor e impotencia funcional de un mínimo de 4 meses de evolución. 68 casos tratados con debridamiento simple del labrum fueron estudiados de manera prospectiva con un seguimiento máximo de 9 años. Usamos el score de Harris modificado en preoperatorio y post operatorio para la evaluación y seguimiento de los resultados. Los procedimientos fueron realizados con la técnica en decúbito dorsal con mesa de tracción y control con intensificador de imágenes intraoperatorio. El protocolo de terapia física incluyo marcha protegida con muletas 15 días y movilización rápida asistida y magnetoterapia. Resultados: Los resultados obtenidos fueron: buenos (73,5 por ciento), pobres y malos (26,4 por ciento). Dependieron fundamentalmente de dos parámetros principales asociados a las variables ambientales: grado de lesión del cartílago (Outerbridge), presencia de signos degenerativos (Osteofitos cefálico superior o inferior); estos asociados a edad, sexo, peso y respuesta biológica de los pacientes. Conclusiones: El desbridamiento artroscópico simple de las lesiones del labrun acetabular tiene resultados satisfactorios en el largo plazo siempre que no estén asociados a otras patologías, especialmente lesiones de cartílago en cualquiera de sus formas o presencia de cambios degenerativos articulares. Así como también se debe tener en cuenta a la hora de indicar este procedimiento la edad y el nivel de actividad de los pacientes (AU)

Osteopathic diagnosis of an acetabular injury.

Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient.

Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture.

Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial.

Efficacy of intraoperative red blood cell salvage and autotransfusion in the treatment of acetabular fractures.

OBJECTIVES: To determine if cell saver (CS) use in patients with acetabular fractures reduces the volume or rate of allogeneic blood transfused intraoperatively and postoperatively and if this translated to a decrease in blood-related charges to the patient. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS: One hundred eighty-six patients with operatively treated acetabular fractures. INTERVENTION: All patients underwent open reduction internal fixation of their acetabular fracture. The decision to use CS was at the surgeon's discretion. MAIN OUTCOME MEASUREMENTS: The volume and rate of intraoperative and postoperative allogeneic blood transfused and blood-related charges were evaluated. RESULTS: CS was used in 60 cases (32%), and the average volume of blood autotransfused was 345 mL. No differences were observed in the rates (58.3% vs 48%, P = 0.1883) or the mean volumes (770 vs 518 mL, P = 0.0537) of intraoperative and postoperative allogeneic blood transfusions between the CS and the non-CS groups. Total blood-related charges in the CS group were significantly higher than that in the nonCS group ($1958 vs $694, P < 0.0001). Subanalyses based on fracture pattern, injury severity score, body mass index, days to surgery, and estimated blood loss were performed. In each subanalyses, no differences were observed in intraoperative and postoperative transfusion rates and volumes, and total blood-related charges were higher in the CS groups. CONCLUSIONS: In the routine use of CS in acetabular surgery, there was no reduction in the volume or rate of allogeneic blood transfused intraoperatively or postoperatively. However, blood-related charges were significantly increased.

Evolution of pelvic and acetabular surgery from ancient to modern times.

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 surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.

Reprodutibilidade da classificação de Tile para fraturas do acetábulo

Classificar corretamente as fraturas acetabulares é crucial para bom planejamento pré-operatório e para redução cirúrgica eficiente. Entretanto, para cumprir seus objetivos, qualquer sistema de classificação deve ser simples e reprodutível. O objetivo deste artigo é avaliar a reprodutibilidade interobservador da classificação de Tile para fraturas do acetábulo. Foram utilizadas 30 imagens radiográficas de 10 fraturas acetabulares nas incidências de Judet, analisadas por 10 observadores, sendo cinco especialistas em cirurgia de quadril e cinco residentes do terceiro ano de ortopedia. A concordância global obtida foi de 72,44 por cento com Kappa (K) = 0,52 (0,48 entre residentes e 0,57 entre especialistas). Conclui-se que a classificação de Tile para fraturas acetabulares apresenta moderada concordância interobservador, não havendo diferença estatisticamente significante entre residentes e especialistas.

Properly classifying acetabular fractures is crucial for a good preoperative planning and for an efficient surgical reduction. However, in order to accomplish its objectives, any classification system must be simple and reproducible. The objective of this article is to assess inter-observer reproducibility of TileÆs classification concerning acetabular fractures. Thirty X-ray images of 10 acetabular fractures at Judet planes were used and assessed by 10 observers, being five hip surgery experts and five 3rd-grade orthopaedic residents. The global consistency achieved was 72.44 percent to Kappa (K) = 0.52 (0.48 among resident doctors and 0.57 among experts). It was concluded that the TileÆs classification of acetabular fractures reveals a moderate inter-observer consistency, with no statistically significant difference between resident doctors and experts.