Surgical treatment for complex acetabular fractures.

OBJECTIVE: To explore the effect of surgical treatment on complex acetabular fractures. METHODS: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean equal to 38.5 years) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8. RESULTS: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score more than 80 points). The rate of excellent and good was about 86%. CONCLUSIONS: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of fractures and choices of appropriate surgical approach and time.

Review of traumatic diaphragmatic hernia associated with pelvis fractures.

OBJECTIVE: To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia (TDH) associated with pelvis fracture reported in recent 10 years. METHODS: A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed. RESULTS: The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34% of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%. CONCLUSIONS: TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis.