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1.
Bone Joint J ; 102-B(2): 155-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009440

RESUMO

AIMS: Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. METHODS: We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). RESULTS: The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d'Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. CONCLUSION: The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155-161.


Assuntos
Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Idoso Fragilizado , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Comores , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suporte de Carga
2.
Medicine (Baltimore) ; 99(1): e18655, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895830

RESUMO

RATIONALE: Developmental dysplasia of the hip (DDH) has an incidence of 5 per 1000 newborns and its management depends on various factors. We present a rare case of DDH with soft tissue obliteration and a bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. PATIENT CONCERNS: A 20-month-old girl presented to our clinic with right hip stiffness after undergoing open reduction and acetabuloplasty at another hospital. DIAGNOSES: The diagnosis of DDH was made using a computed tomography scan that revealed a right hip dislocation with soft tissue obliteration and a bony prominence in the center of the acetabulum. INTERVENTIONS: We used a novel technique for treating the rare presentation of complicated DDH with massive soft tissue obliteration and bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. The right hip was surgically explored. The acetabulum was deepened and resurfaced. Bone cement was applied over the acetabulum to prevent future ankylosis. OUTCOMES: At the follow-up 7 years after the last surgery, the patient had regained full range of motion and a properly reduced right hip with optimal acetabular coverage on radiographs. LESSONS: Care must be taken in any patient with DDH who presents with hip redislocation after open reduction. If deepening and resurfacing of the acetabulum are required, bone cement could be used as a temporary spacer for 8 weeks; this was key in treating our patient.


Assuntos
Acetábulo/lesões , Luxação Congênita de Quadril/cirurgia , Acetábulo/diagnóstico por imagem , Cimentos para Ossos , Feminino , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recidiva , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 99(4): e18395, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977843

RESUMO

BACKGROUND: The purpose of this meta-analysis was to compare the efficacy of the modified Stoppa approach (MSA) and ilioinguinal approach (IA) in the treatment of anterior pelvic ring and acetabular fractures. METHODS: A literature search was conducted using PubMed, Embase, and Cochrane database for articles that compared MSA and IA in the treatment of anterior pelvic ring and acetabular fractures. All the included articles were evaluated by 2 trained reviewers in accordance with the Cochrane Collaboration Handbook for potential risk. The Jadad decision algorithm and Downs and Black scores were also used to assess the quality of the included studies. The extracted data included operative time, intraoperative blood loss, reduction quality, clinical outcome, and complications. RESULTS: Five articles were included in this meta-analysis, with 186 patients in the MSA group and 219 patients in the IA group. Compared with IA, MSA significantly shortened the operative time (P = .0002), decreased intraoperative blood loss (P = .002), and provided better reduction quality (P = .03). Meanwhile, this meta-analysis suggests no significant difference between MSA and IA regarding clinical outcomes (P = .63) and complications (P = .34). The subgroup analysis of complications also showed no statistically significant difference between the 2 groups (including infection, and vascular and nerve injuries). CONCLUSION: According to this meta-analysis, the currently available evidence suggests that MSA can significantly shorten operative time, decrease intraoperative blood loss, and provide better reduction quality than IA in the treatment of anterior pelvic ring and acetabular fractures. In addition, in terms of clinical outcomes and complications, no significant differences were found between the 2 groups. LEVEL OF EVIDENCE: Level IV, meta-analysis.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Perda Sanguínea Cirúrgica , Humanos , Duração da Cirurgia , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Complicações Pós-Operatórias/epidemiologia
4.
J Pediatr Orthop ; 40(2): 86-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923168

RESUMO

BACKGROUND: Traumatic posterior hip dislocations in children and adolescents requires emergent closed reduction. Postreduction imaging is necessary to assess the concentricity of reduction and structural injuries to the hip. There is no a consensus for which imaging is a modality of choice in such condition. The purposes of this study are to describe magnetic resonance imaging (MRI) findings of traumatic posterior hip dislocations and to compare the effectiveness of MRI with computerized tomography (CT) in detecting structural abnormalities of the hip that impact patient management. METHODS: This study is a retrospective review of imaging in traumatically dislocated hips in patients who were treated at our institution. All CT and MRI imaging were reviewed and specific osseous and soft tissue injuries documented by consensus among 2 musculoskeletal pediatric radiologists who interpreted the MRI and CT scans of each patient in a blinded manner. RESULTS: In total, 27 patients (23 males, 4 females) with mean age of 12.5 years (range, 2 to 19 y) with postreduction MRI were evaluated. MRI findings revealed femoral head injuries in 17 (62.9%), posterior labral entrapments in 6 (22.2%), posterior labral tears in 17 (62.9%), posterior wall fractures in 15 (55.5%), fracture of the posterior unossified part of acetabulum in 4 (14.8%), and ligamentum teres injuries in 8 (29.6%). Of 16 patients who had postreduction CT scans, 6 (37.5%) had femoral head fractures, 9 (56.3%) had posterior wall fractures, and 8 (50%) had intra-articular osseous entrapments. All bony fractures and intra-articular entrapment could be seen on MRI imaging. In 16 patients with both CT and MRI, posterior acetabular injury was detected in 10/16 (62.5%) on MRI and 9/16 (56.3%) on CT. Three patients with entrapment of labrums identified on MRI could not be seen on CT scan. One patient with persistently unstable hip after reduction had an entrapped unossified portion of acetabular fracture which was seen on MRI but not on CT. CONCLUSIONS: MRI is superior to CT scan for detection of structural injuries in children and adolescents with traumatic hip dislocation. The unique structural injuries included entrapment of posterior labrum and posterior unossified acetabular fractures could be seen only at MRI. These findings will impact surgical decision making of these injuries. LEVEL OF EVIDENCE: Level IV.


Assuntos
Acetábulo/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Acetábulo/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Luxação do Quadril/terapia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Ligamentos Redondos/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Adulto Jovem
5.
Orthop Clin North Am ; 51(1): 13-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739876

RESUMO

Open reduction and internal fixation of displaced acetabular fractures has been the gold standard for treatment of these complex injuries. The subset of older patients with dome impaction, femoral head impaction, or a posterior wall component are considered for treatment with concomitant open reduction and internal fixation and total hip arthroplasty. Little has been written on the surgical techniques to perform concomitant open reduction and internal fixation plus total hip arthroplasty safely. This article describes the important intrinsic factors for acetabular component stability, choice of surgical approach for management of these injuries, and surgical technique for anterior and posterior approaches.


Assuntos
Acetábulo/cirurgia , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Acetábulo/lesões , Idoso , Artroplastia de Quadril/métodos , Cadáver , Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Redução Aberta/normas , Cuidados Pós-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
6.
Acta Chir Orthop Traumatol Cech ; 86(5): 348-352, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748110

RESUMO

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.


Assuntos
Fraturas Ósseas/complicações , Traumatismos da Perna/cirurgia , Paraplegia/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Transferência Tendinosa/métodos , Acetábulo/lesões , Atividades Cotidianas , Adulto , Idoso , Humanos , Plexo Lombossacral/lesões , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Paraplegia/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos
8.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

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.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Oper Orthop Traumatol ; 31(6): 503-512, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31620832

RESUMO

OBJECTIVE: Safe posterior column screw fixation via an anterior approach under two-dimensional fluoroscopic control. INDICATIONS: Anterior column with posterior hemitransverse fractures (ACPHF); transverse fractures; two-column fractures and T­type fractures without relevant residual displacement of the posterior column after reduction of the anterior column and the quadrilateral plate. CONTRAINDICATION: Acetabular fractures requiring direct open reduction via a posterior approach; very narrow osseous corridor in preoperative planning; insufficient intraoperative fluoroscopic visualization of the anatomical landmarks. SURGICAL TECHNIQUE: Preoperative planning of the starting point and screw trajectory using a standard pelvic CT scan and a multiplanar reconstruction tool. Intraoperative fluoroscopically controlled identification of the starting point using the anterior-posterior (ap) view. Advancing the guidewire under fluoroscopic control using the lateral-oblique view. Lag screw fixation of the posterior column with cannulated screws. POSTOPERATIVE MANAGEMENT: Partial weight bearing as advised by the surgeon. Postoperative CT scan for the assessment of screw position and quality of reduction of the posterior column. Generally no implant removal. RESULTS: In a series of 100 pelvic CT scans, the mean posterior angle of the ideal posterior column screw trajectory was 28.0° (range 11.1-46.2°) to the coronal plane and the mean medial angle was 21.6° (range 8.0-35.0°) to the sagittal plane. The maximum screw length was 106.3 mm (range 82.1-135.0 mm). Twelve patients were included in this study: 10 ACPHF and 2 transverse fractures. The residual maximum displacement of the posterior column fracture component in the postoperative CT scan was 1.4 mm (0-4 mm). There was one intraarticular screw penetration and one perforation of the cortical bone in the transition zone between the posterior column and the sciatic tuber without neurological impairment.


Assuntos
Acetábulo , Fixação Interna de Fraturas , Fraturas Ósseas , Acetábulo/lesões , Idoso , Placas Ósseas , Parafusos Ósseos , Humanos , Masculino , Resultado do Tratamento
10.
Unfallchirurg ; 122(11): 885-900, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31650191

RESUMO

The incidence of periprosthetic hip fractures is increasing due to the increase in endoprosthetic hip replacements. These fractures require a staged and individual treatment concept with the aim of mobilization of the patient as early as possible. The special challenge in the diagnostics is to identify pre-existing signs of loosening of the prosthesis. When the prosthesis is still firmly fixed femoral fractures can be treated with angular stable osteosynthesis. Loosened stems usually have to be revised, mostly in combination with osteosynthesis. Fractures around the acetabulum with a fixed cup can be treated nonoperatively or with osteosynthesis, while loosened cups have to be revised. In revision surgery the stabilization of the dorsal column is crucial for a successful outcome.


Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur , Fraturas do Quadril , Fraturas Periprotéticas/etiologia , Acetábulo/lesões , Artroplastia de Quadril/métodos , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/etiologia , Fraturas do Quadril/terapia , Humanos , Fraturas Periprotéticas/diagnóstico , Fraturas Periprotéticas/terapia , Falha de Prótese , Reoperação
11.
J Orthop Surg Res ; 14(1): 310, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514742

RESUMO

BACKGROUND: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. METHODS: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. RESULTS: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. CONCLUSIONS: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/patologia , Acetábulo/patologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/métodos , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
J Dance Med Sci ; 23(3): 126-132, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31500694

RESUMO

Due to frequent movements involving extreme hip amplitudes, ballet dancers often present with hip pain and chondrolabral lesions as seen in femoroacetabular impingement. The lesions appear even with normal anatomy. Diagnosis is often delayed, and treatment is challenging, especially in skeletally immature patients. This study reports the case of an adolescent ballet dancer suffering from a large symptomatic labral tear. The literature has also been reviewed for context regarding the pathophysiology and current therapeutic management of these injuries.


Assuntos
Acetábulo/lesões , Cartilagem Articular/lesões , Dança/lesões , Acetábulo/diagnóstico por imagem , Adolescente , Cartilagem Articular/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Articulação do Quadril , Humanos
13.
Med Sci Monit ; 25: 5953-5960, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31399554

RESUMO

BACKGROUND Screw penetration into the hip joint is a severe complication during acetabular fracture surgery. The standard fluoroscopic views of the pelvis cannot provide adequate safety during screw insertion. The aim of this research was to determine and evaluate the accuracy of the acetabular lateral view for screw placement. MATERIAL AND METHODS Twenty screws were randomly chosen and intentionally penetrated into the articular surface (1-2 mm), and the remaining 20 screws were extra-articular ones positioned in close proximity to the articular surface. Three surgeons, each evaluating 40 screws, provided a total of 120 rated observations for each screw position. We compared the traditional view or combined with lateral acetabular view with the criterion standard based on unaided visual assessment. A blinded and independent review of each pelvic intraoperative fluoroscopy was made by 3 independent observers. Specificity, sensitivity, positive predictive value, negative predictive value, correct interpretation, intra-class correlation coefficients (ICC), and Youden index were calculated. RESULTS There were significant differences in sensitivity, NPV, correct interpretation, and Youden index between the 2 groups (P<0.05). The ICC was 0.531 when the antero-posterior, iliac, and obturator oblique views were used. The ICC was remarkably increased when using a combination of the ''lateral'' view and the standard views for screw perforation of the joint. CONCLUSIONS Use of the lateral view of the acetabulum can be a complementary method to identify malpositioned screws, and it helps increase the accuracy rate of inserting screws in the treatment of posterior wall fracture.


Assuntos
Acetábulo/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Adulto , Idoso , Parafusos Ósseos , Cadáver , Fluoroscopia/métodos , Fraturas do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Cirurgia Assistida por Computador/métodos
14.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439552

RESUMO

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic-clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/diagnóstico , Convulsões/complicações , Adolescente , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
16.
Acta Orthop Belg ; 85(2): 182-191, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31315008

RESUMO

Most compound acetabular fractures involving both the anterior and posterior columns are caused by high-energy injuries. Patients with compound acetabular fractures are often in critical or poor condition and cannot tolerate major surgery. This study aims to investigate the effectiveness of an ilioischial plate in treating compound acetabular fractures. A consecutive series of 40 patients with complex acetabular fractures were surgically treated and retrospectively reviewed. A modified Stoppa approach in combination with an iliac fossa approach was used. In all of the cases, the anterior column was stabilized with reconstruction plates for the iliac wing and along the iliopectineal line to the pubis. The posterior column was fixed either with the newly developed ilioischial plate running from the ilium to the ischial ramus or with standard fixation techniques. These included either conventional posterior column screws or quadrilateral plate fixation. Patients were divided into an experimental group (ilioischial plate for posterior column fixation) and a control group (standard fixation techniques). In both groups, we found that 90% of all reductions were good to excellent. According to the modified Merle Aubigne and Postel scoring system, the percentage of good to excellent was 85% in the experimental group as compared to 80% in the control group. Compared with the control group, physical function (PF), role physical (RP) and social function (SF) were significantly better in the experimental group (P<0.05). Fracture healing was achieved in all patients. By using the modified Stoppa approach combined with the iliac fossa approach, the ilioischial plate can be directly fixed to the posterior column and the ilium to stabilize the posterior column in patients with complex acetabular fractures.


Assuntos
Acetábulo/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ílio/cirurgia , Acetábulo/cirurgia , Adulto , Placas Ósseas , Parafusos Ósseos , Feminino , Consolidação da Fratura/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Eklem Hastalik Cerrahisi ; 30(2): 106-11, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291857

RESUMO

OBJECTIVES: This study aims to compare mechanical stability of osteosynthesis (plate and screw fixation) alone versus the same method supplemented with hip arthroplasty (hybrid solution) for double column fractures in elderly. PATIENTS AND METHODS: Mechanical investigations were performed on an advanced finite element pelvis model developed for double column fractures. The following simulated implant combinations were analyzed: modular acetabular basket with a ring with polyaxial screws and U-plate; plates with polyaxial screws placed on the medial-horizontal (linea terminalis) and quadrilateral bone surfaces; modular acetabular cup with U-plates; and polyaxial screws in sizes optimized based on a finite element model (FEM). Using the models, the possible shifts in peak load positions arising in different movement patterns caused by load and tension and implant deformation were measured. RESULTS: Hybrid systems resulted in minimal deformation of the implants already available on the market. We observed less possible shifts and greater stability in the acetabular fracture zones, compared to conventional osteosynthesis alone. Optimization with available and compatible implant sizes led to a further significant increase in stability. CONCLUSION: Hybrid method combining osteosynthesis and prosthesis implantation provide more stability in biomechanical models in the treatment of double column fractures in elderly.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Humanos , Modelos Biológicos
18.
Niger J Clin Pract ; 22(6): 862-868, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187774

RESUMO

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.


Assuntos
Acetábulo/lesões , Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Idoso , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Ferida Cirúrgica/complicações , Resultado do Tratamento , Suporte de Carga
19.
PLoS One ; 14(6): e0218612, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216346

RESUMO

INTRODUCTION: Acetabular fractures consist of complex fracture patterns whereby bone fragments are displaced in different directions. Two-dimensional computed tomography (2DCT) gap and step-off measurements tend to underestimate the multidirectional features of these fractures. The aim was to develop a three-dimensional computed tomography (3DCT) measurement method for acetabular fractures and validate whether this method will provide an observer independent fracture characterization. MATERIALS AND METHODS: Sixty patients, operated for an acetabular fracture between 2007 and 2018, were included. The displacement was measured on the pre- and postoperative CT scans. Pre- and postoperative CT-based 3D models were made for each patient. Multiple 3D measurements, namely the 3D step-off, gap and the total gap area were introduced to quantify the preoperative and postoperative displacement. The Wilcoxon signed rank analysis was used to compare the 2DCT and 3DCT measurements. RESULTS: The preoperative displacement was significantly underestimated by 2DCT measurements in comparison with 3DCT measurements (2D vs. 3D; step-off 8 vs. 16 mm with P < 0.001; gap 19 vs. 21 mm with P = 0.001). The same applies to the postoperative residual displacement (2D vs. 3D; step-off 0 vs. 6 mm; gap 3 vs. 8 mm; P < 0.001). The total gap area, defined as the surface area between all fracture lines in the 3D model, was measured for each patient, resulting in a median value of 722 mm2 preoperatively and 168 mm2 postoperatively, with excellent inter- and intra-rater reliability. CONCLUSION: 2DCT measurements tend to underestimate the initial and residual displacement in complex acetabular fractures. A 3DCT analysis of these injuries was developed to overcome this and should be used in addition to the Judet/Letournel and AO/OTA classification systems, in order to provide an observer independent quantifiable fracture description and accurate assessment of the fracture reduction.


Assuntos
Acetábulo/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Modelagem Computacional Específica para o Paciente , Tomografia Computadorizada por Raios X/métodos , Acetábulo/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Ir Med J ; 112(4): 915, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-31243944

RESUMO

Aim To provide the most up to date reference of referral patterns for pelvis and acetabular (PA) fractures in Ireland and discuss where services should ideally be located. Methods A retrospective review was conducted of all referrals to the national referral centre for PA fractures in Ireland for 2016 and 2017. Results Over the two-year study period 456 referrals were made. Mean age of patients was 53 years, 62.9% were male. Management was conservative in 60.7%, operative in 38.2% while 1.1% died prior to transfer. Nearly half of fractures (47.8%) were due to falls with 38.6% due to road trauma. Referrals from the proposed central trauma network accounted for 76.1% of referrals. Median length of stay was 7 days. Average cost of operative treatment was €11,774. Conclusions PA trauma is associated with significant morbidity and costs to both patients and society. Consideration needs to be given to where best to place PA services to ensure the highest quality care in this cohort of patients


Assuntos
Acetábulo/lesões , Fraturas Ósseas/cirurgia , Transferência de Pacientes , Ossos Pélvicos/lesões , Encaminhamento e Consulta , Centros de Traumatologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Assistência à Saúde/organização & administração , Feminino , Fixação Interna de Fraturas , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Ortopedia , Ossos Pélvicos/cirurgia , Estudos Retrospectivos , Adulto Jovem
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