PubMed · 13335909
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R J WEISSENBACH, P PIZON. 1956-05-02. [Acetabular protrusions].. https://pubmed.ncbi.nlm.nih.gov/13335909/
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BACKGROUND: Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. OBJECTIVE: To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. MATERIALS AND METHODS: A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. RESULTS: In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. CONCLUSIONS: It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.
INTRODUCTION: Studies of hip arthroplasty have dealt mainly with total endoprosthesis, while tribology measurement values of hemi-endoprosthetic implants are rare. The small amount of experimental tribological data concerning materials of hemi-endoprosthetic implants in the form of pendulum trials, animal experiments, in vivo measurements on human hip joints and pin on disc studies report friction coefficients between 0.014 and 0.57; the friction coefficients measured in fresh human cadaver hip joints were determined between 0.001 and 0.08. MATERIALS AND METHODS: The HEPFlEx-hip simulator was constructed to test the friction coefficients of unipolar femur head hemi-endoprostheses made of metal or ceramic against fresh cadaveric acetabula. Its plane of movement is uniaxial with a flexion-extension movement of +30/-18 degrees . The force is produced pneumatically dynamic with amounts of 2.5 kN. Newborn calf serum serves as a lubricant. We mounted 20 fresh porcine acetabula and 10 fresh human cadaver acetabula in the HEPFlEx-hip simulator and compared the two unipolar femur head hemi-endoprostheses (metal vs. ceramic). RESULTS: The mean friction coefficients against porcine acetabula were micro=0.017-0.082 for ceramic and micro=0.020-0.101 for metal; against human cadaver acetabula micro=0.017-0.083 for ceramic and micro=0.019-0.118 for metal. The frictional coefficient deltas (metal-ceramic) values of all measurements were Deltamicro=0.004 for porcine acetabula and Deltamicro=0.001 for cadaver acetabula. Box-plots graphics document significantly lower frictional coefficients of the ceramics. CONCLUSIONS: The lower frictional coefficients of ceramic compared to metal against fresh cadaveric acetabula may have a clinical impact on the process of the protrusion of the corresponding femoral head through the acetabulum.
INTRODUCTION: Acetabular fractures remain a challenge for the orthopedic and trauma surgeon, with frequently poor outcome in terms of pain and lack of motion and high rate of posttraumatic arthritis especially in badly reconstructed fractures where the anatomy was not restored. Surgical treatment of malunited acetabular fractures is often necessary, although it can be very complex. CASE PRESENTATION: We report a young woman who sustained both column fracture with central dislocation of the femoral head in which the posterior wall fragment was initially not fixed anatomically. CONCLUSIONS: Surgical dislocation of malunited acetabular fractures is a relatively new therapeutic option that provides full access to the femoral head and acetabulum without compromising the blood supply to the femoral head. Our results show that it can also be of great help in restoring malunited acetabular fractures.