PubMed · 14041582
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W CERWENKA. 1963. [Acetabular protrusion].. https://doi.org/10.1007/bf00415014
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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.
INTRODUCTION: We investigated the results of combined acetabular fractures that were treated through the extensile triradiate approach in this study. MATERIALS AND METHODS: Between January 1996 and January 2001, a total of 48 acetabular fractures were treated surgically (mainly combined fractures). Twenty-five of the combined acetabular fractures that were surgically treated through the triradiate approach with a minimum of 2 years' follow-up were included in the study. The mean patient age was 42 years. There were 8 both-column, 6 T-shaped, 2 anterior column/posterior hemitransverse, 4 transverse with comminuted roof area, 4 posterior wall with comminuted roof area, and 1 posterior column/posterior wall fracture. Associated injuries included two full-thickness chondral injuries of the head, one Pipkin type II fracture, five posterior and one central dislocation of the ipsilateral femoral head, and acetabular marginal impaction in four hips. The average follow-up was 44 months. RESULTS: The postoperative reduction was graded as excellent in 68% and imperfect in 8% of the patients. The hips were evaluated functionally according to the modified Postel-D'Aubigne score and rated as excellent in 7 patients (28%), good in 13 patients (52%), fair in 3 patients (12%) and poor in 2 patients (8%). There were 2 deep infections (8%), 2 avascular necroses of the head (8%), and 4 (16%) non-disabling heterotopic ossifications. CONCLUSION: Our results support the idea that open reduction with the triradiate approach provides good visualization and direct reduction of combined acetabular fractures. Its learning curve for combined fractures is shorter than that for single approaches and provides at least the same rate of anatomical reduction. It should be in the armamentarium of a surgeon dealing with such fractures.
INTRODUCTION: Biodegradable polylevolactic acid implants have become more commonly used for the treatment of fractures and osteotomies over the past few years. In the present study, the biocompatibility and degradation of polylevolactide screws used for rotational acetabular osteotomy were assessed on the basis of radiographic and MRI findings. MATERIALS AND METHODS: Forty-nine hips of 47 patients were analyzed for this study. The average age of the patients at the time of surgery was 38.0 years (range 18-62 years). The original diagnosis was osteoarthritis in 43 hips and osteonecrosis in 6 hips. The mean duration of follow-up was 2.8 years (range 1.5-5.5 years). Anteroposterior radiographs obtained at 1 week, 6 months, 1 year after the operation, as well as the most recent radiographs, were used to assess bony union, the radiolucent tract of each screw, and the sclerotic rim around each screw. Fifteen patients were chosen randomly to undergo MRI. RESULTS: Union of the osteotomized surfaces occurred in all patients within 6 months of surgery. Radiographs showed no osteolysis, no formation of bone cysts, and no displacement of the osteotomized acetabulum in any of the 49 hips. None of the patients was found to have any complications caused by problems with the biocompatibility of the implants. At the final postoperative examination, a central radiolucent tract and a sclerotic rim around the screws were seen in 34/49 hips (69%) and 23/49 hips (47%), respectively. On MRI findings, we were able to detect significant resorption of the screws in two patients after 1.2 and 1.7 years of follow-up. Though localized low-intensity areas on T1-weighted images and high-intensity areas on T2-weighted images were observed at the top of the screws in 5 patients, there was no development of pain, tenderness, or a sinus during the follow-up period. CONCLUSION: Although absorption of polylevolactic acid screws did not occur in a large majority of cases, rotational acetabular osteotomy appears to be a good indication for the use of polylevolactic acid screws.