PubMed · 5459781
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R D Smith. Total hip replacement.. https://pubmed.ncbi.nlm.nih.gov/5459781/
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Open reduction with internal stabilization is considered to be the standard therapy for the treatment of displaced acetabular fractures. The internal fixation is routinely achieved by the use of plates and screws. The use of cerclage wires and cables as a reduction aid and definitive implant for stabilization has only occasionally been reported in the literature. The indication was mostly limited to use in elderly patients with insufficient bone stock. A newly instrument developed on the basis of a standard bone elevator is presented. It allows a safe, semiclosed application of a cerclage wire around the greater ischiatic notch through use of the second window of the ilioinguinal approach. A wide dissection at the "outside" of the pelvis is not necessary.
Injuries of the joints of the pelvis and of the acetabulum are still a problem even today. When the joints of the pelvis are damaged the risk of complicated pelvic injuries, that is to say pelvic injuries with damage to the soft tissues in and around the pelvis, is increased threefold. The lethality, the overall gravity of the injuries, the probability of haemorrhagic complications and the proportion of associated pelvic injuries are also increased. Even when anatomical reconstruction of the lower limb girdle is achieved, long-term secondary conditions such as pain and genitourinary and neurological sequelae frequently persist. Complicated pelvic injuries, i.e. pelvic injury with concomitant damage to organs and soft tissues in the pelvis and pelvic injuries with ipsilateral femoral fracture (floating hip) are special cases. Haemodynamic stabilization of the patient and the treatment of organic lesions must be the first priorities in the interdisciplinary therapy. Even when these priorities are correctly observed, the lethality is almost three times as high as in the case of pelvic injuries not involving soft-tissue damage. Acetabular fractures are a particular challenge even compared with other joint fractures. Operative treatment with anatomical joint reconstruction and stable internal fixation has been shown to have the best results. In addition to the type of fracture and the personal experience of the surgeon concerned, such fracture-specific factors as the presence of further fractures of the posterior wall, comminuted fractures, joint depression fractures and intra-articular fragments increasingly play a part. The long-term result worsens with increasing number of these additional pathologies. The primary cartilaginous damage caused by the accident seems to have a considerable influence on the long-term result following acetabular fractures.
The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief.