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Management of osteoporotic acetabular fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Peter V. Giannoudis, Panagiotis Douras
Delayed THA following acetabular fracture is used either as a staged procedure following initial treatment or as a 1salvage procedure to failed ORIF or posttraumatic degenerative arthritis. Delayed THA after conservative treatment may involve difficulties due to a malunion or nonunion at the fracture site. Salvage THA following ORIF can be complicated by extended scar tissue formation, underlying low-grade infection, hardware penetrating the joint from the previous ORIF, or heterotopic ossification. Bone stock loss and disruption of normal anatomy are predictors of a difficult procedure. In case of low-grade infection, which can be diagnosed with bone biopsies, bone scan, and biochemical investigations, the dilemma for the surgeon is removal or not of the extra-articular metalwork previously used to fix the fracture. If there is clear evidence of involvement, then the metalwork must be removed. Otherwise, careful consideration of the pros and cons must be discussed with the patient prior to decision-making.
Bernese periacetabular osteotomy
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
If the iliac osteotomy or posterior acetabular osteotomy is too close to the articular surface of the hip joint, the strong force generated from the correction of the acetabulum may lead to acetabular fracture.5,6 Prevention methods include the following. First, the iliac osteotomy line should be at least 3–4 cm higher than the top of the articular surface. Second, when the quadrilateral surface is cut, the ischial spine and other bony landmarks should be fully exposed. If necessary, fluoroscopy should be used to ensure more than 1 cm posterior acetabular wall remains. If the fracture has happened on the weight-bearing area, it should be treated immediately following the conventional treatment of acetabular fracture. Treating the fracture on the medial wall of the acetabulum is not necessary, as it is not weight bearing. However, loose bodies should be taken seriously in that condition. When we perform osteotomy on ischium, pubis, and ilium, maintaining fluoroscopy monitoring in different directions may help us avoid intra-articular osteotomy. After the osteotomy is accomplished, the mobility of the fragment should be confirmed to avoid fracture caused by the force of manipulating the correction.
Advances in fractures and dislocations of the hip joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Thomas Pepper, Philip Ahrens, M. Zahid Saeed
Following resuscitation of the patient and reduction of the dislocation, the hip injury remaining is a complex acetabular fracture. Operative management is indicated for all unstable hips and all displaced acetabular fractures. If there are medical contraindications to surgery or the acetabular fracture is undisplaced and the hip stable, conservative management involving longitudinal traction for six weeks followed by minimal weight bearing for a further six weeks may be appropriate.
Total hip arthroplasty, combined with a reinforcement ring and posterior column plating for acetabular fractures in elderly patients: good outcome in 34 patients
Published in Acta Orthopaedica, 2019
Tõnis Lont, Jyrki Nieminen, Aleksi Reito, Toni-Karri Pakarinen, Ilari Pajamäki, Antti Eskelinen, Minna K Laitinen
We retrospectively reviewed the records of all patients over 55 years of age who were diagnosed with and treated for a low-energy comminuted acetabular fracture at our hospitals between January 1, 2008, and September 1, 2017. Patients were identified from a prospectively maintained database that identifies and records all patients referred to and managed in the unit. The study population comprised 59 patients, of whom 25 were treated with ORIF alone and 34 with acute THA including posterior column plating. There were no definitive radiographic criteria for the treatment of patients with either ORIF or THA. Patients who underwent ORIF were treated at the Tampere University Hospital, Tampere, Finland. All patients who underwent THA were operated on at the Coxa Hospital for Joint Replacement, Tampere, Finland, which performs all arthroplasties in the same region. Both hospitals are located in the same building and share the same emergency room. Acute trauma patients are discussed and treatment decisions are made in a collective meeting pragmatically by treating physicians.
Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients
Published in Journal of Investigative Surgery, 2020
Lingzhi Kong, Yaling Yu, Fujian Li, Haomin Cui
An acetabular fracture is often caused by high-energy trauma. The anatomy of acetabular fractures is relatively complicated; thus, there are some difficulties in surgical exposure, reduction, and fixation of the injury. The surgical treatment of acetabular fracture has long been a challenging area of orthopedic trauma [1]. It is more difficult to treat a delayed acetabular fracture that has existed longer than three weeks due to scar formation and massive intraoperative blood loss. The intraoperative hemorrhage affects reduction and fixation of the fracture, which may impair joint function, and it is even life-threatening. Therefore, it is significant to control intraoperative hemorrhage during surgeries for delayed acetabular fractures.