Acetabular fracture surgical technique bookshelf

Materials and methods this is a retrospective clinical study 30 patients in the orthopedic department, hospital sultanah bahiyah. Computed tomography ct is likely superior to plain pelvic radiography for assessment of postoperative reduction, but interobserver reliability may be limited in the absence of a widely adopted technique. Internal fixation of complicated acetabular fractures. Total hip arthroplasty tha is one of the most costeffective and consistently. We appreciate the efforts of the pioneers of these techniques and dedicated education modern surgery of the acetabular surgery.

There may be some complications involved with the treatment in acetabular fracture. Acetabular fractures require a great deal of surgical experience 2, 6, 7, 9. For objective analysis of results, the patients were divided into four groups. This first article in the journals safe surgical technique section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures. An acetabular fracture can also be inferred from an arthritic hip figure 1210, although there are other causes of coxal arthritis, such as a proximal femoral fracture, chronic dislocation, osteochondritis, and. Acetabulum fractures surgical techniques kocher langenbeck ota lecture series iii v06a. The first known descriptions of surgical fixation of acetabular fractures were case reports in 1943. Modified shelf acetabuloplasty endoscopic procedure with allograft. Acetabulum fractures can involve one or more of the two columns, two walls or roof within the pelvis. Since the advent of mandatory seatbelt use, there has been a significant reduction of acetabular fractures to an approximate incidence of 3 per 00.

Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Acetabular hip socket fractures are serious orthopedic injuries, usually resulting from significant trauma. Acetabular fracture is an intraarticular fracture of the most important weight bearing joint, the hip joint, and in order to obtain optimal results, accurate anatomic. After examination of the plain films as well as the ct scan the surgeon should be knowledgeable of the precise anatomy of the fracture he or she is dealing with. Acetabular fractures, associated or not to pelvic ring disruption, are classified on the basis of fracture line, into elementary fractures of the acetabular walls, columns and roof, and into complex fractures. Apr 26, 2017 acetabular fractures are quite challenging injuries for the orthopedic surgeon because of their low incidence and their deep and complex anatomy. Reconstruction of acetabular posterior wall fractures. Each study patient was matched to a control patient. The main load transmission in cats occurs in the central and caudal thirds of the acetabulum, not in the cranial part, as in humans 4. Reconstruction of acetabular posterior wall fractures clinics in orthopedic surgery vol. The shortage of a biomimetic analysis for posterior column acetabular fracture is a problem that needs to be addressed. It is the goal of this work to provide the surgeon with strategic tools to diagnose and evaluate the types of acetabular fractures to arrive at the optimal individual indication, thus taking a fracture anatomyguided approach to reduction and fixation.

Fractures of the femoral head, anterior column, anterior acetabular wall, and high transverse acetabular fractures. Posterior column acetabular fracture fixation using a w. In addition, patients with acetabulum fractures should only be treated in specialized centers, exceeding 20 to 30 cases per year. The cohort of acetabular fracture patients included 50 men and 24 women with a mean age of 52 years sd, 12 years and median followup of 8 years range, 223 years. Apr 26, 2018 evidencebased information on acetabular fracture from hundreds of trustworthy sources for health and social care. Acute total hip replacement for acetabular fractures. The change in pitch that occurs as the shell is seated against the medial wall is often audible. Otherwise, conventional fixation constructs mostly depend on the structure of the acetabulum and the surgical technique, as screw placement in the posterior column of acetabulum has a narrow margin of safety. Jun 22, 2019 acetabular fractures primarily occur in young people who are involved in highvelocity trauma. I do not intend to discuss the possible approaches, as each surgeon will make this choice based on training and principles. A novel fixation system for acetabular quadrilateral plate.

Preop and postop xrays were done in all patients under going acetabular surgery with follow up for 24 months. Acetabular fractures labelled poor surgical choices. Periprosthetic occult fractures of the acetabulum occur. Current surgical interventions for symptomatic hip dysplasia include. In this surgical live demonstration a safe surgical hip dislocation for treatment of an acetabular fracture will be performed by experts in the field. Fractures of the posterior wall of the acetabulum are one of the most common types of acetabular fractures, accounting for up to 30% of all acetabular fractures. Percutaneus screw fixation by singaravadivelu vaidyanathan featuring singaravadivelu vaidyanathan november 2018. In 1951, cauchoix produced a study on the surgical approach. As the selection of surgical approach and fixation methods depends on fracture classification and understanding, the novel classification system can aid the surgeon with decisionmaking. Outcomes of surgical management of acetabular fractures. The pioneers robert judet emile letournel marvin tile anatomical reduction and stable internal fixation 3. Acetabulum fracture an overview sciencedirect topics. Acetabular fracture surgery realigns and stabilizes the displaced joint surfaces while allowing the patient to avoid traction and prolonged bedrest.

Clinical grade the clinical grade was based on the system of daubigne and postel12 and as modified by matta. Background surgical treatment of acetabular fracture and the anatomic reconstruction of the hip. In general, surgical fracture stabilization is indicated in all acetabular fractures, where anatomic reduction and stable fixation are deemed possible. The oxford centre for evidence based medicine cebm hierarchy of evidence was used to determine the level of evidence of. Total hip arthroplasty tha techniques statpearls ncbi bookshelf. Acetabular fractures occur primarily in young adults as a result of highvelocity trauma. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual realitystyle environment. Nov 28, 2018 analysis of the fracture pattern, displacement of the fragments, and meticulous preoperative planning go a long way in easing the difficulties faced in the surgical treatment of acetabular fracture. Early surgical intervention within 3 weeks makes reduction easier with larger chances of anatomic reduction.

Pneumonia or an infection of the lungs is a common complication in patients who are on the bed for long. The authors present a simple fluoroscopically guided technique for the percutaneous removal of intraarticular debris between the femoral head and the acetabular. Outcome of surgical stabilisation of acetabular fractures. Prospective study on seventysix cases of fractured acetabulum with. Effect of surgical treatment on mortality after acetabular f.

Outcomes after surgical treatment of acetabular fractures. Conversely, the rate of periprosthetic acetabular fractures found during surgery was 0. Clinical and radiological results correlate closely as anatomic reductions yeild best clinical results. Pdf acetabular fractures in patients aged 55 years. This study is aimed to concentrate on the outcome of surgical treatment for displaced acetabular fracture in the local setting. Because of the complex acetabular anatomy, various classification schemes have been suggested 35, but the judetletournel classification system remains the most widely accepted 2, 4, 6. Surgical treatment of bothcolumn acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Acetabular fractures are a pelvic fracture, which may also involve the ilium, ischium, andor pubis depending on fracture configuration. Safe surgical technique for associated acetabular fractures patient. Results of 167 consecutive cases of acetabular fractures.

Biological fixation of posterior wall fractures of acetabulum. Open anatomic reduction with internal fixation is the recommended treatment for fractures causing instability or incongruity of the hip joint. Acetabular fraacture management with surgical approaches. Tips and tricks for placement of reduction tools will be presented. Acetabular fractures, safe surgical technique, acetabular fixation, patient safety introduction the anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns. Acetabular fracture is an intraarticular fracture of the most important weightbearing joint, the hip joint, and in order to obtain optimal results, accurate anatomic. The kocherlangenbeck approach was used in the surgical treatment of 14 63. Surgical dislocation technique for the treatment of. Outcome of surgical treatment for displaced acetabular. Seldom study has compared the application of threedimensional 3d printing technology and traditional methods of contouring plates intraoperatively for the surgical treatment of. Roughly, a distinction is made between fractures of the posterior and anterior acetabulum. Alternatively, the appropriate qls plate can be used as part of the surgeons fixation plan for transverse acetabular fractures, t fractures, and fractures of the posterior column, where the fracture patterns may have included the quadrilateral surface.

Acetabular fracture biologics for trauma bone graft harvest femoral neck fracture ilioinguinal approach implant materials intertrochanteric fractures intertrochanteric hip fracture pathological hip fracture. Minimally invasive surgical treatment of minimally. In this article, a surgical technique of arthroscopic fixation with haplla thread pins with concomitant shelf acetabuloplasty for the treatment of. Tshaped fracture a tshaped acetabular fracture fig. Combined transverse and posterior wall fractures, transverse multifragmentary fractures, and ttype fractures are the most common indications for this technique. Total hip arthroplasty after acetabular fracture is. Many times patients will have additional injuries that require immediate treatment. Surgical treatment for bothcolumn acetabular fractures. Surgical treatment for posterior dislocation of hip. This study indicates that older methods of exposure diagnosing the fracture anatomy and fixation techniques were not adequate for treatment of posterior wall fractures of the acetabulum. It is important to protect the shells rim and inner taper from any damage during implantation. The patients with displaced acetabular fractures between the age range years and 50 years. Thus, the posterior column fractures should be addressed first. Accurate classification of acetabular fractures is important for determining the proper surgical treatment 1, 2.

T type acetabular fracture treated through surgical hip dislocation. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. Arthroscopic management for acetabular rim stress fracture and. The first surgical treatment for a fracture of the acetabulum was performed by levine, in 19431.

Valuable information is provided on fracture types, proper instrumentation, imaging studies, complication avoidance, and more. Acetabular fractures had been generally treated conservatively up until 50 years ago, but the poor outcomes caused by displaced fractures have led to increased interest in surgical treatment. Assessing postoperative reduction after acetabular fracture. Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. Full surgical technique details can be found in lsp69. Characteristics of hip socket fracture acetabular hip socket fractures can result from falls, automobile accidents or other traumatic.

Chapter 47 acetabular fracture brett bolhofner key points diagnosis or detection of the presence of a fracture involving the acetabulum accurate imaging and defining of the fracture pattern and displacements planning of a surgical approach that will address particular fracture patterns and displacements intraoperative reduction of fracture fragments through selected approaches. The patients with unstable fracture dislocation of hip either anterior or posterior. Present here is the audiovideo of the live surgery where in posterior wall of the acetabulum has been stabilised biologically by innovating minimal invasive technique by. Acetabulum fractures surgical techniques kocher langenbeck. Functional outcome of the surgical management of acute. Endoscopic shelf acetabuloplasty for treating acetabular large. Sep 04, 20 the aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. Moed introduction fractures of the acetabulum are relatively uncommon injuries, usually resulting from highenergy trauma in young adult patients. Modified smithpetersen approach and its possibilities for extension. This section focuses on the arthroscopic surgical techniques enabling arthroscopic reduction and internal fixation of the acute and the malunited femoral head fracture as well as the acetabular rim and anterior column fracture. Figures 2, 3, 4 and 5a,b,c show a preoperative xrays, msct and postoperative xrays of the patients with transversal transtectal acetabular fractures and the iliac bone fracture. The fracture classification system developed by judet and letournel is the most widely accepted system. Acetabular fracture an overview sciencedirect topics. Surgical dislocation has recently gained popularity in certain types of acetabular fracture because of its 360 degrees access to the acetabulum.

A remarkable graphic and pictorial atlas that belongs on the bookshelf of every specialist. Surgical treatment for posterior dislocation of hip combined with. Acetabulum fractures surgical approaches everything you. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. After the surgical approach is completed, the next step required prior to. A hip with a malreduced acetabular fracture is doomed to a posttraumatic arthrosis. Bothcolumn fractures are the most complicated group of acetabular fractures. A detailed discussion of acetabular surgical repair is beyond the scope of this article. Because acetabular fractures damage the cartilage surface of the bone, an important goal of surgery is to restore a smooth.

This study presents a novel classification system for acetabular fractures. Acetabular fractures primarily occur in young people who are involved in. Modified stoppa approach for surgical treatment of acetabular. T type acetabular fracture treated through surgical hip. These severe injuries often require urgent closed reduction of the hip and surgery to restore hip joint stability and articular surface anatomically. Hip socket fracture uw orthopaedics and sports medicine. Mo journal articles acetabular reconstruction using the.

Revision shell, with or without augmentation, has been implanted and it is determined that there is not adequate stability for the acetabular reconstruction. Percutaneous manipulation of intraarticular debris after. Acetabular fractures are generally diagnosed in one of two ways. There has been an increase in the number of acetabulum fractures resulting from a fall of fewer than 10 feet, likely due to the rise in osteopenia. Surgical treatment of displaced acetabular fractures. Neurological deficits were common preoperatively, but the majority of these deficits had resolved by followup. For more detailed descriptions, readers are referred to the texts listed under further reading at the end of this article. The anterior approach to hip and pelvis springerlink.

Percutaneus fixation of anterior column fracture of acetabulum. Acetabular fractures are challenge for treating surgeons. Operating 5 cases a year is meaningless and will inevitably lead to bad results. For all orthopaedists who treat fractures of the pelvis and acetabulum, this book is an essential professional resource. Depending on acetabular bone quality, the surgeon may choose to ream linetoline.

Acetabular fractures primarily occur in young people who are involved in highvelocity trauma. Underreaming by 1 to 2 mm of the actual trident hemispherical shell size is recommended to achieve interference fit. The objective of this study was to evaluate surgeonindependent parameters that might influence radiographic outcome and early complication rates of highenergy acetabular fractures treated by open reduction and internal fixation via the kocher. Three out of 100,000 inhabitants are estimated to suffer one each year 1. Acetabular fracture goals initiate an independent home exercise program be able to get back into normal activities develop a normal gait pattern without assistive devices.

In a smaller number of cases, a lowenergy incident, such as a fall from standing, may cause an acetabular fracture in an older person who has weaker bones. In this study, the rate of occult fractures of the acetabulum seen on postoperative ct images was 8% 41 of 486 hips. Acetabular fractures, safe surgical technique, acetabular fixation, patient safety introduction. An acetabular fracture is a break in the socket portion of the ballandsocket hip joint. The anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns. The reported incidence is approximately 3 per 100,000 per year. Fracture type, age, and gender are prognostic factors for the surgical outcome after orif of highenergy acetabular fractures. In short, the 3d printing technique assists in the treatment of complicated acetabular fractures, and demonstrates better feasibility and effectivity than conventional methods 15. We report the surgical outcome in 52 patients with acetabular otherwise considered as poor surgical choices. Trabecular metal acetabular revision system cupcage. Acetabular fracture, minimally invasive technique, conservative therapy, longterm outcome, risk factors background with an incidence of 3100,000 per year, pelvic fractures account for about 28% of all fractures 1.

This growing interest in surgery has also resulted in a variety of fracture classifications and surgical. Surgical treatment of acetabulum posterior wall fractures. The treatment of acetabular fractures remains one of the most challenging tasks that orthopaedic surgeons face because of the complex anatomy, limited surgical access to the fracture sites, and postoperative uncertainties. The exact classification of acetabular fractures is complex ct scan required. Outcome of surgical treatment for displaced acetabular fractures. Acetabular fractures in older patients assessment and. Let me simply say that the ideal approach should expose the full extent of the bone loss and allow perfect access to the inferior margin in order to ensure successful reconstruction. A depth gauge can be inserted through the screw holes and. Because acetabular fractures damage the cartilage surface of the bone, an important goal of surgery is to restore a smooth, gliding hip surface. Column concept two columns converging to form a cavity 4. Crown of death anastomosis between obturatory vessels and external oblique vessels average 6. It offers a complete classification system, encompassing nearly all fracture patterns.

In our setup, the incidence of displaced acetabular fractures is on the rise due to increased incidences of automobile and occupational injuries. The majority of acetabular fractures are caused by some type of highenergy event, such as a car collision. They are more complex injuries as compared to other parts of body. Acetabular fractures, kocherlangenbeck, posterior approach, outcome background acetabular fractures are rare injuries. Pelvic packing surgery live realtime instructional video. However, the surgical approaches required, the ability to receive an anatomic reduction, and the application of rigid internal fixation techniques is more complex. Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. Fractures of the pelvis and acetabulum download ebook. Modified stoppa approach for surgical treatment of acetabular fracture ha yong kim, md, dae suk yang, md, chang kyu park, md, won sik choy, md department of orthopedic surgery, eulji university hospital, eulji university college of medicine, daejeon, korea received march 27, 2014. Patients with a previous acetabular fracture required a tha at a median time of 4 years range, 124 years.

Powell department of surgery, university of calgary, ac144c 140329th street nw, calgary, alta. Following the surgical approach and exposure of the retroacetabular surface. Hip dislocation combined with acetabular fracture remains a. Fracture of the extremities, head injuries, chest, abdomen and pelvic ring injuries are the most commonly associated ones 3. Decision making in acetabulum fractures trauma international. Stoppa approach to the acetabulum for fractures vumedi. Most acetabular fractures are treated with surgery. Jan 17, 2016 narrated, annotated lecture 1 of 2 on acetabulum fracture surgical techniques with kocher langenbeck from the ota resident lecture series narrated by saqib rehman, md, from. Despite improvement in surgical technique, acetabular fracture involving quadrilateral plate represents a challenge to the surgeon because of its deep location and a very thin bone 14, especially in elderly individuals which are often combined with comminution and osteoporosis 4, 5.

Although great progress of surgical technique has been made, the choice of approach is controversial. During the operation, your doctor will reconstruct the normal anatomy of the hip jointaligning the bone fragments to restore the surface of the acetabulum, and fitting the femoral head into the hip socket. All cats undergoing surgical stabilisation of acetabular fractures returned to full or acceptable function by the end of the followup period and there was a low number of intraoperative and shortterm complications. Surgical management of fracture of acetabulum 76 p j m h s vol. Acetabular fractures are usually caused by highenergetic trauma. Dr siebenrock and dr tannast will answer questions throughout the procedure. Acetabular revision system cage to create a cupcage construct is made after the. Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. In this case the surgeon realigns or reduces the bones in a precise manner so as to prevent the development of post injury related issues, especially arthritis. The patients with displaced acetabular fracture who would present within three weeks period of injury informed consent. Usually those patients who along with the acetabular fracture also have displacement of joint often require an orif or open reduction with internal fixation in the surgical treatments. Nov 24, 2016 acetabular fraacture management with surgical approaches 1.

Quality of reduction after acetabular fracture surgery is an important predictor of clinical outcome. The results published by letournel and judet in 1993 remain the gold standard in the management of acetabulum fractures 4. Although significant strides have been made in fracture fixation nowadays, acetabular fracture fixation surgery still remains an extensive surgery with a significant potential complication rate15,17,22. Orif or open reduction with internal fixation technique. An interactive surgical planning tool for acetabular.

Preoperative radiographs and computed tomographic ct. In young patients, the management may be complicated by other injuries. Acetabular fracture ball and socket hip joint trauma. A surgical approach will be selected with the expectation that. A total of 1,028 patients with acetabular fractures, who had undergone surgical treatment from june 2011 to january 2017 in 7 leveli trauma centers, were recruited into this study.

Minimally invasive treatment of bothcolumn acetabular. Ebraheims educational animated video describes the surgical approaches associated with fracture of the acetabulum. Fractures of the proximal end of the femur occur often on. These hip socket fractures are not common they occur much less frequently than fractures of the upper femur or femoral head the ball portion of the joint.

Pao alone or with the addition of hip arthroscopic surgery remains a challenging procedure. Safe surgical technique for associated acetabular fractures. Feb 21, 2016 surgical treatment of associated patterns of acetabular fractures is effective but often difficult and technically demanding. Threecolumn classification for acetabular fractures.

Acetabular revision with reconstruction of bone loss aims of acetabular revision 8 r reconstruction of acetabular bone loss r reestablishment of the rotation centre at original acetabular position r readjustment of leg length r stable fi xation of new cup pr 040802 en euus. University clinic of orthopedic surgery, inselspital, bern, switzerland, ch. Deep vein thrombosis and pulmonary embolism are some of the complications of acetabular fracture surgery. This movie shows a surgical technique for endoscopic shelf acetabuloplasty for. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur. This study reported a 63% to 37% male to female ratio 1. A combination of threedimensional printing and computer.