[Bilateral acetabulum fracture after suffering sport trauma]

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

BACKGROUND

Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown.

MATERIALS AND METHODS

A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes.

RESULTS

Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13-84) and mean follow-up was 19.8 months (range 1.5-56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%).

CONCLUSIONS

Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

Designation and Validation of a Posterior Anatomical Plate for the Anterior Column of the Acetabulum

Background

Surgical treatment of acetabular fractures is one of the greatest challenges for orthopedic surgeons. Fixation of most displaced fractures requires extensive exposure, which may lead to complications, including blood loss, neural or vascular injury, postoperative infection, wound healing problems, and heterotopic bone formation.

Material/Methods

This study was conducted to certify an anatomic plate with an anterior column lag screw guiding device to repair the posterior acetabulum. Complete pelvic spiral computed tomography (CT) scan data were collected from 56 patients. The posterior column of the acetabulum was simulated with a lag screw. The guiding device for the plate was designed by measuring the position of the screw point and the direction and maximum diameter of the screw.

Results

The distance from the screw point to the apex of the greater sciatic notch was farther in women than in men. The distance from the screw point to the ischial spine was also farther in women than in men. The θ angle (front inclination angle) of the screw was lower in women than in men. The ϕ angle (camber screw angle) was greater in women than in men. The success rate when using the guided device was significantly higher than when using traditional pedicle screws.

Conclusions

The guided device was very useful for improving placement success and accuracy rates of the acetabular posterior anatomical anterior column plate using antegrade lag screws, and for reducing surgical risk and injury.