1
|
Lannes X, Moerenhout K, Duong HP, Borens O, Steinmetz S. Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly patients: a retrospective observational cohort study of fifty one patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:2131-2138. [PMID: 32772320 PMCID: PMC7584544 DOI: 10.1007/s00264-020-04757-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
Purposes Acetabular fractures are more and more common in the elderly. Open reduction and internal fixation (ORIF) may lead to poor outcomes and high revision rates. Primary total hip arthroplasty (THA) combined with internal fixation, also known as the combined hip procedure (CHP), associated with dual mobility cup (DM-CHP) could be an efficient procedure in selected elderly patients. The aim of this study is to compare functional and radiological outcomes between ORIF and DM-CHP. Methods Between 2007 and 2018, 51 patients older than 65 years were surgically treated for acetabular fractures. Twenty-six patients were treated by DM-CHP and 25 by ORIF. Each group was divided into two subgroups regarding a single or combined approach. Hospital stay, surgical time, intraoperative blood loss, and complications were documented. The Harris Hip Score (HHS) was used for measuring the functional outcome. Radiological analysis was used to assess the centre of rotation in the DM-CHP group. Results Median surgery time and intra-operative blood loss were higher in DM-CHP than those in ORIF. Early medical complication rate was higher for a combined approach as compared with a single posterior approach in DM-CHP (p = 0.003). Dislocation rate was 7.7% in DM-CHP. Revision rate was higher in ORIF (20% versus 7.7%). HHS was similar in both groups. Conclusions DM-CHP leads to similar functional outcomes and less revision than ORIF. This study strengthens the practice of using only the posterior approach for primary THA in the elderly. Dual mobility is a valid therapeutic option for acetabular fractures in elderly patients.
Collapse
Affiliation(s)
- Xavier Lannes
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Kevin Moerenhout
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Hong Phuoc Duong
- Institute for Research in Rehabilitation, Clinique romande de réadaptation Sion, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Olivier Borens
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| |
Collapse
|
2
|
Ziran N, Soles GLS, Matta JM. Outcomes after surgical treatment of acetabular fractures: a review. Patient Saf Surg 2019; 13:16. [PMID: 30923570 PMCID: PMC6420740 DOI: 10.1186/s13037-019-0196-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. The first known descriptions of surgical fixation of acetabular fractures were case reports in 1943. In 1964, Robert Judet, Jean Judet, and Émile Letournel published a landmark article describing a classification system and surgical approaches to treat acetabular fractures. These teachings had a significant effect on clinical outcomes after surgical fixation of acetabular fractures. In 1980, Letournel demonstrated 80% good-to-excellent results in 492 hips, and in 2012, Joel Matta demonstrated 79% survivorship in 816 patients follow surgical acetabular fixation. Both Letournel and Matta have definitively shown that anatomic reduction of the fracture is the most influential factor predictive of clinical outcome. The intent of this review is to summarize the salient factors affecting clinical outcomes after surgical treatment of acetabular fractures.
Collapse
Affiliation(s)
- Navid Ziran
- 1St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, 500 W. Thomas Road, Suite 850, Phoenix, Arizona 85013 USA
| | - Gillian L S Soles
- 2Department of Orthopaedics, Strong Memorial Hospital, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14620 USA
| | - Joel M Matta
- 3The Steadman Clinic, 181 West Meadow Drive Suite 400, Vail, Colorado 81657 USA
| |
Collapse
|
3
|
Sahu RL. Resultado do tratamento cirúrgico de fraturas acetabulares desviadas: estudo prospectivo. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
4
|
Lal SR. Outcome of surgical treatment for displaced acetabular fractures: a prospective study. Rev Bras Ortop 2017; 53:482-488. [PMID: 30027083 PMCID: PMC6052189 DOI: 10.1016/j.rboe.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to evaluate the functional outcome of surgically treated acetabular fractures. Methods A prospective longitudinal study was undertaken in this hospital during the period from December 2010 to December 2014. A total number of 46 patients with the diagnosis of acetabular fracture were included in the study. The main cause of the acetabular injury was a road traffic accident. All the patients were treated surgically with plates and screws. Outcome was assessed radiologically and functionally, employing the Harris Hip Score. The mean follow-up period of the patients in the postoperative period was 30 months (24–36 months). Results The results were excellent in 60.86%, good in 21.73%, fair in 8.69%, and poor in 8.69%. Post-operative complications of acetabular fracture such as heterotopic ossification were found in 2.17%, osteoarthritis in 6.52%, skin infections in 4.34%, nerve lesions in 2.17%, and vascular necrosis in 4.34% of patients. More than 80% of patients were satisfied with the results of acetabular surgeries. Conclusion These results show that internal fixation of acetabular fractures leads to a good outcome in the majority of patients.
Collapse
Affiliation(s)
- Sahu Ramji Lal
- Department of Orthopaedics, Sharda University, Greater Noida, India
| |
Collapse
|
5
|
Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature. J Orthop Trauma 2016; 30:285-93. [PMID: 27206254 DOI: 10.1097/bot.0000000000000538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report methods of measurement of radiographic displacement and radiographic outcomes in acetabular fractures described in the literature. METHODS A systematic review of the English literature was performed using EMBASE and Medline in August 2014. Inclusion criteria were studies of operatively treated acetabular fractures in adults with acute (<6 weeks) open reduction and internal fixation that reported radiographic outcomes. Exclusion criteria included case series with <10 patients, fractures managed >6 weeks from injury, acute total hip arthroplasty, periprosthetic fractures, time frame of radiographic outcomes not stated, missing radiographic outcome data, and non-English language articles. Basic information collected included journal, author, year published, number of fractures, and fracture types. Specific data collected included radiographic outcome data, method of measuring radiographic displacement, and methods of interpreting or categorizing radiographic outcomes. DATA SYNTHESIS The number of reproducible radiographic measurement techniques (2/64) and previously described radiographic interpretation methods (4) were recorded. One radiographic reduction grading criterion (Matta) was used nearly universally in articles that used previously described criteria. Overall, 70% of articles using this criteria documented anatomic reductions. CONCLUSIONS The current standard of measuring radiographic displacement in publications dealing with acetabulum fractures almost universally lacks basic description, making further scientific rigor, such as testing reproducibility, impossible. Further work is necessary to standardize radiographic measurement techniques, test their reproducibility, and qualify their validity or determine which measurements are important to clinical outcomes. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
6
|
Dodd A, Osterhoff G, Guy P, Lefaivre KA. Assessment of functional outcomes of surgically managed acetabular fractures. Bone Joint J 2016; 98-B:690-5. [DOI: 10.1302/0301-620x.98b5.36292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/25/2015] [Indexed: 01/06/2023]
Abstract
We performed a systematic review of the literature pertaining to the functional outcomes of the surgical management of acetabular fractures. A total of 69 articles met our inclusion criteria, revealing that eight generic outcome instruments were used, along with five specific instruments. The majority of studies reported outcomes using a version of the d’Aubigne and Postel score, which has not been validated for use in acetabular fracture. Few validated outcome measures were reported. No psychometric testing of outcome instruments was performed. The current assessment of outcomes in surgery for acetabular fractures lacks scientific rigour, and does not give reliable outcome data for either scientific comparison or patient counselling. Take home message: The use of non-validated functional outcome measures is a major limitation of the current literature pertaining to surgical management of acetabular fractures; future studies should use validated outcome measures to ensure the legitimacy of the reported results. Cite this article: Bone Joint J 2016;98-B:690–5.
Collapse
Affiliation(s)
- A. Dodd
- University of British Columbia, Third
floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - G. Osterhoff
- University of British Columbia, Third
floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - P. Guy
- University of British Columbia, Third
floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - K. A. Lefaivre
- University of British Columbia, Third
floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
7
|
Short-term results of percutaneous treatment of acetabular fractures: functional outcomes, radiographic assessment and complications. INTERNATIONAL ORTHOPAEDICS 2015; 40:1703-1708. [DOI: 10.1007/s00264-015-2987-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/24/2015] [Indexed: 12/29/2022]
|
8
|
Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma 2014; 28:313-9. [PMID: 24100918 DOI: 10.1097/01.bot.0000435627.56658.53] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the reduction quality, surgery time, and early postoperative complications between the 2 following surgical approaches: the ilioinguinal and the anterior intrapelvic (AIP or modified Rives-Stoppa). DESIGN Retrospective study. PATIENTS Comparison of 122 patients operated in our center between 1996 and 2003 with the ilioinguinal approach and 103 cases operated between 2004 and 2011 with the AIP approach. SETTING Level 1 trauma center, acetabular fracture surgery referral center. OUTCOME MEASUREMENT The patients' demographics, fracture type, fracture reduction quality, surgery time, and postoperative complications were compared. RESULTS Anatomic reduction was achieved in 84 patients (68.9%) treated by the ilioinguinal approach and in 85 patients (82.5%) treated by the AIP approach (P = 0.018). In both the columns, acetabular fracture type anatomic reduction was achieved in 54.2% of the ilioinguinal group and 79.4% of the AIP group (P = 0.018). In the ilioinguinal group, surgery time decreased as the number of surgeries increased (P = 0.021), whereas a similar trend was not found in the AIP group. Fracture type distribution and complication rates were similar for both the groups. CONCLUSIONS The AIP approach is a safe alternative that offers better exposure and possibly improved reduction quality of acetabular fractures compared with the ilioinguinal approach. We believe that the major advantage of the AIP approach is that it enables reduction of the posterior column and the quadrilateral plate from the contralateral side and enables application of a buttress plate below the pelvic brim. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
9
|
Abo-Elsoud M, Radwan YA, Gobba M, Sadek F. Short-segment fixation through a limited ilioinguinal approach for treating anterior acetabular fractures: a historical-control study. INTERNATIONAL ORTHOPAEDICS 2014; 38:1469-75. [PMID: 24797562 DOI: 10.1007/s00264-014-2354-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/07/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE We evaluated the potential advantages of short-segment fixation of certain anterior acetabular fracture patterns through a limited ilioinguinal approach. METHODS Two patient groups were studied. The first group comprised 22 patients (20 men, two women; average age 36 years) treated using the short-segment fixation protocol through a limited ilioinguinal approach. We modified the use of short pelvic brim plates, spring plates and posterior-column screws as reduction and fixation tools (leaving the distal end of the fracture unfixed) to keep the dissection entirely lateral to the iliac vessels. The second (control) group comprised 31 patients with matched fracture patterns fixed through the standard ilioinguinal approach. All patients were followed up for a minimum of two years. The estimated amount of blood loss (primary outcome measure), operative time, postoperative radiographic assessment of reduction quality and functional score assessment (secondary outcome measures) were compared between groups. RESULTS The short-segment-fixation group had significantly less blood loss (p < 0.0001) and shorter operative time (p = 0.002) compared with the control group. However, there were no significant differences in the quality of fracture reduction and functional scores between groups at the final follow-up. No major complications were encountered in either group. CONCLUSION Short-segment fixation through a limited ilioinguinal approach is a safe and effective alternative for treating certain patterns of anterior acetabular fractures. Decreased blood loss and shorter operative time with less soft tissue dissection are the main advantages of this approach.
Collapse
Affiliation(s)
- Mohamed Abo-Elsoud
- Orthopedic Surgery and Traumatology Department, Cairo University Kasr Al-Aini, Giza, Egypt
| | | | | | | |
Collapse
|
10
|
Briffa N, Pearce R, Hill AM, Bircher M. Outcomes of acetabular fracture fixation with ten years' follow-up. ACTA ACUST UNITED AC 2011; 93:229-36. [PMID: 21282764 DOI: 10.1302/0301-620x.93b2.24056] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We report the outcome of 161 of 257 surgically fixed acetabular fractures. The operations were undertaken between 1989 and 1998 and the patients were followed for a minimum of ten years. Anthropometric data, fracture pattern, time to surgery, associated injuries, surgical approach, complications and outcome were recorded. Modified Merle D'Aubigné score and Matta radiological scoring systems were used as outcome measures. We observed simple fractures in 108 patients (42%) and associated fractures in 149 (58%). The result was excellent in 75 patients (47%), good in 41 (25%), fair in 12 (7%) and poor in 33 (20%). Poor prognostic factors included increasing age, delay to surgery, quality of reduction and some fracture patterns. Complications were common in the medium- to long-term and functional outcome was variable. The gold-standard treatment for displaced acetabular fractures remains open reduction and internal fixation performed in dedicated units by specialist surgeons as soon as possible.
Collapse
Affiliation(s)
- N Briffa
- Department of Trauma and Orthopaedics, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | | | | | | |
Collapse
|
11
|
Ayoub M. Is it possible that most of the displaced acetabular fractures can be managed through a single ilioinguinal approach? 2–7 Years experience results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2010. [DOI: 10.1007/s00590-010-0704-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Gupta RK, Singh H, Dev B, Kansay R, Gupta P, Garg S. Results of operative treatment of acetabular fractures from the Third World--how local factors affect the outcome. INTERNATIONAL ORTHOPAEDICS 2007; 33:347-52. [PMID: 17940767 DOI: 10.1007/s00264-007-0461-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 07/24/2007] [Accepted: 07/30/2007] [Indexed: 12/19/2022]
Abstract
The objective of this study was to assess the outcome of operations on acetabular fractures from a developing country in the presence of locally available facilities. Sixty-three acetabular fractures were assessed at an average follow up of 52.94 months after operation. Twenty-six patients operated upon in the first three years and 37 operated thereafter were separately studied to discover the effect of the learning curve. Regarding the fractures, 47 of 63 (74.6%) had excellent/good results (Harris Hip Score>80). The complications included broken drill bit in eight patients (12.69%), deep infection and heterotopic ossification in five patients (7.93%), avascular necrosis and sciatic nerve palsy in two patients (3.17%) and implant failure in one patient (1.58%). The results collected during the learning curve were inferior in the complex fractures (p value<0.001). Complications were common in patients opting for local implants and in those operated after over 2 weeks delay.
Collapse
Affiliation(s)
- Ravi K Gupta
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India.
| | | | | | | | | | | |
Collapse
|
13
|
Fernández-Fernández R, Foruria de Diego A, Peleteiro-Pensado M, Gil-Garay E. Resultados del tratamiento conservador de las fracturas de cotilo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|