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Yao Y, Ye H, Fang W, Feng R, Zhang C, Zheng L, Lv H, Li J, Jing J. Dislocation Does Not Seem To Be an Absolute Factor Effecting the Short- to Medium-Term Poor Prognosis of Patients with Acetabular Posterior Wall Fracture. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38423035 DOI: 10.1055/a-2265-0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Dislocation is a complication of acetabular fractures involving the posterior wall, but whether dislocation is an absolute factor impacting the short- to medium-term prognosis of the hip joint remains controversial. This study aimed to compare the short- to medium-term clinical and radiological results among patients diagnosed with an acetabular fracture involving the posterior wall, with or without dislocation.Seventy-nine patients diagnosed with an acetabular fracture involving the posterior wall were retrospectively divided into posterior dislocation and non-dislocation groups. All fractures were open reduction + internal fixation with a plate screw combination through the single Kocher-Langenbeck approach. The short- to medium-term radiographic outcomes of follow-up were evaluated using the Matta radiologic grading system, while the clinical outcomes were evaluated using the modified Merle d'Aubigné-Postel evaluation system.The mean follow-up duration for all patients was 43.90 (range 24-75) months. Both groups achieved similar short- to medium-term clinical and radiographic results. There seems to be no significant differences between the two groups regarding the short- to medium-term assessment of clinical and radiographic results and the occurrence of postoperative complications (p > 0.05).In patients with acetabular fractures involving the posterior wall, hip dislocation is probably not an absolute determinant of a poor outcome. Even with early reduction, the short- to medium-term prognosis results appear similar to those of patients without dislocation.
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Affiliation(s)
- Yunfeng Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Houlong Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wang Fang
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ru Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chun Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liujie Zheng
- Department of Orthopaedic Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Lv
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Li
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Risk Factors for Deep Infection and Conversion Total Hip Arthroplasty After Operative Combined Pelvic Ring and Acetabular Fractures. J Orthop Trauma 2022; 36:573-578. [PMID: 35605104 DOI: 10.1097/bot.0000000000002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine risk factors for deep infection and conversion total hip arthroplasty (THA) after operative management of combined pelvic ring and acetabular injuries. DESIGN Retrospective case control study. SETTING Level 1 trauma center. PATIENTS AND INTERVENTION We reviewed 150 operative combined pelvic ring and acetabular injuries at our institution from 2010 to 2019, with an average follow-up of 690 (90-3282) days. MAIN OUTCOME MEASUREMENTS Deep infection and conversion THA. RESULTS Patients who developed deep infection (N = 17, 11.3%) had higher rates of hip dislocation ( P = 0.030), intraoperative transfusion ( P = 0.030), higher body mass index (BMI) ( P = 0.046), increased estimated blood loss ( P < 0.001), more intraoperative units transfused ( P = 0.004), and longer operative times ( P = 0.035). Of the 84 patients with 1-year follow-up, 24 (28.6%) required conversion to THA. Patients requiring conversion THA were older ( P = 0.022) and had higher rates of transverse posterior wall fracture pattern ( P = 0.034), posterior wall involvement ( P < 0.001), hip dislocation ( P = 0.031), wall comminution ( P = 0.002), and increased estimated blood loss ( P = 0.024). The order of the pelvic ring versus acetabular fixation did not affect rates of conversion to THA ( P = 0.109). Multiple logistic regression showed that an increased number of intraoperative units transfused [adjusted odds ratio (aOR) = 1.56, 95% confidence interval (CI) = 1.16-2.09, P = 0.003] and higher BMI (aOR = 1.10, 95% CI = 1.01-1.16, P = 0.024) were independently associated with an increased odds of deep infection. Posterior wall involvement was independently associated with an increased odds of conversion THA (aOR = 5.73, 95% CI = 1.17-27.04, P = 0.031). CONCLUSIONS Rates of deep infection and conversion THA after operative fixation of combined injuries were 11.3% and 28.6%, respectively. Higher average BMI and number of intraoperative units of blood transfused were independently associated with deep infection, whereas posterior wall involvement was independently associated with conversion to THA in these patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Sahito B, Abro A, Kumar V, Hussain B, Ahmed K, Kamboh A, Qadir A, Ali M. Bilateral asymmetrical hip dislocations with acetabulum fractures; a case report. Trauma Case Rep 2021; 32:100453. [PMID: 33778147 PMCID: PMC7985565 DOI: 10.1016/j.tcr.2021.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Bilateral hip dislocation is a rare injury and asymmetrical hip dislocations are even very rare entities. We are reporting two cases of bilateral asymmetrical hip dislocations with associated acetabulum fractures. Mechanism of injury in first case was fall from height and in other case road traffic accident. Associated injuries were midshaft femur fracture and sciatic nerve (Peroneal part). Anterior hip dislocation in both cases is reduced closely but posterior hip dislocation in both cases relocated openly due to ipsilateral femur fracture in first case and unstable hip in second case. Acetabulum fractures fixed with reconstruction plate. Postoperative recovery of patient was uneventful except sciatic nerve injury (Peroneal part) lead to foot drop that is supported with ankle foot arthrosis.
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Affiliation(s)
- Badaruddin Sahito
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Awais Abro
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Vijay Kumar
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Bakht Hussain
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Khalil Ahmed
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Azam Kamboh
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Abdul Qadir
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Maratib Ali
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
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Moon JK, Lee J, Yoon PW, Chang JS, Kim JW. Efficacy of total hip arthroplasty after operatively treated acetabular fracture. Arch Orthop Trauma Surg 2020; 140:973-979. [PMID: 32296966 DOI: 10.1007/s00402-020-03447-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We evaluated the clinical and radiological outcomes of patients following total hip arthroplasty (THA) for acetabular fracture. MATERIALS AND METHODS This was a retrospective cohort study in a single center. The medical records of patients who underwent THA from March 2002 to March 2017 were reviewed. Inclusion criteria were THA and a history of open reduction and internal fixation of acetabular fractures. Thirty-seven patients with a mean age of 56.2 years were enrolled. The Harris hip score (HHS), acetabular fracture classification, time interval between acetabular fracture and THA, cause of THA, surgical approach, implant type, complications, radiographic results, and Kaplan-Meier survival curves were analyzed. RESULTS All patients were followed up for an average of 6.6 years. The mean preoperative HHS of 42.5 had improved to 83.5 at the final follow-up (p < 0.05). There were 29 cases of post-traumatic arthritis, 6 cases of avascular necrosis, and 4 cases of non-union. The average interval from injury to THA was 58 months (range 4-336 months). The re-admission rate was 18.9%. Patients who underwent conversion to THA due to post-traumatic arthritis combined with non-union acetabular fracture developed clinical failure more frequently than patients with post-traumatic arthritis (p = 0.037). At 12 years, 83.4% of patients were free from revision of femoral and acetabular components. CONCLUSION THA secondary to an operatively treated acetabular fracture provides good symptomatic relief, but shows relatively inferior survival rates, and clinical failure was related to post-traumatic arthritis with acetabular non-union.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jaehyung Lee
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, Good Gangan Hospital, Busan, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Giaretta S, Silvestri A, Momoli A, Micheloni GM. Asymmetric bilateral hip dislocation in young man: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:183-186. [PMID: 30715022 PMCID: PMC6503424 DOI: 10.23750/abm.v90i1-s.8067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/14/2022]
Abstract
Bilateral hip dislocation is a rare event, asymmetric dislocation is even rarer. Due to the intrinsic stability of the hip joint this lesions usually follow a high energy trauma. Because of the common associated lesions, the initial clinical assessment should be performed thoroughly. CT scan rather than x-rays offers a complete survey of these possible associated injuries such as thoracic or abdominal bleedings, neurologic lesions or fractures directly associated with the hips dislocations. The first goal should be reduction of the dislocation to prevent avascular necrosis (AVN) of the femoral head and arthritis. We report a case of a young man with right anterior hip dislocation and left posterior hip dislocation with associated fracture of the posterior wall. (www.actabiomedica.it)
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Affiliation(s)
- Stefano Giaretta
- Orthopedic and Traumatology Unit, Ospedale San Bortolo, Vicenza.
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Abstract
OBJECTIVES To identify the risk factors for early reoperation after operative fixation of acetabular fractures. DESIGN Retrospective evaluation. SETTING Level I Trauma Center. PATIENTS Seven hundred ninety-one patients with displaced acetabular fractures treated with open reduction and internal fixation (ORIF) from 2006 to 2015. Average follow-up was 52 weeks. MAIN OUTCOME MEASURES Early reoperation after acetabular ORIF, defined as secondary procedure for infection or revision within 3 years of initial operation. RESULTS Fifty-six (7%) patients underwent irrigation and debridement for infection and wound complications. Four associated risk factors identified were length of stay in the intensive care unit, pelvic embolization, operative time, and time delay between injury and surgical fixation. Sixty-two (8%) patients underwent early revision, including 45 conversions to total hip arthroplasty, 10 revision ORIF, 6 fixation device removals because of concern for joint penetration (2 acutely and 4 > 6 months after surgery), and 1 stabilization procedure. Three risk factors associated with early revision were hip dislocation, articular comminution, and concomitant femoral head or neck injury. Combined injuries to the pelvic ring and acetabulum, fracture pattern, marginal impaction, and body mass index had no significant effect on early revision surgery. CONCLUSIONS Risk factors for early reoperation after operative fixation of acetabular fractures differed based on the reason for return to the operating room. Infection was more likely to occur in patients who had prolonged stays in the intensive care unit, had prolonged operative times, were embolized, or experienced delay in time to fixation. Revision was more likely with hip dislocation, articular comminution, femoral head or neck fracture, and advancing age. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis. J Orthop Trauma 2017; 31:650-656. [PMID: 28742784 DOI: 10.1097/bot.0000000000000966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices. STUDY DESIGN Multicenter retrospective cohort. SETTING Eight Level 1 Trauma Centers. PATIENTS/PARTICIPANTS One hundred one patients met inclusion criteria. INTERVENTION Surgical treatment of both the acetabular and femur fractures. MAIN OUTCOME MEASUREMENTS The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries. RESULTS Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05). CONCLUSIONS We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Wolfson N, Lerner A, Roshal L. Terror-Related Trauma. ORTHOPEDICS IN DISASTERS 2016. [PMCID: PMC7121158 DOI: 10.1007/978-3-662-48950-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In our current era, terrorist attacks have become a part of our daily life experience almost worldwide. New terrorist groups are emerging and the number of terrorist attacks is constantly rising.
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Affiliation(s)
- Nikolaj Wolfson
- Department of Orthopedics, California Pacific Medical Center, San Francisco, California USA
| | - Alexander Lerner
- Department of Orthopedic Surgery, Bar Ilan Univ, Ziv Medical Ctr, Zefat, Israel
| | - Leonid Roshal
- Urgent Pediatric Surgery and Trauma, Clinical and Research Institute, Moscow, Russia
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Belehalli P, Kumar M, Prakash B, Veerappa L. Positron emission tomography-computed tomography in the assessment of viability of femoral head in acetabular fractures. INTERNATIONAL ORTHOPAEDICS 2014; 38:1057-62. [PMID: 24430428 DOI: 10.1007/s00264-013-2260-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 12/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to use positron emission tomography-computed tomography (PET-CT) imaging as a tool for assessment of viability of femoral head in acetabular fractures and help in early detection of complications like avascular necrosis (AVN) of the femoral head. METHODS In our study PET-CT was done pre-operatively and six weeks postoperatively in 31 patients who underwent open reduction and internal fixation (ORIF) of acetabular fractures and fracture-dislocations. There were 26 male and five female patients who were treated in our institute between January 2009 and July 2010. Patients were subsequently followed up with plain radiographs for a mean period of 3.8 years and minimum of two years. RESULTS Although seven out of 31 patients showed avascularity of the femoral head on PET-CT in the pre-operative period, only two patients progressed to AVN at final follow up, whereas the other five patients regained the vascularity at the end of six weeks. There was no statistically significant correlation between vascular status on pre-operative scan and the presence of AVN on final follow-up radiograph. There was a significant correlation between avascularity of the femoral head on the sixth week PET-CT and AVN in the final radiograph. CONCLUSION PET-CT seems to be useful as a prognostic investigation in the assessment of the vascular status of the femoral head following injuries around the hip. Both pre-operative and postoperative imaging are necessary to understand the time-dependent changes in blood flow following injury.
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Zlotorowicz M, Czubak J, Caban A, Kozinski P, Boguslawska-Walecka R. The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography. Bone Joint J 2013; 95-B:1453-7. [PMID: 24151262 DOI: 10.1302/0301-620x.95b11.32383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.
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Affiliation(s)
- M Zlotorowicz
- The Medical Centre of Postgraduate Education, Gruca Teaching Hospital, Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Konarskiego 13, 05-400 Otwock, Poland
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Chiron P, Lafontan V, Reina N. Fracture-dislocations of the femoral head. Orthop Traumatol Surg Res 2013; 99:S53-66. [PMID: 23357042 DOI: 10.1016/j.otsr.2012.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/23/2012] [Indexed: 02/02/2023]
Abstract
This review describes bone and nerve injury mechanisms during a femoral head fracture-dislocation and outlines a novel classification system that uses computed tomography scanning (CT scan) to help determine how to best treat these fractures in an emergency setting or in chronic cases. A series of 55 cases with CT scan performed in the emergency department (ED) and an average follow-up of 9 years (range 3-13) was used as a basis to develop the classification system; this system takes into account the size of the fragments and any associated acetabular wall or femoral neck fractures. The suggested course of action is based on the CT scan results after the hip joint is reduced. Conservative treatment is indicated every time the head fragments and any potential acetabular wall fragments are properly reduced and there are no foreign bodies (37.7%). Osteochondral head fragments below the fovea must be removed (36.3%). Fragments that are one-third or one-quarter of the head size can either be removed (7.2%) or reduced and fixed (5.4%). A novel medial approach is described that provides minimally invasive access to the anterior-inferior part of the femoral head, which should extend the indications for preservation of one-third head fragments. If the femoral neck is also fractured or a one-half head fragment exists in elderly patients, a total hip replacement should be considered right way (9%). At the latest follow-up, osteoarthritis was present in 43.7% of cases, but was mostly well tolerated - 94% of patients had a WOMAC score between 80 and 100 with signs of osteoarthritis visible on radiographs. Paradoxically, avascular necrosis (9%) is due to small head fractures. The results of our series are compared with the few series that have been published since CT scanning has been systematically used in the ED.
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Affiliation(s)
- P Chiron
- Orthopaedics and Trauma Surgery, Rangueil University Hospital Centre, 1, avenue J.-Poulhès, Toulouse cedex 09, France.
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DSA observation of hemodynamic response of femoral head with femoral neck fracture during traction: a pilot study. J Orthop Trauma 2012; 26:407-13. [PMID: 22739255 DOI: 10.1097/bot.0b013e318216dd60] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the early influence of traction on blood supply to the femur head after femoral neck fractures using digital subtraction angiography (DSA). DESIGN Prospective case series. SETTING University Level I trauma center. PATIENTS Nine patients who sustained a unilateral femoral neck fracture underwent selective femoral artery DSA within 2-23 days after their injury. INTERVENTION DSA of the medial and lateral circumflex femoral artery was performed for all 9 fractured hips before traction. Repeat DSA study of the femoral head circulation was performed after the addition of 3 kg of traction in 7 patients and 5 kg of traction in 6 patients. For comparison, DSA was also performed on the uninjured hip in 8 of the 9 patients. MAIN OUTCOME MEASURE Blood circulation of the femoral head was evaluated by observing morphology of the feeding arteries, perfusion volume, venous drainage, and the circulation time of the microvasculature. RESULTS Femoral neck fracture damaged the retinaculum artery and led to femoral head hemodynamic disorder in all 9 cases. Application of linear traction and repeat DSA decreased femoral head perfusion (faint arterial imaging and delayed venous display) in all patients' retinaculum arteries except the inferior branch compared with the pretraction imaging. These findings were more pronounced as the traction was increased from 3 to 5 kg. These findings were significant (P < 0.05). CONCLUSIONS Traction impairs blood perfusion to the femoral head. Blood flow in the retinacular arteries was reduced and venous drainage impeded. Traction may be one of the major causes of femoral head osteonecrosis after femoral neck fracture.
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Tassinari E, Sudanese A, Traina F, De Fine M, Toni A. Total hip arthroplasty in a patient affected by post-traumatic acetabular non-union: case report and review of the literature. Hip Int 2009; 18:324-8. [PMID: 19097012 DOI: 10.1177/112070000801800410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty in the presence of acetabular non-union can be demanding. The irregular anatomy, the defect, and the presence of fibrous and necrotic tissue can hamper insertion of the acetabular component. We present a case of total hip arthroplasty in a patient with post-traumatic necrosis of the femoral head and non-union of the acetabulum and follow-up one year after the operation. Following accurate preoperative planning, removal of the pseudarthrosis material, and the use of the femoral head as an autograft, it was possible to insert the acetabular cup satisfactorily in a single-stage procedure.
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Affiliation(s)
- E Tassinari
- 1st Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
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Pascarella R, Maresca A, Cappuccio M, Reggiani LM, Boriani S. Asymmetrical bilateral traumatic fracture dislocation of the hip: a report of two cases. ACTA ACUST UNITED AC 2008; 92:109-11. [PMID: 18504531 DOI: 10.1007/s12306-008-0045-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/14/2008] [Indexed: 12/26/2022]
Abstract
We report on two cases of simultaneous asymmetrical bilateral hip dislocation. Both patients were involved in car accidents. The first case is a 23-year-old man who had a bilateral hip dislocation, anterior on the right side and posterior on the left associated with bilateral femoral head fracture. The second case presented the same dislocations of the hips associated with acetabular fracture on the right side. Closed reduction of the hips was performed in both cases. In the first case the femoral head fragments was subsequently removed. In the second case internal fixation of the acetabular fracture was postponed.
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Affiliation(s)
- Raffaele Pascarella
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore, Largo Negrisoli 2, Bologna, Italy.
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Giannoudis PV, Grotz MRW, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. ACTA ACUST UNITED AC 2005. [PMID: 15686228 DOI: 10.1302/0301-620x.87b1.15605] [Citation(s) in RCA: 354] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Over the past 40 years, the management of displaced fractures of the acetabulum has changed from conservative to operative. We have undertaken a meta-analysis to evaluate the classification, the incidence of complications and the functional outcome of patients who had undergone operative treatment of such injuries. We analysed a total of 3670 fractures. The most common long-term complication was osteoarthritis which occurred in approximately 20% of the patients. Other late complications, including heterotopic ossification and avascular necrosis of the femoral head, were present in less than 10%. However, only 8% of patients who were treated surgically needed a further operation, usually a hip arthroplasty, and between 75% and 80% of patients gained an excellent or good result at a mean of five years after injury. Factors influencing the functional outcome included the type of fracture and/or dislocation, damage to the femoral head, associated injuries and co-morbidity which can be considered to be non-controllable, and the timing of the operation, the surgical approach, the quality of reduction and local complications which are all controllable. The treatment of these injuries is challenging. Tertiary referrals need to be undertaken as early as possible, since the timing of surgery is of the utmost importance. It is important, at operation, to obtain the most accurate reduction of the fracture which is possible, with a minimal surgical approach, as both are related to improved outcome.
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Affiliation(s)
- P V Giannoudis
- Department of Trauma & Orthopaedics, St James's University Hospital, Leeds, England, UK
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Abstract
Missed diagnosis of avascular necrosis (AVN) may result in substantial morbidity. Early diagnosis is crucial for appropriate intervention and, ultimately, improved outcome. Emerging physicians need to recognize AVN to avoid unsatisfactory clinical results for their patients. Avascular necrosis (AVN) of the bone can occur when the blood supply to the bone is disrupted and is usually found in areas with terminal circulation. Commonly involved bones include the femoral head, talus, and scaphoid.
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Affiliation(s)
- Christopher C Lee
- Department of Emergency Medicine, Flushing Hospital Medical Center, 45th Avenue at Parsons Boulevard, Flushing, NY 11355, USA.
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