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Midterm results of digastric trochanteric flip osteotomy for high acetabular posterior wall fracture. INTERNATIONAL ORTHOPAEDICS 2022; 46:1881-1889. [PMID: 35610389 PMCID: PMC9349159 DOI: 10.1007/s00264-022-05446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Kocher-Langenbeck (K-L) approach is widely used in surgery of posterior wall fracture of acetabulum. However, challenges are frequently encountered in fractures involving the superior dome due to its short of view. We aimed to evaluate the efficacy of digastric trochanteric flip osteotomy (DTFO) in the K-L approach for high posterior wall acetabular fracture (HPWF). METHODS From January 2014 to December 2016, 39 patients who suffered high posterior wall fracture (HPWF) were included in this retrospective study. All the patients were divided into two groups according to surgery type (17 standard K-L approach (control group), 22 with DTFO (DTFO group)). The Matta criterion was used to evaluate the accuracy of reduction according to post-operative CT image, while modified Harris hip score and 12-item short-form health survey (SF-12) were applied to measure the clinical outcomes. RESULTS The median follow-up period was 55 (45 to 62.5) months. Blood loss and operation time were similar between the two groups. DTFO group achieved much more anatomical reduction than the control group (54.6% vs. 35.3%; OR, 2.2; 95% CI, 0.6 ~ 8.08). Significantly better functional outcomes were found in the DTFO group (10% higher points than the control group, p < 0.05). All the patients receiving good-to-anatomical reduction ended with good or excellent outcomes. The total incidence of complications in the DTFO group was much lower than in the control group (40.9% vs. 70.6%, p = 0.07). CONCLUSIONS Compared with the traditional K-L approach, the intraoperative DTFO technique enabled better quality of reduction in patients with HPWF, thus ensuring superior clinical outcomes.
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Liu X, Li M, Liu J, Liu Z, Zhang L, Tang P. [Research progress of different surgical approaches in treatment of acetabular both-column fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:661-666. [PMID: 34142489 DOI: 10.7507/1002-1892.202012113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of different surgical approaches in the treatment of acetabular both-column fractures. Methods The domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized. Results The ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What's more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement. Conclusion The reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.
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Affiliation(s)
- Xiao Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Ming Li
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Jianheng Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Zhongyang Liu
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Licheng Zhang
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China.,National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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Phelps KD, Crickard CV, Li K, Harmer LS, Andrews McArthur E, Sample Robinson K, Sims SH, Hsu JR. Why Make the Cut? Trochanteric Slide Osteotomy Can Improve Exposure to the Anterosuperior Acetabulum. J Orthop Trauma 2021; 35:106-109. [PMID: 32658016 DOI: 10.1097/bot.0000000000001900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define relative increases in visual bony surface area and access to critical landmarks with the addition of a trochanteric slide osteotomy to a Kocher-Langenbeck approach. METHODS A Kocher-Langenbeck approach followed by a trochanteric slide osteotomy was sequentially performed on 10, fresh-frozen, hemipelvectomy cadaveric specimens. Visual and palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J. RESULTS The acetabular surface area exposed was 27.66 (±6.67) cm2 for a Kocher-Langenbeck approach. This increased to and 41.82 (±7.97) cm2 with the addition of a trochanteric osteotomy. The exposed surface area was increased by 51.2% for the trochanteric osteotomy (P < 0.001). The superior margin of the acetabulum could be visualized and palpably accessed in both exposures. Access to the more anterosuperior portions of the acetabulum was consistently possible in the trochanteric osteotomy but not with the Kocher-Langenbeck approach. CONCLUSIONS A trochanteric osteotomy may visually improve access to the most anterosuperior acetabulum but does not significantly improve surgical access to relevant portions of the superior acetabulum when compared with a Kocher-Langenbeck approach.
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Affiliation(s)
- Kevin D Phelps
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Colin V Crickard
- Commander, Medical Corps, United States Navy, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Katherine Li
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Luke S Harmer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Erica Andrews McArthur
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | | | - Stephen H Sims
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; and
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Mei XY, Bhanot K, Tsvetkov D, Rajgopal R, Safir OA, Kuzyk PR. Current Uses of the Transtrochanteric Approach to the Hip: A Systematic Review. JBJS Rev 2018; 6:e2. [PMID: 29979233 DOI: 10.2106/jbjs.rvw.17.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The indications and technique for the transtrochanteric approach to the hip have evolved greatly since its initial popularization in the 1960s. The purpose of this systematic review was to assess current uses of this approach on the basis of indications, osteotomy technique, trochanteric fixation method, complications, and functional outcome. METHODS A comprehensive search of MEDLINE and Embase databases from January 2000 to July 2017 was performed in accordance with the PRISMA guidelines. Articles were divided into 3 major categories on the basis of the type of hip surgery performed: (1) primary arthroplasty, (2) revision arthroplasty, and (3) joint-preserving procedures. Patient data were then analyzed according to these 3 categories. RESULTS Seventy-six studies (5,028 hips), mainly of Level-IV evidence, were included. Four types of osteotomy were reported for a variety of indications. Rates of nonunion were 6.0% (303 of 5,028) across all studies, 4.2% (39 of 921) for primary arthroplasty, 6.7% (114 of 1,690) for revision arthroplasty, and 4.4% (56 of 1,278) for joint-preserving procedures. Rates of dislocation were 1.5% (14 of 921) for primary arthroplasty and 4.6% (77 of 1,690) for revision arthroplasty. The rate of osteonecrosis after joint-preserving procedures was 1.1% (14 of 1,278). Rates of deep infection were 1.1% (55 of 5,028) across all studies, 0.1% (1 of 921) for primary arthroplasty, 2.1% (36 of 1,690) for revision arthroplasty, and 0.6% (8 of 1,278) for joint-preserving procedures. CONCLUSIONS The transtrochanteric approach remains useful in cases requiring extensile exposure of the acetabulum or femoral medullary canal. However, trochanteric complications continue to pose a clinical challenge. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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Abstract
In the time since Letournel popularised the surgical treatment of acetabular fractures, more than 25 years ago, there have been many changes within the field, related to patients, surgical technique, implants and post-operative care. However, the long-term outcomes appear largely unchanged. Does this represent stasis or have the advances been mitigated by other negative factors? In this article we have attempted to document the recent changes within the surgery of patients with a fracture involving the acetabulum, outline contemporary management, and identify the major problem areas where further research is most needed. Cite this article: Bone Joint J 2017;99-B:1125–31
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Affiliation(s)
- M. Rickman
- Royal Adelaide Hospital and University
of Adelaide, Level 4, Bice
Building, North Terrace, Adelaide
SA5000, Australia
| | - V. D. Varghese
- Royal Adelaide Hospital and University
of Adelaide, Level 4, Bice
Building, North Terrace, Adelaide
SA5000, Australia
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Gupta S, Singh J, Virk JS. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures. Chin J Traumatol 2017; 20:161-165. [PMID: 28526613 PMCID: PMC5473740 DOI: 10.1016/j.cjtee.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 11/05/2016] [Accepted: 11/11/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum. It also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetabulum fractures. METHODS From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d'Aubigne and Postel score. The strength of the abductors was assessed according to the Medical Research Council (MRC) grading system. RESULTS Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. CONCLUSION Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.
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Affiliation(s)
- Sandeep Gupta
- Department of Orthopaedics, Government Medical College and Hospital (GMCH), Chandigarh, India
| | - Jagdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, India
| | - Jagandeep Singh Virk
- Department of Orthopaedics, Government Medical College and Hospital (GMCH), Chandigarh, India,Corresponding author.
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Dubina AG, Wickramaratne N, O'Toole RV, Manson TT. Assessment of trochanteric osteotomy fragment union after acetabular fracture surgery. Injury 2017; 48:384-387. [PMID: 27955824 DOI: 10.1016/j.injury.2016.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/23/2016] [Accepted: 08/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trochanteric osteotomies are performed in conjunction with standard approaches to improve surgical exposure during open reduction and internal fixation (ORIF) of acetabular fractures. The literature on total hip arthroplasty reports nonunion rates as high as 30% associated with trochanteric osteotomies; however, few data exist regarding the outcomes of trochanteric osteotomies for acetabular fracture surgery. Our hypotheses were 1) patients receiving trochanteric osteotomies during ORIF of acetabular fractures have a low rate of nonunion of the osteotomy fragment, and 2) hip abduction precautions are not necessary with digastric type osteotomies. PATIENTS AND METHODS A retrospective review was conducted to identify patients with acetabular fractures between July 2002 and June 2010 (n=734 fractures) who required trochanteric osteotomies (n=64, 9% of fractures). Forty-seven met inclusion criteria of adequate follow-up (>56days). No excluded patient experienced a complication. Fractures were classified using the Letournel-Judet classification system. RESULTS Only seven (20%) of 35 patients who received digastric osteotomies had hip abduction precautions applied during the postoperative period. All study patients were shown to have radiographic union at the trochanteric osteotomy site (100% union rate, n=47). Hip abduction precautions intended to protect the osteotomy site and reduce the risk of nonunion and fixation failure were infrequently applied to patients with digastric osteotomies (20%) in this cohort. Multiple protective factors against nonunion were present in this study population compared with previous arthroplasty studies from other institutions. CONCLUSIONS Trochanteric osteotomies are not associated with a significant nonunion rate, and digastric osteotomies might be safely managed without hip abduction precautions.
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Affiliation(s)
- Andrew G Dubina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Niluka Wickramaratne
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robert V O'Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Theodore T Manson
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States.
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Collinge CA, Ziran NM, Coons DA. Relationship Between the Superior Gluteal Vessels and Nerve at the Greater Sciatic Notch. Orthopedics 2015; 38:e929-33. [PMID: 26488790 DOI: 10.3928/01477447-20151002-62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/06/2015] [Indexed: 02/03/2023]
Abstract
Bleeding from the superior gluteal (SG) blood vessels at the greater sciatic notch is frequently encountered during acetabular fracture surgery. The purpose of this study is to define the positional anatomy of the superior gluteal vessels and nerve (SGVAN) at the greater sciatic notch. Twenty-three hemipelvi were dissected in whole human cadavers. The greater sciatic notch and SGVAN were visualized via a posterior surgical approach, identified deep in the greater sciatic notch, and traced superficially. Branches of the SGVAN and their anatomical relationship to each other were recorded. In the notch, SG arteries comprised a single vessel in 18 (78%) of 23 specimens, with all of these dividing at varying distances (1-3.5 cm) along the lateral ilium after dividing into superior and inferior branches. The SG artery branches were contiguous with periosteum of the bony notch in all specimens. More than 1 SG nerve branch was seen in the greater sciatic notch of all specimens, including an inferior branch that exited caudal or caudal-superficial to the SG vessels. The caudal-most SG nerve branch was directly adjacent to the bony notch's periosteum in 15 (65%) of 23 specimens. The SGVAN are at risk in patients undergoing acetabular fracture surgery. Individuals performing surgery along the acetabulum's posterior column would expect to encounter a major SG nerve branch (deep inferior) before encountering the SG vessels in all cases. Iatrogenic injuries to the SGVAN might be prevented by avoiding use of cautery in this area if hemorrhage is encountered.
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Bartlett CS, Birch CE. Femoral head reduction osteoplasty for fracture dislocation: A surgical technique. Injury 2015; 46:1689-94. [PMID: 25816707 DOI: 10.1016/j.injury.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral head fractures with subchondral impaction and cartilage loss are difficult to treat successfully. Although multiple surgical management options have been described, no one technique has proven superior, particularly in the young high-demand population. TECHNIQUE A femoral head reduction osteoplasty was performed following a surgical dislocation of the hip. A peripherally based wedge of bone was resected off the damaged central third of the head followed by reduction and fixation of the remaining fragments. This technique resulted in a smaller yet congruent femoral head. METHODS A healthy 40-year old labourer sustained a traumatic crush injury while at work, resulting in a left femoral head fracture dislocation with an associated posterior wall acetabular fracture. Significant femoral head impaction and cartilage loss limited the treatment options. RESULTS Intraoperative reduction and postoperative imaging demonstrated near anatomic reconstruction of femoral head with a congruent hip joint. Superiorly at the level of resection, the medial-lateral diameter was reduced by 5-6mm (approximately 12-15% the diameter of the original head) by the osteoplasty. At five years, Harris Hip Score was 86, Oxford Hip Score 36, and UCLA score 89. Hip abductor strength was full, range of motion near normal, and the patient ambulated without antalgia. Radiographs demonstrate a congruent joint and patchy avascular necrosis without collapse. The patient maintained full employment as a labourer. CONCLUSIONS Femoral head reduction osteoplasty is a viable option that may produce durable intermediate-term results for complex femoral head fracture with superior impaction and chondral damage. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Craig Scott Bartlett
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, United States.
| | - Christopher Erik Birch
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, United States.
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Kim JJ, Kim JW, Oh HK. The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof. Orthop Traumatol Surg Res 2014; 100:967-70. [PMID: 25453921 DOI: 10.1016/j.otsr.2014.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/31/2014] [Accepted: 09/09/2014] [Indexed: 02/02/2023]
Abstract
There is extension of the Kocher-Langenbeck approach using trochanteric osteotomy for posterior wall fracture extending to acetabular roof, but it exposes to complications such as nonunion, breakage, and heterotopic ossification. The current study introduces a submuscular sliding plate technique. We retrospectively analyzed 13 patients treated with this technique. It is based on conventional method for posterior wall fracture. After reduction of roof fragment with direct visualization, a pre-contoured plate was passed through a submuscular tunnel under the gluteus medius and minimus. A small split incision was performed on the muscles, and screws were inserted with a triple trocar complex safely under fluoroscopic imaging. All patients had fracture union without complications. X-rays results showed anatomical reduction in 10 cases and imperfect reduction in 3 cases. Our results were satisfactory, particularly without heterotopic ossifications despite no prophylactic regimen of NSAID was applied and no neurological complications, so we believe that this technique is a good option for posterior wall fractures extending to the acetabular roof.
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Affiliation(s)
- J J Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, South Korea
| | - J W Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, 875, Haeun-daero, Haeundae-gu, Busan 612-862, South Korea.
| | - H K Oh
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 875, 2240 Daehwa-dong, Ilsanseo-gu, Goyang 411-706, South Korea
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Sarlak AY, Selek O, Inanir M, Musaoglu R, Baran T. Management of acetabular fractures with modified posterior approach to spare external hip rotators. Injury 2014; 45:732-7. [PMID: 24360076 DOI: 10.1016/j.injury.2013.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 08/09/2013] [Accepted: 11/11/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the present study the quality of reduction and incidence of complications in hip external rotator sparing modified posterior approach was assessed in both simple and complex acetabular fractures. MATERIALS AND METHODS This retrospective study includes 37 patients (38 hips) with a mean age of 42.1 years (range 21-60), that had been treated for displaced acetabular fractures from June 2007 through May 2011. They were reviewed at a mean of 3 years (20-67 months). RESULTS The fractures were classified according to the Letournel-Judet classification. Anatomic reduction and stable fixation of the fracture with less than 2mm residual displacement was achieved in 28 of 38 hips. At the final follow up the patients were evaluated clinically according to Merle d'Aubigne and Postel scoring system which had been modified by Matta and radiologically based on the criteria described by Matta. The clinical results were excellent in 20, good in 8, fair in 8, and poor 2 hips. Complications included two superficial local wound infection and 10 heterotopic ossification with 7 of the cases having grade I heterotopic ossification. Avascular necrosis of the femoral head was not seen in any of the 38 hips. One patient with preoperative sciatic nerve palsy had complete recovery of neurologic function. There were no cases of deep vein thrombosis or pulmonary embolism. CONCLUSION The functional outcome was satisfactory in most of the cases and comparable with other larger series. Using the limited part of Henry's sciatic nerve exposure skin incision - working in the plane between gluteus maximus and the tensor fascia lata as in the classical Gibson approach and two portal external rotator hip sparing approach resulted in good fracture reduction without approach related complications.
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Affiliation(s)
- Ahmet Y Sarlak
- Department of Orthopaedics and Traumatology, Kocaeli University School of Medicine, Umuttepe, Kocaeli, Turkey.
| | - Ozgur Selek
- Department of Orthopaedics and Traumatology, Kocaeli University School of Medicine, Umuttepe, Kocaeli, Turkey
| | - Murat Inanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University School of Medicine, Umuttepe, Kocaeli, Turkey
| | - Resul Musaoglu
- Department of Orthopaedics and Traumatology, Kocaeli University School of Medicine, Umuttepe, Kocaeli, Turkey
| | - Tuncay Baran
- Department of Orthopaedics and Traumatology, Kocaeli University School of Medicine, Umuttepe, Kocaeli, Turkey
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Grenier G, Leblanc E, Faucheux N, Lauzier D, Kloen P, Hamdy RC. BMP-9 expression in human traumatic heterotopic ossification: a case report. Skelet Muscle 2013; 3:29. [PMID: 24330639 PMCID: PMC3878643 DOI: 10.1186/2044-5040-3-29] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/20/2013] [Indexed: 11/17/2022] Open
Abstract
Background Heterotopic ossification (HO) is defined as the abnormal formation of mature bone in soft tissue, notably skeletal muscle. The morbidity of HO in polytraumatized patients impacts the functional outcome, impairs rehabilitation, and increases costs due to subsequent surgical interventions. Case presentation We present the case of a 34-year-old African male who developed severe HO around his right hip 11 days after a major trauma. Immunohistochemical analyses of resected tissue revealed that several BMPs were expressed in the HO, including highly osteogenic BMP-9. Conclusions To the best of our knowledge, this is the first report of local BMP expression, notably BMP-9, in traumatic HO, and suggests that BMP-9, possibly through mrSCs, can contribute to HO formation in soft tissues when a suitable microenvironment is present.
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Affiliation(s)
| | | | | | | | | | - Reggie C Hamdy
- Shriners Hospital for Children, 1529 Cedar Avenue, Montreal, QC H3G 1A6, Canada.
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Heterotopic ossification rates after acetabular fracture surgery are unchanged without indomethacin prophylaxis. Clin Orthop Relat Res 2013; 471:2776-82. [PMID: 23440617 PMCID: PMC3734400 DOI: 10.1007/s11999-013-2871-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach. QUESTIONS/PURPOSES We therefore determined (1) the incidence of HO after acetabular fracture surgery through a posterior approach; (2) the incidence of symptoms attributable to HO; and (3) the rate of reoperation for HO. METHODS We retrospectively reviewed the records of all 423 patients with acetabular fractures following our clinical protocol change; of these, 120 were treated with a Kocher-Langenbeck approach and included. The presence of radiographic HO was documented a minimum of 10 weeks postoperatively using the classification of Brooker et al. Symptoms and reoperations were recorded. RESULTS The overall incidence of radiographic HO was 47% (56 of 120 patients): 26% Class I-II 13% Class III, and 8% Class IV. Overall, 15% of patients developed symptoms; 3.3% underwent reoperations for excision of HO. There were no major differences between the incidence of moderate and severe HO in this study when compared with the indomethacin and placebo groups from the prior study. CONCLUSIONS Our incidence of moderate and severe HO has not changed since discontinuing indomethacin. These findings support our institutional decision to abandon routine indomethacin prophylaxis after acetabular surgery. We recommend improved surgical techniques to limit damage to the abductors and improved risk stratification of patients when considering treatment options for HO prophylaxis.
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Letter to the editor: Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res 2010; 468:906-7. [PMID: 20024632 PMCID: PMC2816744 DOI: 10.1007/s11999-009-1200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Osgood GM. Posterior wall acetabular fractures: update on surgical indications, fixation techniques and outcome measurements. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181b3a5f2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hadjicostas PT, Thielemann FW. The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures. Injury 2008; 39:907-13. [PMID: 18599058 DOI: 10.1016/j.injury.2007.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 10/13/2007] [Accepted: 12/03/2007] [Indexed: 02/02/2023]
Abstract
From January 2003 and February 2006, 31 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a single approach, involving a straight lateral incision centered over the greater trochanter, trochanteric osteotomy and dislocation of the femoral head. The mean age of the patients was 48 (range 20-74 years) with a mean follow up 24 months (range from 20 to 42 months). Ten fractures were classified as simple, and 21 as complex fractures. The mean time to surgery was 4.5 days (range from 0 to 14 days). Mean operating time was 118 min (range 52-168). Five patients presented with posterior dislocation of the hip joint at the time of initial presentation. The trochanteric fragment was fixed with three 3.5mm cortical screws. Congruent reduction was achieved in all patients and all osteotomies healed within 5 months. Clinical evaluation was based on the modified Merle d'Aubigne and Postel scoring. Motor strength of abduction was evaluated according to the Medical Research Council grading. Clinical scoring was excellent to good in 24%. The strength of the abductors was grade 0/5 in a patient with Brooker's class IV heterotopic ossification, and 3/5 in the two patients with necrosis of the femoral head. There were five patients with grade 4/5 and the 5/5 in the rest. Complications included two segmental femoral head necrosis, one of them combined with necrosis of the weight bearing acetabular dome area. These patients required total hip replacement. Mild heterotopic ossification grade II was seen in one patient and significant (grade IV), in another patient. Two patients developed superficial wound infection over the trochanteric area and another two patients persistent pain due to irritation caused by the screws. One patient developed peroneal nerve palsy which resolved 3 months after the surgery. The trochanteric slide osteotomy can enhance the exposure of the whole acetabulum and the femoral head. This allows better evaluation of any osteochondral lesions, intra-articular bony fragments and fracture steps, providing a more accurate reduction and easier fixation of the acetabular fracture.
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Affiliation(s)
- Panayiotis T Hadjicostas
- Schwarzwald-Baar Hospital, Department of Trauma and Reconstructive Surgery, Villingen-Schwenningen, Germany.
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