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Soetjahjo B, Adriansyah D, Fauzan A, Satmoko BA. Acetabular fracture and central hip dislocation in osteogenesis imperfecta child treated surgically with bone grafts augmented by recombinant human bone morphogenetic protein-2: A rare case report. Int J Surg Case Rep 2023; 108:108436. [PMID: 37392586 PMCID: PMC10382760 DOI: 10.1016/j.ijscr.2023.108436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Rare congenital disorder osteogenesis imperfecta (OI) can make treating complex acetabular fractures-dislocations challenging. Open reduction and internal fixation (ORIF) with locking plates and screws may not produce satisfactory results. We present the outcome of ORIF with reconstruction locking plate and screw augmented by bone grafts with recombinant bone morphogenetic protein-2 (rhBMP-2) for OI type I child with Judet-Letournel both column type acetabular fracture associated with central hip dislocation. CASE PRESENTATION We present a case of a 13-year-old female OI type I patient with right hip pain after falling while biking. Both eyes had blue sclera and OI family history. Intraoperatively, the Stoppa approach was used. Proximal femoral skeletal traction was used to reduce the femoral head and aid bone graft reconstruction of the acetabular wall. Intraosseous injection of rhBMP-2 was added. Fractures were fixed with a curved reconstruction locking plate and screws. Bones and soft tissues were gently manipulated to prevent blood loss. Radiographic and functional results were remarkable. CLINICAL DISCUSSION Fractures and blood loss are more likely to occur in OI type I patients due to collagen type I deficiency. Proximal femur skeletal traction is crucial for ORIF plating in acetabular fractures with central hip dislocation. This minimizes bone and soft tissue manipulation. RhBMP-2-injected bone grafts have structural support and osteoinductive properties that enhance bone healing. Despite its exceptional results in this case, further research is needed. CONCLUSION The combination of our technique and rhBMP-2 effectively accelerates bone healing in OI patient treated with ORIF.
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Affiliation(s)
- Bintang Soetjahjo
- Orthopedic and Traumatology Department, dr. Moewardi General Hospital, Surakarta, Indonesia.
| | - Denny Adriansyah
- Orthopedic and Traumatology Department, dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Ahmad Fauzan
- Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
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Li Y, Feng R, Liu X, Wang G, Wang W, Lu Q, Huang W, Wu H, Cai X. A Post-Traumatic Osteoarthritic Model of Hip Following Fracture of Acetabulum in Rabbit: A Preliminary Study by Macroscopic and Radiographic Assessment. Orthop Surg 2021; 13:296-305. [PMID: 33398932 PMCID: PMC7862151 DOI: 10.1111/os.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objective To develop a post‐traumatic osteoarthritic model of hip following fracture of acetabulum in rabbit for revealing biochemical mechanism of post‐traumatic osteoarthritis. Methods A total of 36 mature male New Zealand white rabbits were equally divided into sham group (n = 12), non‐ORIF group (n = 12), and open reduction and internal fixation (ORIF) group (n = 12). Except for the sham group, rabbits had survival surgeries to create acetabular fractures of dorsal wall for simulating dashboard impaction mechanism. The ORIF group received open reduction and internal fixation, while fractures in the non‐ORIF group were left as displaced but transverse fracture and dislocation was reduced. Besides intraoperative appearance and postoperative recovery, macroscopic and radiographic characteristics of the hips were recorded and assessed by a radiographic scoring scale at 3 weeks, 6 weeks, and 6 months, respectively. Results Out of 24 modeled acetabula, 21 (87.5%) were pure dorsal wall fractures as proposed and the remaining three were associated fractures (dorsal wall plus transverse fracture) accompanied by dorsal dislocation or not. All hips were stable, and no sciatic nerve injury was observed. One rabbit in the ORIF group died of deep infection 4 days after surgery. Rabbits in the sham and ORIF groups returned to normal gait in 2 weeks, but animals in the non‐ORIF group suffered from limping and restricted movement. As the time progressed, the hips in the non‐ORIF group experienced progressive and severe degeneration which exhibited dramatically malformed and hypertrophic joints at 6 months, but the ORIF group maintained much better morphological structure. Corresponding to morphological changes, the average radiographic scores of the non‐ORIF group increased from 1.25 at 3 weeks to 2.75 at 6 months and showed statistically significant difference when compared to the sham group at all three time points (P = 0.011, 0.011, 0.015, respectively, <0.0167). Although the scores of the ORIF group showed apparent improvements (increased from 0.67 at 3 weeks to 2.00 at 6 months), there was no significant difference between the two modeled groups at all three time points. Conclusion The fracture model with high consistency and reproducibility showed progressive post‐traumatic osteoarthritic changes which could be improved by open reduction and internal fixation surgery and provided an alternative selection for investigating potential pathogenesis and pathology of post‐traumatic osteoarthritis following fracture of acetabulum.
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Affiliation(s)
- Yanjin Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Ruibing Feng
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Guodong Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Wei Wang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Orthopedics, Hubei Province hospital of Traditional Chinese Medicine, Wuhan, China
| | - Qilin Lu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Hubei 672 Orthopaedics Hospital of Integrated Chinese & Western Medicine, Wuhan, China
| | - Wei Huang
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China.,Department of Spine Surgery, Jingmen NO.2 People's Hospital, Jingmen, China
| | - Haiyang Wu
- Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Xianhua Cai
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China.,Department of Orthopaedic Surgery, PLA Middle Military Command General Hospital, Wuhan, China
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Chen W, Gao Z, Ma L. Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy. Int Orthop 2020; 45:1609-1614. [PMID: 33108471 DOI: 10.1007/s00264-020-04856-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND We investigated the causes of failure of the Allis manoeuvre for posterior hip dislocations with an associated Pipkin type I femoral head fractures. The effectiveness of a modified Allis manoeuvre was also evaluated. METHODS From January 2013 to December 2016, we enrolled five patients with a posterior hip dislocation associated by a Pipkin type I femoral head fracture who were treated initially with the Allis manoeuvre that subsequently failed. Radiographic evaluations were performed to determine the cause of failure, and then a modified Allis manoeuvre was performed. During this procedure, the hip and knee joints of the injured lower limb were both flexed to 90°, and the leg was pulled posteriorly following an upward force to reduce the dislocation. Reduction was assessed by radiographic evaluation. RESULTS In all patients, the fractured femoral head was incarcerated on the superior edge of the posterior rim of the acetabulum, resulting in failure of the conventional Allis manoeuvre. Satisfactory reduction was achieved with a modified Allis manoeuvre. The mean follow-up duration was 31 months. The femoral head fracture healed after four months on average. The mean Harris score was 91 at the final follow-up. Re-dislocation or femoral head necrosis was not observed. CONCLUSIONS For posterior hip dislocations associated with a Pipkin type I femoral head fracture, failed reduction is often caused by incarceration of the fractured femoral head on the superior edge of the posterior rim of the acetabulum. The modified Allis manoeuvre can effectively reduce the combined injury in a closed fashion.
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Affiliation(s)
- Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Ze Gao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Lijie Ma
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China.
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