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Sample records for acetabular internal fracture

  1. [Acetabular fractures].

    Science.gov (United States)

    Gänsslen, A; Oestern, H J

    2011-12-01

    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.

  2. FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF ACETABULAR FRACTURES BY INTERNAL FIXATION

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    Sagar

    2015-06-01

    Full Text Available BACKGROUND: The treatment of acetabular fractures has seen major advances in the field of orthopaedic traumatology. Conservative treatment of acetabular fractures leads to poor results. Newer diagnostic tools like the Computed Tomography (CT scan help in analyzing the three dimensional disturbance in the normal anatomy and plan the surgical management accordingly. In recent years operative treatment has become the treat ment of choice in the management of acetabular fractures as precise anatomical reduction with adequate internal fixation can be attained. OBJECTIVES : To evaluate the functional outcome of operatively managed acetabular fractures , and assess the efficacy of operative fixation of acetabular fractures , and also study the complications of operative fixation of acetabular fractures. MATERIALS AND METHODS: Fifty five patients (49 male & six female admitted to Sanjay Gandhi Institute of Trauma and Orthopaedics wi th acetabular fractures underwent open reduction and internal fixation. All patients were evaluated with Matta et al score with a minimum of follow up of six months. RESULTS: There were 24 (43.6% patients with bicolumnar fractures , 15(27.3% had posterior column fractures , 10(18.1% had posterior wall fractures , five (9.1% had transverse fractures , and one (1.8% patient had an anterior column fracture. Full weight bearing was attained in thirty five (63.6% patients in 16 weeks and in twenty (36.4% pati ents after 16 weeks. Forty five (81.8% patients were free of complications. According to Matta et al score 27(49.1% had excellent , 15(27.3% had good , nine (16.4% had fair , and four (7.3% had poor results. CONCLUSION: Open reduction and internal fixati on of acetabular fractures is a reliable technique , minimizes healing time and provides congruent joint reduction. Operative treatment of acetabular fractures results in predictable union and good clinical results with a low rate of complications.

  3. Operative strategy of acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    WANG Yan; TANG Pei-fu; HUANG Peng

    2006-01-01

    Anatomic structure of acetabular fractures are complex and operative exposure and fixation are extremely difficult.For those obviously displaced acetabular fractures, close reduction is doomed to cause deformative healing. Open reduction with internal fixation (ORIF) not only results in anatomic reduction, but also brings complications. No matter which method will be adopted, traumatic arthritis or avascular necrosis of femoral head might occur. In order to treat acetabular fractures more effectively, orthopedic surgeons should be required to fully master the acetabular anatomy, biomechanics, classification and the necessary knowledge for complication prevention.

  4. Occult internal iliac arterial injury identified during open reduction internal fixation of an acetabular fracture: a report of two cases.

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    Chaus, George W; Heng, Marilyn; Smith, Raymond M

    2015-07-01

    We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. There were no preoperative signs or symptoms indicative of a vascular injury. These cases emphasise the heightened awareness one must have when treating widely displaced posterior column fractures of the acetabulum, especially those fractures with extension into the greater sciatic notch, as previously formed clot can become dislodged and hemostasis lost. We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.

  5. Periprosthetic acetabular fractures.

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    Benazzo, Francesco; Formagnana, Mario; Bargagliotti, Marco; Perticarini, Loris

    2015-10-01

    The aim of this article is to propose a diagnostic and therapeutic algorithm for the acetabular periprosthetic fractures. This article explores the current literature on the epidemiology, causes and classification of periprosthetic acetabular fractures. Integrating data with the experience of the authors, it offers a guide to diagnosis and possible therapeutic strategies. Intra-operative fractures can occur during rasping, reaming or implant impaction, and they must be treated immediately if the component(s) is (are) unstable. Post-operative fractures can be due to major trauma (acute fractures) or minor forces in bone osteolysis; it is possible to plan reconstruction and fixation according to fracture characteristics. Treatment choice depends upon fracture site and implant stability. Periprosthetic acetabular fractures are uncommon complications that can occur intra-operatively or post-operatively, and a reconstructive surgeon must be able to manage the procedure. Accurate planning and reconstruction implant are necessary to achieve good cup stability.

  6. An Unusual Combination of Acetabular and Pelvic Fracture: Is This a New Subtype of Acetabular Fracture?

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    Reza Tavakoli Darestani

    2013-01-01

    Full Text Available Introduction: Acetabular fractures are a common problem among young males. An acetabular fracture with disruption of the joint surface, if untreated, will rapidly lead to post-traumatic osteoarthritis. Proper reduction and internal fixation depend on accurate classification and the quality of imaging.Case Presentation: We present an unusual form of acetabular fracture, which is not included in the conventional classification (Judet and Letournel ; this occurred in a middle-aged male who was operatively treated without any complications. In this case due to posterior extension of the fracture into the SI joint and concomitant anterior column fracture in the area above the acetabular dome, no portion of the acetabular anterior surface remained connected to the innominate bone.Conclusions: We recognized this type of fracture and treated it similarly to both column fractures. We recommend that the classification of acetabular fractures be modified to include this type of fracture.

  7. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation....... Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction...... was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0...

  8. Surgical treatment for complicated acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Ning An; Yang Yanmin

    2004-01-01

    Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures. Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures, 7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.

  9. CT classification of acetabular fractures

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    Marincek, B.; Porcellini, B.; Robotti, G.

    1984-05-01

    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  10. Acetabular fracture types vary with different acetabular version

    National Research Council Canada - National Science Library

    Werner, Clément M. L; Copeland, Carol E; Ruckstuhl, Thomas; Stromberg, Jeff; Turen, Clifford H; Bouaicha, Samy

    2012-01-01

    .... While several investigations figured out what role femoral position during impact plays in distinct fracture patterns, no data exists on the influence of acetabular version on the fracture type...

  11. Surgical treatment of displaced acetabular fractures

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    Milenković Saša

    2011-01-01

    Full Text Available Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Niš from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average. According to the classification by Judet and Letournel, 15 (68.18% patients had an elementary acetabular fracture, whereas 7 (31.82% patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36% patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18% patients, good in 4 (18.18% patients and moderate in 3 (13.63% patients. According to Merle d’Aubigné Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54% patients, good in 7 (31.81% patients and moderate in 3 (13.63% patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

  12. [Periprosthetic acetabular fractures in geriatric patients].

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    Herath, S C; Rollmann, M F R; Histing, T; Holstein, J H; Pohlemann, T

    2017-02-01

    Periprosthetic acetabular fractures in geriatric patients are rare injuries; however, the incidence is increasing because of the current demographic developments. For diagnosis of periprosthetic acetabular fractures, conventional X‑ray images are regularly complemented by computed tomography (CT). For exclusion of loosening of the prosthesis more advanced techniques, such as single photon emission CT (SPECT/CT) are applied. In addition to classification of periprosthetic acetabular fractures by the traditional system of Letournel there are several other classification systems, which take into account the etiology of the fracture and the stability of the prosthesis. While, under certain circumstances conservative treatment of periprosthetic acetabular fractures is possible, operative treatment often requires extensive surgical procedures to restore the stability of the acetabulum as a support for the cup of the prosthesis. Besides the traditional techniques of acetabular osteosynthesis, special revision systems, augmentations and allografts are used for the reconstruction of periprosthetic acetabular fractures. To determine a therapeutic regimen patient-specific preconditions as well as fracture pattern and type of prosthesis need to be taken into account. In the literature there are several algorithms, which are aimed at supporting the attending physician in making the correct decision for the treatment of periprosthetic acetabular fractures. In cases of periprosthetic acetabular fractures even experienced surgeons are faced with great challenges. Thus, treatment should be carried out in specialized centers.

  13. Surgical Management of Acetabular Fractures: A Case Series

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    Hassan Rahimi

    2013-01-01

    Full Text Available Introduction: For decades, acetabular fractures were treated conservatively. Judet et al. in 1960s established the operative treatment of these fractures by continuous improvement of pre-operative evaluation and classification of fractures. Several studies demonstrated that accurate fracture reduction decreases the incidence of post-traumatic arthritis and improves functional outcome.Case Series: We report 67 consecutive patients who underwent surgical treatment for acetabular fracture; 44 patients were available for follow-up. In 35 (79.5% cases, congruent reductions were achieved. The final mean Harris hip score was 81.8 (53-95. Functional outcomes according to Harris score were excellent and good in 31 patients (70.5%.Conclusions: The results of internal fixation of displaced acetabular fractures in our series were satisfactory.

  14. Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures

    DEFF Research Database (Denmark)

    Oberst, Michael; Hauschild, Oliver; Konstantinidis, Lukas;

    2012-01-01

    BACKGROUND: This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a na....... In addition, the complication rate in the navigated group was significantly lower. CONCLUSION: We support the use of navigation systems and a 3D image intensifier as helpful tools during ORIF of displaced acetabular fractures. LEVEL OF EVIDENCE: Therapeutic study, level III....... acetabular fractures led to a significant increase in skin-to-skin time. Postoperative radiolographic analysis revealed an improvement in the quality of fracture reduction in the 3D navigation group. Navigation in combination with the 3D images of the ISO-C 3D limited the need for extended approaches...

  15. Quality of life following total hip arthroplasty in patients with acetabular fractures, previously managed by open reduction and internal fixation

    Institute of Scientific and Technical Information of China (English)

    Prasoon Kumar; Ramesh Kumar Sen; Vishal Kumar; Ankit Dadra

    2016-01-01

    Purpose:Total hip replacement (THR) is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips.Acetabular fractures managed either conservatively or operatively by fixation tend to present later with secondary joint changes that require THR.In this study we evaluated the functional outcome and quality of life achieved by such patients.Methods:Our study was carried out as a retrospective trial by recruiting patients who underwent THR from June 2006 to May 2012.A total of 32 patients were included with a mean age of 46.08 years ranging from (25-65) years.We evaluated the quality of life in the patients using scoring techniques of Short Musculoskeletal Functional Assessment (SMFA) and the 12-Item Short Form Health Survey (SF-12).Functional outcome was assessed using Harris Hip Score (HHS).Results:The mean HHS of the patients was 84.3 with a range from 56 to 100.The SMFA averaged 13.3.The SF-12 score averaged 49.1.The correlation of the HHS with SF-12 was positive (p =0.001) while with SMFA there was a negative correlation (p =0.001).Conclusion:From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.

  16. Primary total hip arthroplasty for acetabular fracture

    Institute of Scientific and Technical Information of China (English)

    WANG Zi-ming; SUN Hong-zhen; WANG Ai-min; DU Quan-yin; WU Siyu; ZHAO Yu-feng; TANG Ying

    2006-01-01

    Objective: To explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.Methods: We retrospectively summarized and analyzed the traumatic conditions, fracture types, complications,operative time, operative techniques, and short-term curative effect of 11 patients( 10 males and 1 female, with a mean age of 42. 4 years ) with acetabular fracture who underwent primary total hip arthroplasty.Results: The patients were followed up for 6-45 months ( mean = 28 months). Their average Harris score of postoperative hip joint was 78.Conclusion: Under strict mastery of indications,patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

  17. Treatment algorithm of acetabular periprosthetic fractures.

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    Simon, Paul; von Roth, Philipp; Perka, Carsten

    2015-10-01

    Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. The management of these fractures can be challenging. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. Periprosthetic acetabular fractures can occur intra-operatively, in particular during insertion of non-cemented cups or in the context of revision surgery. Post-operative causes for periprosthetic acetabular fractures are traumatic events or, more commonly, pelvic discontinuity due to severe bone loss related to osteolysis. Despite their aetiology, the main objective of surgery is to achieve a stable acetabular component and fracture. While stable fractures and implants could be treated non-operatively, unstable fractures require surgery to achieve component stability and allow appropriate biological fixation of the revision cup. Assessment of the stability plays a crucial role before determining the treatment strategy. There is a large variety of surgical techniques available for the management of these fractures. This review article outlines the epidemiology, aetiology and current classification systems, and provides a distinct diagnostic and therapeutic algorithm for the treatment of periprosthetic acetabular fractures.

  18. Periprosthetic acetabular fracture associated with extensive osteolysis.

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    Chatoo, M; Parfitt, J; Pearse, M F

    1998-10-01

    Periprosthetic fracture of the acetabulum is an uncommon complication of total hip arthroplasty. The management is reported to be difficult, and complications such as nonunion and implant loosening are common. We described herein a case of nontraumatic periprosthetic acetabular fracture associated with significant osteolysis, which was successfully managed by addressing the fracture and osteolysis independently.

  19. Plain film analysis of acetabular fracture

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    Kim, Chang Soo; Han, Sang Suk; Yoon, Eu Giene; Cha, Seong Sook; Eun, Tchoong Kie; Chung, Duck Hwan [Inje Medical College Paik Hospital, Pusan (Korea, Republic of)

    1986-02-15

    Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports total weight of human body. Because of different methods of surgical approach according to fracture type, precise interpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray films showing acetabular fracture. The results were as follows: 1. Almost 60% of the cases-were in their 2nd and 3rd decades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was traffic accident (33 cases, 86.8%), followed by fall down (4 cases, 10.5%), and slip down (1 case, 2.7%). 4. Elementary fractures were 21 cases (55.3%), and associated fractures were 17 cases (44.7%). 5. Among elementary fractures, posterior wall fractures were 9 cases (23.7%), followed by anterior column fractures (8 cases, 21.1%), anterior wall fractures (4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases (21.1%), followed by both column fractures (6 cases, 15.8%), anterior and hemitransverse fractures (3 cases, 7.8%). 7. Other pelvic bone fractures associated with the acetabular fracture were as follows: fractures of contralateral pubic rami (6 cases, 15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of other organs adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra (2 cases, 5.3%) and uterus (1 cases, 2.6%)

  20. Surgical treatment for complex acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    LIU Qiang; WU Dou; LI Ping; HAN Shu-feng

    2006-01-01

    Objective: To explore the effect of surgical treatment on complex acetabular fractures.Methods: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean = 38. 5 years ) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.Results: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score > 80 points). The rate of excellent and good was about 86 %.Conclusions: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.

  1. Computed tomography of the acetabular fractures

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    Jung, Ho Young; Suh, Jin Suck; Park, Chang Yun; Lee, Kil Woo [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.

  2. Conservatively treated acetabular fractures: A retrospective analysis

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    Narender Kumar Magu

    2012-01-01

    Full Text Available Background: There are a few studies reporting the long term outcome of conservatively treated acetabular fractures. The present study aims to evaluate the quality of reduction, and radiological and functional outcome in displaced acetabular fractures treated conservatively. Materials and Methods: Sixty-nine patients (55 men and 14 women with 71 displaced acetabular fractures (mean age 38.6 years managed conservatively were retrospectively evaluated. There were 11 posterior wall, 5 posterior column, 6 anterior column, 13 transverse, 2 posterior column with posterior wall, 9 transverse with posterior wall, 6 T-shaped, 1 anterior column with posterior hemi-transverse, and 18 both-column fractures. The follow-up radiographs were graded according to the criteria developed by Matta J. Functional outcome was assessed using Harris hip score and Merle d′Aubigne and Postel score at final followup. Average follow-up was 4.34 years (range 2-11 years. Results: Patients with congruent reduction (n=45 had good or excellent functional outcome. Radiologic outcome in incongruent reduction (n=26 was good or excellent in 6 and fair or poor in 20 hips. The functional outcome in patients with incongruent reduction was good or excellent in 16 and satisfactory or poor in 10 hips. Good to excellent radiologic and functional outcome was achieved in all patients with posterior wall fractures including four having more than 50% of broken wall. Good to excellent functional outcome was observed in 88.8% of both-column fractures with secondary congruence despite medial subluxation. Conclusions: Nonoperative treatment of acetabular fractures can give good radiological and functional outcome in congruent reduction. Posterior wall fractures with a congruous joint without subluxation on computed tomography axial section, posterior column, anterior column, infratectal transverse or T-shaped, and both-column fractures may be managed conservatively. Small osteochondral fragments

  3. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China.

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    Liu, Xinwei; Xu, Shuogui; Zhang, Chuncai; Su, Jiacan; Yu, Baoqing

    2010-10-01

    Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40-50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D'Aubigne-Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply.

  4. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China

    Science.gov (United States)

    Liu, Xinwei; Xu, Shuogui; Su, Jiacan; Yu, Baoqing

    2009-01-01

    Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40–50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D’Aubigne−Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply. PMID:20012433

  5. Bilateral acetabular fracture without trauma

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    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.

    1999-01-01

     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  6. Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

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    Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

    2017-02-01

    Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even stronger if in-hospital mortality was excluded (p = 0.00074). Finally

  7. A reduction clamp for an aiming component in associated acetabular fractures

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    Zhang-Fu Wang

    2015-01-01

    Full Text Available Background: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. Materials and Methods: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. Results: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp′s aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. Conclusion: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

  8. Análise epidemiológica das fraturas acetabulares Epidemiological analysis on acetabular fractures

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    Maurício Silveira Maia

    2011-01-01

    Full Text Available O objetivo deste trabalho é realizar um estudo epidemiológico das fraturas acetabulares na cidade de Campinas e entorno, tendo em vista poucos trabalhos publicados a respeito deste assunto. Prontuários cedidos pelo Serviço de Arquivamento Médico (SAM do Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp, dos anos de 2004 a 2008 com diagnósticos de fratura acetabular foram analisados por seis observadores que coletaram idade do paciente, sexo, lado acometido da fratura, mecanismo de lesão, material de síntese utilizado, complicações operatórias, fraturas associadas, tempo de internação pré e pós- operatória, tempo de internação total e número de sessões de fisioterapia pré e pós-cirurgia. Foi observado nesta demografia que o lado esquerdo foi o mais acometido; mecanismo de lesão que mais ocasiona esse tipo de fratura são os acidentes automobilísticos; das complicações cirúrgicas, as lesões do ciático tiveram maior ocorrência; o material de síntese mais utilizado são as placas de reconstrução.This aim of this work was to carry out an epidemiological study on acetabular fractures in the city of Campinas and surrounds, in view of the few published papers on this subject. Medical files with a diagnosis of acetabular fracture between the years 2004 and 2008 that were made available by the Medical Archiving Service of Hospital das Clínicas, State University of Campinas (UNICAMP were analyzed by six observers. Data on patients' ages, sex, side affected by the fracture, mechanism of injury, material used for synthesis, complications of the operation, associated fractures, length of hospitalization before and after the surgery, time of total internment and number of physiotherapy sessions before and after the surgery were gathered. It was observed in this population that the left side was more affected; the mechanism of injury that most often caused this type of fracture was automobile accidents

  9. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    Science.gov (United States)

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma.

  10. Successful cementless cup reimplantation using cortical bone graft augmentation after an acetabular fracture and cup displacement.

    Science.gov (United States)

    Torres, Bryan T; Chambers, Jonathan N; Budsberg, Steven C

    2009-01-01

    To report repair of a periprosthetic acetabular fracture with concurrent component displacement after cementless total hip arthroplasty (THA). Clinical case report. Dog (n=1) with an acetabular fracture after THA. Acetabular repair was performed on a highly comminuted periprosthetic acetabular fracture after cementless THA. A bulk, structural corticocancellous autograft from the ipsilateral ilial wing was used for repair and reconstruction of the dorsal acetabular wall before reimplantation of a cementless acetabular component. Repair of a periprosthetic acetabular fracture with a bulk structural autograft was successful in reconstruction of the dorsal acetabular wall and in reestablishing a stable, functional cementless THA acetabular prosthesis. Structural corticocancellous autografts from the ilium can be successfully used in repair of periprosthetic acetabular fractures after THA. Structural corticocancellous grafting from the ilium can be considered as a treatment option for repair of periprosthetic acetabular fractures after THA.

  11. Total hip arthroplasty with cementless cup after acetabular fracture

    Directory of Open Access Journals (Sweden)

    Marcelo Alfonso Lugones

    2012-12-01

    Full Text Available Background Acetabular fractures are a common cause of degenerative hip arthritis. The incidence of post-traumatic osteoarthritis has been reported between 12% and 57% and avascular necrosis of the femoral head may occur in 2% to 40% after posterior fracture dislocation. The fracture is often caused by major trauma in road accidents, at work or during sports, and patients usually present for total hip replacement (THR at an earlier age than the general arthritic population. We describe and analyze our patients with uncemented acetabular reconstruction in post-traumatic arthritis and compare them with THR in non-traumatic arthritis. Methods We retrospectively evaluated 19 patients who underwent uncemented acetabular reconstruction due to post-traumatic arthritis secondary to acetabular fracture. Results The average age at the time of arthroplasty was 52.2 years (19-83. The age at the time of fracture was 47.9 years (16-81. The average time between the acetabular fracture and THR was 52.4 months (4-360. The average follow-up was 4.25 years. No acetabular component loosening or infections were seen in either group. The Harris Hip Score at an average follow-up of 4.25 years was 89.3 (57-99. The follow-up in the control group with non-traumatic arthritis was 4.9 years, and the Harris Hip Score was 94.1 points (78-100. There were no significant difference in the Harris Hip Score between groups (p = 0.24. Conclusion Uncemented acetabular reconstruction in post-traumatic arthritis secondary to acetabular fracture is a more difficult procedure than routine arthroplasty in patient with non-traumatic arthritis. In the short-term there are no clinical or radiographic differences in THR with uncemented acetabular cups in post-traumatic arthritis patients compared to patients with non-traumatic arthritis.

  12. Acetabular fractures following rugby tackles: a case series

    LENUS (Irish Health Repository)

    Good, Daniel W

    2011-10-05

    Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting \\'the tackle\\' to only two players may well reduce the likelihood of this life-altering injury.

  13. Materials biocompatibility in the internal fixation of pelvic fracture combined with acetabular fracture%骨盆并髋臼骨折内固定材料的生物相容性

    Institute of Scientific and Technical Information of China (English)

    高明杰; 陶杰; 周孜辉; 杜琳

    2015-01-01

    BACKGROUND:Pelvic fractures combined with acetabular fractures are mostly caused by high-energy violence, often accompanied by severe complications and high mortality, and surgical fixation is preferred in most cases. OBJECTIVE:To investigate the internal fixation of pelvic fracture combined with acetabular fracture and to analyze the material biocompatibility. METHODS:A computer-based search of Wanfang, CNKI and PubMed databases was performed for articles related to the internal fixation of pelvic fracture combined with acetabular fracture and material biocompatibility published from 2005 to 2014. The keywords were“pelvis fractures, acetabulum fractures, internal fixators, materials”in Chinese and English, respectively. Articles published in authoritative journals or recently were preferred, and final y 29 articles were enrol ed in result analysis. RESULTS AND CONCLUSION:Steel plate reconstruction or screw internal fixation is often used for clinical treatment of pelvic fracture combined with acetabular fracture. Titanium plate is often chosen with similar elastic modulus to the bone and good biocompatibility. The titanium plate is pre-bended before implantation to match the bone surface of the fracture site. Absorbable screws have good histocompatibility and non-toxic side effects, which can avoid the electrolysis and corrosion of metal screws and maintain certain strength in early period of internal fixation;over time, the fracture is gradual y healed, the material strength gradual y decreases, and the material is final y degraded into water and carbon dioxide to achieve good clinical outcomes. It is difficult and high-risk for treatment of pelvic fracture combined with acetabular fractures, and active treatment and damage control are recommended as soon as possible. A reasonable treatment plan can be developed based on the type of fracture. Plate internal fixation and minimal y invasive fixation developed by the three-dimensional reconstruction techniques

  14. Acetabular fractures before and after the introduction of seatbelt legislation

    Science.gov (United States)

    Al-Qahtani, Saeed; O’Connor, Gregory

    1996-01-01

    Objectives To compare the incidence and severity of acetabular fractures and associated injuries before and after seatbelt legislation. Design A retrospective study. Setting Two major trauma centres, which are teaching hospitals. Patients Three hundred and ninety-three patients who sustained acetabular fractures during the 5 years before and 5 years after seatbelt legislation was enacted. Of these, the fractures in 198 patients (50.4%) resulted from a motor vehicle accident. Main Outcome Measures The number and severity of acetabular fractures and associated injuries. Results There has been a significant reduction in the number of acetabular fractures (p = 0.005) since seatbelt use became mandatory, and the complexity of the fractures has decreased. There has also been a marked reduction in associated injuries, such as fractures of other bones, and head, chest and abdominal injuries (p < 0.001). Conclusion The seatbelt law has been a useful preventive measure, resulting in a reduction in the incidence of acetabular fractures and associated injuries. PMID:8697323

  15. A Novel Approach for Treatment of Acetabular Fractures

    Science.gov (United States)

    Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

    2016-01-01

    Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

  16. Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Hideto Irifune

    2015-01-01

    Full Text Available Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.

  17. Femoral artery thrombosis after internal fixation of a transverse acetabular fracture in a patient with osteogenesis imperfecta type I

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    Morgan Steven J

    2008-01-01

    Full Text Available Abstract Osteogenesis imperfecta is a genetic disorder characterized by increased susceptibility to fractures and vascular injuries due to connective tissue fragility. In this case report, we present a patient with osteogenesis imperfecta type I who sustained a transverse fracture of the right acetabulum while transferring from bed to chair. The fracture was repaired through an ilioinguinal approach. During the surgery, an iatrogenic injury to the femoral artery and vein occurred. This intraoperative complication was salvaged by immediate vascular repair. We discuss the possible causes of iatrogenic vascular injuries in patients with osteogenesis imperfecta. Orthopaedic surgeons should be aware of this potentially devastating complication in this particular patient cohort.

  18. Experimental study on treatment of acetabular anterior column fractures: applyment of a minimally invasive percutaneous lag screw guide apparatus

    OpenAIRE

    Zhang, Li-hai; Zhang, Li-cheng; Si, Qing-hua; Gao, Yuan; Su, Xiu-Yun; Zhao, Zhe; Tang, Pei-Fu

    2016-01-01

    Background The aim of this study was to design a new minimally invasive percutaneous lag screw guide apparatus and to verify its adjuvant treatment of acetabular anterior column fracture on pelvis specimens. Methods This guide apparatus was self-developed based on the principles of “two points form a line” and “Rectangle”. Using C-arm fluoroscopy, this guide apparatus was used to conduct minimally invasive percutaneous lag screw internal fixation of acetabular anterior column fractures. Ten h...

  19. Outcomes of post-operative periprosthetic acetabular fracture around total hip arthroplasty.

    Science.gov (United States)

    Pierce, Todd P; Cherian, Jeffrey J; Jauregui, Julio J; Elmallah, Randa D K; Mont, Michael A

    2015-05-01

    Post-operative periprosthetic acetabular fractures are rare, but serious complication following total hip arthroplasty (THA). As the number of THA performed each year increases so will the expected number of periprosthetic fractures, thus making the treatment of these fractures an important topic for discussion. The purpose of this review is to analyze the recent evidence on risk factors, fracture classification schemes and treatment strategies that have been used for periprosthetic acetabular fractures around THA. The modified Paprosky classification is the most widely used and is a useful guide for management strategies. This classification system provides the guidelines for developing multiple treatment algorithms for decision making. Treatment options for surgical management include open reduction and internal fixation with plating, use of reconstruction cages, trabecular metal augments and bone grafting as needed. Treatment decisions are still an area of controversy and current research.

  20. Development of site-specific locking plates for acetabular fractures.

    Science.gov (United States)

    Xu, Meng; Zhang, Li-Hai; Zhang, Ying-Ze; He, Chun-Qing; Zhang, Li-Cheng; Wang, Yan; Tang, Pei-Fu

    2013-05-01

    Site-specific locking plates have gained popularity for the treatment of fractures. However, the clinical use of a site-specific locking plate for acetabular fractures remains untested due to production limits. To design a universal site-specific locking plate for acetabular fractures, the 3-dimensional (3D) photographic records of 171 pelvises were retrospectively studied to generate a universal posterior innominate bone surface. Using 3D photographical processing software, the 3D coordinate system was reset according to bony landmarks and was scaled based on the acetabular diameter to allow a direct comparison between surfaces. The measured surface was separated into measurement units. At each measurement unit, the authors calculated the average z-axis values in all samples and obtained the 3D coordinate values of the point cloud that could be reconstructed into the universal surface. A plate was subsequently designed in 3D photographical processing software, and the orientation and distribution of locking screws was included. To manufacture a plate, the data were entered into Unigraphics NX version 6.0 software (Siemens PLM Software, Co, Ltd, Plano, Texas) and a CNC digital milling machine (FANUC Co, Ltd, Yamanashi, Japan). The resulting locking plate fit excellently with the reduced bone surface intraoperatively. Plate contouring was avoided intraoperatively. Universal 3.5-mm locking screws locked successfully into the plate, and their orientations were consistent with the design. No screw yielded to acetabular penetration. This method of designing a site-specific acetabular locking plate is practical, and the plates are suitable for clinical use. These site-specific locking plates may be an option for the treatment of acetabular fractures, particularly in elderly patients.

  1. Impaction bone grafting and a cemented cup after acetabular fracture

    NARCIS (Netherlands)

    Bronsema, E.; Stroet, M.A. Te; Zengerink, M.; Kampen, A. van; Schreurs, B.W.

    2014-01-01

    PURPOSE: Patients suffering from post traumatic osteoarthritis of the acetabulum often require a total hip arthroplasty at a relatively young age. Long-term data outcome studies for this population are lacking. We report on the long-term outcome of 20 acetabular fractures in 20 patients treated with

  2. Central acetabular fracture dislocations: an unusual complication of seizures

    Energy Technology Data Exchange (ETDEWEB)

    Lovelock, J.E.; Monaco, L.P.

    1983-08-01

    Central acetabular fracture-dislocations resulting from convulsions are rare. The literature is reviewed in this regard and we add two additional cases in which hyponatremia was the cause of seizure activity. In most cases this type of injury is seen in bone already weakened by underlying disease.

  3. Early total hip arthroplasty for severe displaced acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; ZHANG Yu-kun; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Cao; LIU Yong; TIAN Hong-tao

    2006-01-01

    Objective : To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures.Methods: Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years (1-6 years) and the average period from fracture to operation was 8 days (5-21 day). The average age of the patients was 53 years (26-69 years).Results: At the final follow-up the Harris hip score averaged 82(69-100) points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of late loosening of the prosthesis. One patient had severe central displacement of the cup.Conclusions: In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.

  4. Posterior acetabular column and quadrilateral plate fractures: fixation with tension band principles.

    Science.gov (United States)

    Aly, Tarek A; Hamed, Hany

    2013-07-01

    Acetabular fractures can be classified into 5 simple and 5 associated fracture patterns. A significant amount of variation and complexity exists in these fractures patterns. Fractures of the posterior wall are the most common acetabular fractures. Comminution of the quadrilateral plate adds to fracture instability, and more rigid and stable internal fixation is mandatory. The goal of this study was to assess the results of reconstruction of comminuted posterior wall fractures of the acetabulum associated with quadrilateral plate fractures using the tension band technique. Twelve patients (9 men and 3 women) were included in the study. Mean patient age was 38.6 years (range, 24-47 years). Minimum follow-up was more than 2 years postoperatively. Reconstruction of the fracture included anatomic reduction of the fracture and fixation with a buttress plate for the posterior column and a prebent one-third tubular plate for the quadrilateral plate fracture. Clinical results were excellent in 58% of patients and good in 17% of patients. Radiologic results were excellent in 50% of patients and good in 17% of patients. Radiologically, based on the fracture gap postoperatively, 8 (66%) patients showed anatomic reduction, 2 (17%) showed good reduction, and 2 (17%) showed poor reduction. The study confirms that this method of reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum.

  5. Management of periprosthetic acetabular fractures in elderly patients--a minimally invasive approach.

    Science.gov (United States)

    Zettl, Ralph; Eschbach, Daphne; Ruchholtz, Steffen

    2015-09-01

    Periprosthetic acetabular fractures are rare and in the current literature largely underreported. The management is reported to be difficult. Treatment varies from non-operative to open reduction and internal fixation up to revision of the acetabular components. A prospective consecutive case series in acetabular fractures was performed in a level 1 trauma centre. All patients with pre-existing total hip replacement were followed up for one year. Perioperative data, complications, radiological results, functional outcome and quality of life were measured. Eight (15%) of 53 patients who were included in the study underwent total hip arthroplasty before and had stable implants at time of fracture. Mean age of the patients was 83 years. All of them were female. Mean operative time was 85 minutes. There were no soft tissue complications like infection or nerve damage in the post-operative course. No revision was needed. Two patients died in between the follow up. The Harris hip score was a mean of 77, with quality of life comparable to persons in the same age. Minimally invasive reconstruction of the anterior column is a viable method to conserve stable acetabular components in this type of fracture. Short operation time and limited incisions are the most conclusive advantages.

  6. Functional outcome of the surgical management of acute acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Naseem Munshi; Asad Abbas; Mohamed Amirali Gulamhussein; Ghulam Mehboob; Rija Aitzaz Qureshi

    2015-01-01

    Objective:To assess the functional outcome of early surgical management of displaced acetabular fractures and the complications associated with the procedure. Methods: This is a case series study and data was collected using specialized performance. The study included 75 patients and the sampling technique was a non-probability purposive type. Patients presenting with close displaced acetabular fractures of more than 2 mm within 10 days of injury were included. However, elderly patients presenting after 10 days of injury, with evidence of local infection, severe osteoporotic bone and co-morbid such as chronic obstructive pulmonary disease were not included in the study. New acetabular scoring system was used for assessing outcome of patients. Results:A total of 75 patients were operated on. Union was achieved in anatomical position in 66 (88%) patients and in malposition in 9 (12%) patients. Excellent results were obtained in 18 (24%) patients, good results in 41 (54.6%), fair results in 12 (16%), and poor results in 4 (5.4%) patients. Postoperative complications included infection [5 (6.7%)], heterotropic ossification [3 (4%)], sciatic nerve injury [10 (13.3%)], avascular necrosis [3 (4%)] patients. Conclusions: Patients with displaced acetabular fractures should be referred to specialised centres. Early surgical intervention and experienced management is a prime factor in achieving good results.

  7. Can experts in acetabular fracture care determine hip stability after posterior wall fractures using plain radiographs and computed tomography?

    Science.gov (United States)

    Davis, Adrian T; Moed, Berton R

    2013-10-01

    % (16/28) and 47% (15/32), respectively. Orthopedic traumatologists expert in acetabular fracture care cannot adequately determine hip stability status for fractures involving 20%-50% of the posterior wall using plain radiographs, computed tomography, and the patient's hip dislocation status. If the diagnosis is in doubt, open reduction and internal fixation clearly is the much safer course than nonoperative treatment. Examination under anesthesia should be considered as a helpful addition to the surgeon's armamentarium in determining hip stability status for these fractures.

  8. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  9. Stress fracture in acetabular roof due to motocross: case report

    Directory of Open Access Journals (Sweden)

    Alexandre de Paiva Luciano

    2016-06-01

    Full Text Available ABSTRACT One of the first steps to be taken in order to reduce sports injuries such as stress fractures is to have in-depth knowledge of the nature and extent of these pathological conditions. We present a case report of a stress fracture of the acetabular roof caused through motocross. This type of case is considered rare in the literature. The description of the clinical case is as follows. The patient was a 27-year-old male who started to have medical follow-up because of uncharacteristic pain in his left hip, which was concentrated mainly in the inguinal region of the left hip during motocross practice. After clinical investigation and complementary tests, he was diagnosed with a stress fracture of the acetabular roof.

  10. Stress fracture in acetabular roof due to motocross: case report.

    Science.gov (United States)

    de Paiva Luciano, Alexandre; Filho, Nelson Franco

    2016-01-01

    One of the first steps to be taken in order to reduce sports injuries such as stress fractures is to have in-depth knowledge of the nature and extent of these pathological conditions. We present a case report of a stress fracture of the acetabular roof caused through motocross. This type of case is considered rare in the literature. The description of the clinical case is as follows. The patient was a 27-year-old male who started to have medical follow-up because of uncharacteristic pain in his left hip, which was concentrated mainly in the inguinal region of the left hip during motocross practice. After clinical investigation and complementary tests, he was diagnosed with a stress fracture of the acetabular roof.

  11. Atypical periprosthetic acetabular fracture in long-term alendronate therapy.

    Science.gov (United States)

    Marongiu, Giuseppe; Capone, Antonio

    2016-01-01

    Bisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing.

  12. Atypical periprosthetic acetabular fracture in long-term alendronate therapy

    Science.gov (United States)

    Marongiu, Giuseppe; Capone, Antonio

    2016-01-01

    Summary Bisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing. PMID:28228784

  13. Ipsilateral Traumatic Posterior Hip Dislocation, Posterior Wall and Transverse Acetabular Fracture with Trochanteric Fracture in an adult: Report of First Case

    Directory of Open Access Journals (Sweden)

    Skand Sinha

    2013-10-01

    Full Text Available Introduction: Posterior dislocation of the hip joint with associated acetabular and intertrochanteric fracture is a complex injury. Early recognition, prompt and stable reduction is needed of successful outcome. Case Report: 45 year old male patient presented with posterior dislocation of the hip with transverse fracture with posterior wall fracture of acetabulam and intertrochanteric fracture on the ipsilateral side. The complex fracture geometry was confirmed by CT scan. The patient was successfully managed by open reduction and internal fixation of intertrochanteric fracture was achieved with dynamic hip screw (DHS plate fixation followed by fixation of acetabular fracture with reconstruction plate. Conclusion: Hip dislocation combined with acetabular fracture is an uncommon injury; this article presents a unique case of posterior wall and transverse fractures of ipsilateral acetabulum with intertrochanteric fracture in a patient who sustained traumatic posterior hip dislocation. Early surgical intervention is important for satisfactory outcomes of such complex fracture-dislocation injuries. Keywords: Hip dislocation; acetabular fractures; intertrochanteric fracture; operative treatment.

  14. Multiplanar and 3D CT of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Haveri, M.; Suramo, I.; Laehde, S. [Oulu Univ., Dept. of Diagnostic Radiology (Finland); Junila, J. [Oulu Univ., Dept. of Orthopaedic Surgery (Finland)

    1998-05-01

    Purpose: To establish a standard protocol for the multiplanar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data on acetabular fractures, and to assess the usefulness of these reformats. Material and Methods: Acetabular fractures in 15 patients were imaged by means of plain radiographs, transaxial CT, MPR reformats, and SSD reformats. Results: The classification of the acetabular fracture was revised in 7/15 cases when the transaxial CT images were read after the plain radiographs. Although the MPR and SSD reformats did not alter the classification, they did add to the degree of confidence in the diagnosis in 9/15 cases. In 2 patients, the MPR and SSD reformats indicated operative instead of conservative treatment. In the MPR reformats, the following views were considered essential in all cases: (a) along the anterior column; (b) along the posterior column; and (c) along both columns and the inferior ramus. In the SSD reformats, the following views were considered essential in all cases: (d) the latero-caudal en face view into the acetabulum; and 180 opposite to this, (e) the medio-cranial view (facing the quadrilateral plate). In 10/15 cases, these views were all that was needed for classification. It was, however, essential to remove the femur from the images before reconstructing the SSD views. Conclusion: Complex acetabular fractures with displacement should be evaluated by means of transaxial CT and additional MPR and SSD reformats. The use of appropriate standard MPR and SSD views shortens the time required to produce the reformats and thereby maximizes the benefit gained. (orig.).

  15. An interactive surgical planning tool for acetabular fractures: initial results

    Directory of Open Access Journals (Sweden)

    Marincek Borut

    2010-08-01

    Full Text Available Abstract Background Acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment. Methods 7 patients (5 male and 2 female; median age 53 y (25 to 92 y with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture. The workflow included following steps: (1 Formation of a patient-specific bone model from preoperative computed tomography scans, (2 interactive virtual fracture reduction with visuo-haptic feedback, (3 virtual fracture fixation using common osteosynthesis implants and (4 measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available. The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition. Results Preoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach

  16. Complications of acetabular fracture surgery in morbidly obese patients.

    Science.gov (United States)

    Porter, Scott E; Russell, George V; Dews, Robert C; Qin, Zhen; Woodall, James; Graves, Matthew L

    2008-10-01

    To compare the early complications with operative treatment of acetabular fractures in morbidly obese (body mass index >or=40) patients when compared with all other patients. Retrospective review. University medical center. Four hundred thirty-five consecutive patients with acetabular fractures operatively treated by a single surgeon. Forty-one of these patients were morbidly obese (group 1) and were compared with the remaining patients (group 2). Group 2, therefore, included patients who were clinically overweight and obese. Operative repair of acetabular fracture. Outcome variables included patient positioning time, total operative time, estimated intraoperative blood loss, length of hospital stay, perioperative complications, and late complications. The average total operative time was 293 minutes for group 1 and 250 minutes (P = 0.008) for group 2. The hospital stay for group 1 averaged 26 days versus 15 days in group 2 (P operative times, and greater estimated intraoperative blood loss. The majority of complications were related primarily to wound healing problems and successfully controlled with aggressive approach to surgical debridement.

  17. Paediatric acetabular fractures. Data from the German Pelvic Trauma Registry Initiative

    DEFF Research Database (Denmark)

    von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C

    2012-01-01

    and treatment of acetabular fractures in children (fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent......The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome......%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents....

  18. Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

    Science.gov (United States)

    Scheinfeld, Meir H; Dym, Akiva A; Spektor, Michael; Avery, Laura L; Dym, R Joshua; Amanatullah, Derek F

    2015-01-01

    Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

  19. CHOICE OF SURGICAL APPROACH FOR ACETABULAR COMPONENT’S IMPLANTATION USING CURRENT CLASSIFICATION FOR ARTHRITIS FOLLOWING ACETABULAR FRACTURE

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available Degenerative-dystrophic changes in hip after treatment of acetabular fracture, over the time, develops about in 60% of affected people. In such cases, total hip replacement is used. Existing classifications (for example AO or Letournel are good for fracture treatment, but not for arthritis following acetabular fracture. The group of patients, with post traumatic arthritis, is heterogeneous with severity of post traumatic anatomic changes. Basis for surgical approach, could be current classification for post traumatic changes – taking into account features of anatomic functional changes in hip and the bone defects of acetabulum. In this article is demonstrated X-ray and clinical basing for current classification.

  20. Navigated percutaneous screw fixation of a periprosthetic acetabular fracture.

    Science.gov (United States)

    Gras, Florian; Marintschev, Ivan; Klos, Kajetan; Fujak, Albert; Mückley, Thomas; Hofmann, Gunther O

    2010-10-01

    Periprosthetic fractures are severe complications of total hip arthroplasty with increasing incidence. Most fractures are localized around the femoral component of prosthesis, whereas periacetabular fractures are rare and their management is difficult. In most cases, an operative procedure with revision and exchange of the acetabular cup is necessary. The approaches are demanding and an increased risk of complications is reported. We present the case of a female patient with a cementless total hip arthroplasty due to severe arthritis, suffering of an infratectal transverse periprosthetic fracture. After an initial conservative treatment attempt, we performed a minimally invasive screw fixation using navigated 2-dimensional fluoroscopic guidance. In this report, the literature for treatment recommendations is reviewed and the chosen navigation technique discussed. Copyright © 2010. Published by Elsevier Inc.

  1. Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital

    Science.gov (United States)

    Taufiq, Intikhab; Najjad, Muhammad Kazim Raheem; Khan, Naveed; Zia, Osama Bin

    2016-01-01

    Purpose Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. Materials and Methods Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. Results There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. Conclusion Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome. PMID:28097111

  2. Computed tomography in pelvic and acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Born, H.; Schmidt, C.

    1988-06-01

    In a retrospective study we analyzed the results of 127 patients, who were examined not only by means of conventional radiography but also by means of computed tomography after a trauma of the pelvic. Our investigations were based upon such patients, to whom a definite diagnostic procedure of plain radiography had been performed. Therefore all polytraumatized patients were inapplicable. They were only examined by computed tomography because of other more important accompanying injuries of other body regions. We compared the results of 127 patients with pelvic trauma. The results of the CT were in accordance with the results of the plain radiography for 103 patients. The results of the CT concerning the availability and the localization of the fractures were basically coincident with the plain radiography for 22 patients, but the CT showed a higher degree of trauma and additional intraarticular fragments. Two isolated lesions of the sacroiliac joint could not be recognized by both methods. They could only be diagnosed by bone scintigraphy on the third day after trauma.

  3. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    Institute of Scientific and Technical Information of China (English)

    De-Yong Huang; Liang Zhang; Yi-Xin Zhou; Chun-Yu Zhang; Hui Xu; Yong Huang

    2016-01-01

    Background:Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures,and good results have been reported with the use of these cups;however,the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear.This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures.Methods:A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012.Among these patients,two were lost to follow-up.Therefore,39 patients (39 hips) were finally included in this study.The Harris hip score before and after the surgery,satisfaction level of the patients,and radiographic results were assessed.Results:The mean Harris hip score increased from 34 (range,8-52) before surgery to 91 (range,22-100) at the latest follow-up examination (P < 0.001).The results were excellent for 28 hips,good for six,fair for three,and poor for two.Among the 39 patients,25 (64%) and 10 (26%) were very satisfied and somewhat satisfied,respectively.All cups were found to be fully incorporated,and no evidence of cup migration or periacetabular osteolysis was noted.Conclusions:Despite the technically demanding nature of the procedure,THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures.

  4. Simultaneous periprosthetic acetabular fracture and contralateral B-type compression injury of the pelvic ring: a case report of a rare injury combination.

    Science.gov (United States)

    Märdian, Sven; Schaser, Klaus-Dieter; Wichlas, Florian; Schwabe, Philipp

    2013-01-01

    The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma.

  5. Simultaneous Periprosthetic Acetabular Fracture and Contralateral B-Type Compression Injury of the Pelvic Ring: A Case Report of a Rare Injury Combination

    Directory of Open Access Journals (Sweden)

    Sven Märdian

    2013-01-01

    Full Text Available The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma.

  6. Simultaneous Periprosthetic Acetabular Fracture and Contralateral B-Type Compression Injury of the Pelvic Ring: A Case Report of a Rare Injury Combination

    Science.gov (United States)

    Märdian, Sven; Wichlas, Florian

    2013-01-01

    The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma. PMID:24222878

  7. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  8. Value of 3-D CT in classifying acetabular fractures during orthopedic residency training.

    Science.gov (United States)

    Garrett, Jeffrey; Halvorson, Jason; Carroll, Eben; Webb, Lawrence X

    2012-05-01

    The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.

  9. Surgical Stabilization of Pelvic and Acetabular Fractures: A Review on the Determinants of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    SS Sathappan

    2010-03-01

    Full Text Available AIM: Pelvic and acetabular fractures are associated with high-energy trauma. The aim of this study was to identify factors that are associated with specific clinical outcomes following treatment for these fractures. METHODS: A consecutive series of 30 patients who had surgical intervention for either pelvic or acetabular fractures formed the sample for this study. Clinical variables reviewed were: age, associated injuries, number of surgical procedures, time to surgery and post-operative complications. Clinical outcomes were assessed using Matta’s grading of post- operative fracture reduction alignment, and functional outcomes were graded using D'Aubigne & Postel’s Hip scoring system. RESULTS: Study subjects included twelve pelvic fractures and eighteen acetabular fractures. Patients older than 50 years of age had poorer hip scores despite surgery. Earlier fracture fixation (within five days was associated with better hip scores. Patients with acetabular fractures generally had better functional outcomes than patients with pelvic fractures (mean hip score 15.0 vs. 13.5. Closer anatomical reduction of acetabular fractures was associated with better functional outcome. CONCLUSION: Improved clinical outcomes are associated with younger age, fewer concomitant injuries, shorter time interval to surgery and more closely approximated anatomical fracture reduction.

  10. Simultaneous bilateral shoulder and bilateral central acetabular fracture dislocation: What to do?

    Institute of Scientific and Technical Information of China (English)

    Hardik Sheth; Abhijeet Ashok Salunke; Ramesh Panchal; Jimmy Chokshi; G.I.Nambi; Saranjeet Singh; Amit Patel

    2016-01-01

    Musculoskeletal injuries following seizures have a high morbidity and mortality.These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure.Present study highlights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures.Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery.Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.

  11. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Directory of Open Access Journals (Sweden)

    Espandar R

    2012-01-01

    Full Text Available Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS, Harris hip score (HHS, force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.Results : The mean HHS was 82.5 (55-95. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

  12. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    Energy Technology Data Exchange (ETDEWEB)

    Williams, T.R. [Portsmouth Naval Medical Center, Radiology Department, Charette Health Care Center, Portsmouth, VA (United States); Puckett, M.L.; Shin, A.Y.; Gorman, J.D. [Naval Medical Center San Diego, Radiology Department, San Diego, CA (United States); Denison, G. [US Naval Hospital Guam (United States)

    2002-05-01

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  13. Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty.

    Science.gov (United States)

    Resch, H; Krappinger, D; Moroder, P; Auffarth, A; Blauth, M; Becker, J

    2017-04-01

    Fractures of the acetabulum in younger patients are commonly treated by open reduction and internal fixation. For elderly patients, stable primary total hip arthroplasty with the advantage of immediate postoperative mobilization might be the adequate treatment. For this purpose, a sufficiently stable fixation of the acetabular component is required. Between August 2009 and 2014, 30 cases were reported in which all patients underwent total hip arthroplasty additionally to a customized implant designed as an antiprotrusion cage. Inclusion criteria were an acetabular fracture with or without a previous hemiarthroplasty, age above 65 years, and pre-injury mobility dependent on a walking frame at the most. The median age was 79.9 years (65-92), and of 30 fractures, 25 were primary acetabular fractures (83%), four periprosthetic acetabular fractures (14%), and one non-union after a failed ORIF (3%). The average time from injury to surgery was 9.4 days (3-23) and 295 days for the non-union case. Mean time of surgery was 154.4 min (range 100 to 303). In 21 cases (70%), mobilization with full weight bearing was possible within the first 10 days. Six patients died before the follow-up examination 3 and 6 months after surgery, while 24 patients underwent radiologic examination showing consolidated fractures in bi-plane radiographs. In 9 patients, additional CT scan was performed which confirmed the radiographical results. 13 had regained their pre-injury level of mobility including the non-union case. Only one patient did not regain independent mobility. Four complications were recognized with necessary surgical revision (one prosthetic head dislocation, one pelvic cement leakage, one femoral shaft fracture, and one infected hematoma). The presented cage provides the possibility of early mobilization with full weight bearing which represents a valuable addition to the treatment spectrum in this challenging patient group.

  14. Stabilization of an acetabular fracture with cables for acute total hip arthroplasty.

    Science.gov (United States)

    Mears, D C; Shirahama, M

    1998-01-01

    A critical stage of total hip arthroplasty for an acute acetabular fracture where extensive comminution, impaction, and osteopenia thwart the application of conventional open or closed methods, especially in the elderly, is stable fixation of the acetabulum. The use of 2-mm braided cables permits effective immobilization of the fracture for use in conjunction with a hybrid arthroplasty. The method is consistent with the use of a conventional arthroplastic incision and is suitable for other applications including the fixation of periprosthetic fractures, bulk allografts, and conventional acetabular fractures.

  15. [Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].

    Science.gov (United States)

    Mai, J G; Gu, C; Lin, X Z; Li, T; Huang, W Q; Wang, H; Tan, X Y; Lin, H; Wang, Y M; Yang, Y Q; Jin, D D; Fan, S C

    2017-03-01

    Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all

  16. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist.

    Science.gov (United States)

    Molière, S; Dosch, J-C; Bierry, G

    2016-01-01

    Pelvic ring fractures when caused by trauma, either violent or in demineralized bone, generally consist of injuries in both the anterior (pubic symphysis and rami) and posterior (iliac wing, sacrum, sacroiliac joint) portions. Injury classifications are based on injury mechanism and pelvic stability, and are used to determine treatment. Acetabular fractures, associated or not to pelvic ring disruption, are classified on the basis of fracture line, into elementary fractures of the acetabular walls, columns and roof, and into complex fractures. Fractures of the proximal end of the femur occur often on demineralized bone following low-energy trauma. The fractures are categorized by anatomic location (neck, trochanter and subtrochanteric region) and degree of displacement. These variables determine the risk of osteonecrosis of the femoral head, which is the main complication of such fractures.

  17. Displaced Anterior Column Acetabular Fracture: Closed Reduction and Percutaneous CT-Navigated Fixation

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, R.W.; Staedele, H.; Messmer, P.; Regazzoni, P.; Steinbrich, W.; Gross, T. [Univ. Hospital of Basel (Switzerland). Dept. of Radiology

    2004-10-01

    The purpose of this study is to demonstrate the feasibility of computer-tomography-navigated closed reduction and percutaneous fixation (CRPF) in a patient with an externally rotated left acetabular fracture. After a follow-up of 18 months the patient was pain-free and had a normal range of motion in both hip joints. Radiologically, the fracture was fully consolidated, remodelled, and there were no signs of osteoarthritis. To our knowledge, CT-navigated CRPF of a rotated acetabular fracture has not been reported before. Further studies regarding the feasibility of the method are warranted(CRPF)

  18. Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Theodorou, S.J. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)]|[Department of Clinical Radiology, University of Manchester, Manchester (United Kingdom); Theodorou, D.J. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)]. E-mail: daphne_theodorou@hotmail.com; Schweitzer, M.E. [Department of Radiology, New York University Hospital for Joint Diseases, NY (United States); Kakitsubata, Y. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Resnick, D. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)

    2006-02-15

    AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy.

  19. Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture.

    Science.gov (United States)

    Jo, Woo Lam; Lee, Woo Suk; Chae, Dong Sik; Yang, Ick Hwan; Lee, Kyoung Min; Koo, Kyung Hoi

    2016-10-01

    Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.

  20. Long-term survival and risk factors for failure of the native hip joint after operatively treated displaced acetabular fractures.

    Science.gov (United States)

    Clarke-Jenssen, J; Røise, O; Storeggen, S A Ø; Madsen, J E

    2017-06-01

    Our aim in this study was to describe the long-term survival of the native hip joint after open reduction and internal fixation of a displaced fracture of the acetabulum. We also present long-term clinical outcomes and risk factors associated with a poor outcome. A total of 285 patients underwent surgery for a displaced acetabular fracture between 1993 and 2005. For the survival analysis 253 were included, there were 197 men and 56 women with a mean age of 42 years (12 to 78). The mean follow-up of 11 years (1 to 20) was identified from our pelvic fracture registry. There were 99 elementary and 154 associated fracture types. For the long-term clinical follow-up, 192 patients with complete data were included. Their mean age was 40 years (13 to 78) with a mean follow-up of 12 years (5 to 20). Injury to the femoral head and acetabular impaction were assessed with CT scans and patients with an ipsilateral fracture of the femoral head were excluded. A total of 36 patients underwent total hip arthroplasty (THA). The overall ten-year survival of the hip joint was 86% (95% confidence interval (CI) 81% to 90%) and the 20-year survival was 82% (95% CI 76% to 87%). Injury to the femoral head and acetabular impaction were the strongest predictors of failure, with the long-term survival rate falling towards 50% in these patients. The survival fell to 0% at three years when both these risk factors were present in patients aged > 60 years. The long-term survival of the native hip joint after acetabular fractures was good, but the presence of injury to the femoral head and acetabular impaction proved to be strong predictors of failure, especially in patients aged > 60 years. These patients may be better treated with a combination of open reduction and internal fixation and primary arthroplasty. Cite this article: Bone Joint J 2017;99-B:834-40. ©2017 The British Editorial Society of Bone & Joint Surgery.

  1. Direct hip joint distraction during acetabular fracture surgery using the AO universal manipulator.

    Science.gov (United States)

    Calafi, L Afshin; Routt, M L Chip

    2010-02-01

    Certain acetabular fractures may necessitate distraction of the hip joint for removal of intra-articular debris and assessment of reduction. Distraction can be accomplished by manual traction, using a traction table or an AO universal manipulator (UM). The UM is a relatively simple and an inexpensive device that can provide focal distraction in a controlled manner without the risks associated with the use of a traction table. We describe a technique using the UM for hip joint distraction during acetabular fracture surgery through a Kocher-Langenbeck surgical exposure.

  2. Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

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    A. Ortega-Briones

    2017-01-01

    Full Text Available Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d’Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up. No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d’Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

  3. Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

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    Serafino Carta

    2017-01-01

    Full Text Available Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification were treated. The patients were divided into two groups. The total hip arthoplasty (THA group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12 health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

  4. ROLE OF COMPUTED TOMOGRAPHY AND 3D RECONSTRUCTIONS IN PELVIC RIM AND ACETABULAR FRACTURES

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    Somasekhar

    2015-03-01

    Full Text Available To determine the role of computed tomography and 3D Reconstructions in classification of pelvic rim and acetabular fractures and assessing possible changes in fracture classification . We collected retrospective information in a period of 18 months in our institution , of patients with pelvic injuries considering --- demographic data , radiological examination performed and the moment when it was performed , fracture classification and management . In 12 cases ( 54% there were isolated pelvic rim fr actures and 7 cases of isolated acetabular fractures ( 32% and 3 cases ( 14% involving both . After the CT scan was obtained , the initial classification was changed in five cases ( 22 . 7% . Tridimensional CT based modeling is very helpful in the classificati on of pelvic fractures and is a complement of the plain X - ray .

  5. Treatment of periprosthetic acetabular fractures after previous hemi- or total hip arthroplasty: Introduction of a new implant.

    Science.gov (United States)

    Resch, H; Krappinger, D; Moroder, P; Blauth, M; Becker, J

    2016-04-01

    Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization. Acetabular fracture with or without previous hemi- or total hip arthroplasty. Non-displaced acetabular fractures. Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components. Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended. Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery. In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.

  6. Bone impaction grafting and a cemented cup after acetabular fracture at 3-18 years.

    NARCIS (Netherlands)

    Schreurs, B.W.; Zengerink, M.; Welten, M.L.M.; Kampen, A. van; Slooff, T.J.J.H.

    2005-01-01

    The outcome of total hip arthroplasty after acetabular fracture is compromised. We studied if the bone impaction grafting technique could provide long-term prosthesis survival in deformed and irregular acetabula. We studied 20 hips in 20 patients (mean age, 53.3 years; range, 35-75 years) that were

  7. Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools.

    Science.gov (United States)

    Manganaro, Matthew S; Morag, Yoav; Weadock, William J; Yablon, Corrie M; Gaetke-Udager, Kara; Stein, Erica B

    2017-01-01

    Acetabular fractures are frequently encountered in some clinical practices, and the precise classification of these fractures greatly influences treatments and outcomes. The authors identified the need for an educational aid when teaching acetabular fracture classifications, given the complex spatial anatomy and the nonintuitive classification system that is commonly used. Three-dimensional ( 3D three-dimensional ) printing is an evolving technique that has applications as an educational aid, providing the student with a tangible object to interact with and learn from. In this article, the authors review their experience creating 3D three-dimensional printed models of the hip for educational purposes. Their goal was to create 3D three-dimensional printed models for use as educational aids when teaching acetabular fracture classifications. Complex cases involving a combination of fracture types, subtle nondisplaced fractures, and/or fractures with associated osteopenia or artifacts were excluded. The selected computed tomographic (CT) scans were loaded into a medical 3D three-dimensional volume-rendering program, and a 3D three-dimensional volumetric model was created. Standard Tessellation Language ( STL Standard Tessellation Language ) files were then exported to STL Standard Tessellation Language model-editing software and edited to retain only the involved hemipelvis. In some cases, the proximal femur and ipsilateral hemisacrum may be included to emphasize hip alignment or disruption of the force transfer. Displaced fracture fragments can be printed as separate segments or a single unit after the addition of struts. Printing was performed by using an additive manufacturing principle, with approximately 36-48 hours needed for printing, postprocessing, and drying. The cost to print a 1:1 scale model was approximately $100-$200, depending on the amount of plastic material used. These models can then be painted according to the two-column theory regarding acetabular

  8. Minimum ten-year follow-up of acetabular fracture fixation from the Irish tertiary referral centre.

    LENUS (Irish Health Repository)

    Magill, Paul

    2012-04-01

    Successful outcome from acetabular fracture fixation is multi-factorial. Long-term results are not frequently reported. Pooling such data from high output centres will help progress acetabular fixation. This paper presents the first ten-year data from the Irish tertiary referral centre.

  9. Long-term outcome of operative management of delayed acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    ZHU Shi-wen; SUN Xu; YANG Ming-hui; LI Yu-neng; ZHAO Chun-peng; WU Hong-hua; CAO Qi-yong

    2013-01-01

    Background Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma.The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.Methods The operative approaches,procedures,results,and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital.Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.Results Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years).Excellent functional results were observed in 10 hip joints,good results in 40,fair results in 11,and poor results in nine.The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head,a time beyond 42 days from injury to operative management,and dislocation of femoral head during the injury.Some of the problems,which were observed included postoperative infection in two hips,iatrogenic sciatic nerve injury in eight hips,traumatic arthritis in 15 hips,heterotopic ossification in 17 hips,and necrosis of the femoral head in six hips.Conclusion A careful selection of operative indications for delayed acetabular fractures in combination with a proper ooerative aPProach and appropriate reduction and fixation could guarantee relatively good results.

  10. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    Science.gov (United States)

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

    2013-12-01

    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p fractures toward improving clinical prognoses.

  11. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

    Science.gov (United States)

    Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

    2008-03-01

    Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

  12. Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature.

    Science.gov (United States)

    Dodd, Andrew; Osterhoff, Georg; Guy, Pierre; Lefaivre, Kelly A

    2016-06-01

    To report methods of measurement of radiographic displacement and radiographic outcomes in acetabular fractures described in the literature. 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 (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. 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. 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. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  13. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

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    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  14. Spontaneous acetabular periprosthetic fracture in a patient continuously having zoledronic acid.

    Science.gov (United States)

    Tantavisut, Saran; Tanavalee, Aree; Thanakit, Voranuch; Ngarmukos, Srihatach; Wilairatana, Vajara; Wangroongsub, Yongsak

    2014-09-01

    Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate.

  15. Spontaneous Acetabular Periprosthetic Fracture in a Patient Continuously Having Zoledronic Acid

    Science.gov (United States)

    Tantavisut, Saran; Thanakit, Voranuch; Ngarmukos, Srihatach; Wilairatana, Vajara; Wangroongsub, Yongsak

    2014-01-01

    Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate. PMID:25177464

  16. Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof

    Energy Technology Data Exchange (ETDEWEB)

    Grangier, C.; Garcia, J.; Howarth, N.R. [Departement de Radiologie, Division de Radiodiagnostic, Hopital Cantonal Universitaire de Geneve, CH-1211 Geneva 14 (Switzerland); May, M. [Departement de Radiologie, Division de Radio-Oncologie, Hopital Cantonal Universitaire de Geneve, CH-1211 Geneva 14 (Switzerland); Rossier, P. [Departement de Radiologie, Division de Medecine Nucleaire, Hopital Cantonal Universitaire de Geneve, CH-1211 Geneva 14 (Switzerland)

    1997-09-01

    Twenty patients with sacral and acetabular roof insufficiency fractures were reviewed retrospectively. There were 16 women (80%) and 4 males (age range 48-86 years, excluding an 8-year-old boy). Thirteen patients had a known tumour, and nine had received pelvic irradiation. All patients, except one who was asymptomatic, presented with low back or hip pain. In patients with a known tumor, metastases were suspected. Plain radiography (20), bone scintigrams (16), MR examinations (20), and bone densitometry (14) were performed. Nine patients also each had a CT scan. Results and conclusions. In three cases the CT scan performed 10-25 days after onset of symptoms was interpreted as normal. MR examination performed a few days after the CT scan showed in each of these three patients a fracture line with a band of edema. Scintigraphy was very sensitive, but the H-shaped pattern of sacral uptake, specific for an insufficiency fracture, was detected in only three of 16 cases. The earliest MR sign was medullary edema, seen as early as 18 days after the onset of symptoms. On spin echo (SE) T1-weighted images (T1WI), the hypointense signal of edema could mask a fracture line. On SE T2WI the fracture line could be detected within the hyperintense edema (10 of 17 patients with examinations including SE T2WI). However, in four patients a fracture of the sacrum was not seen on T2WI, these having been obtained in the axial plane. For this reason, intravenous gadolinium was injected, revealing a fracture line in 12 of 14 examinations, or fat suppression sequences were performed, revealing a fracture line in five of five cases. The total number of fractures detected was 17 [15 fractures of the sacrum (bilateral in 10 cases) and two of the acetabular roof]. At a later stage, the edema resolved and the fracture was clearly seen. The two cases of fracture of the acetabular roof were easily recognized at MRI, particularly in the sagittal plane. (orig./AJ). With 5 figs., 2 tabs.

  17. Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture.

    Science.gov (United States)

    Salih, S; Currall, V A; Ward, A J; Chesser, T J S

    2009-11-01

    Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial.

  18. A Modified Stoppa (Technique Approach for Treatment of Pediatric Acetabular Fractures

    Directory of Open Access Journals (Sweden)

    Mehmet Elmadag

    2013-01-01

    Full Text Available Pediatric acetabular fractures are rare, and anterior column fractures are even rarer. Generally, conservative treatment is applied. If there is displacement of more than 2 mm or findings of instability or fragments within the joint, then surgical treatment is applied. Anterior and posterior approaches may be used in surgical treatment. With pediatric patients, even greater care should be taken in the choice of surgery to be performed according to the fracture pattern to avoid postoperative triradiate cartilage damage. Therefore, minimally invasive surgery is more appropriate. We herein present a case of an acetabulum anterior column posterior hemitransverse fracture following a traffic accident, which was treated surgically using a modified Stoppa (technique approach.

  19. The choice of surgical approach in the treatment of two-column acetabular fractures

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    A. A. Grin’

    2014-01-01

    Full Text Available The study aimed a comparison of treatment results in patients with two-column acetabular fractures (AO, Type C when using different operative approaches: ilioinguinal (12, Y-type (16 and a combination of posterior-lateral and ilioinguinal approaches (3. Surgical treatment was carried out not later than 3 weeks after injury. The joint congruence was reached in all the cases. The operative time, blood loss, complications, long-term results of treatment were evaluated. The study showed the effectiveness of ilioinguinal approach in case of the simple two-column fractures. When treating patients with complex fractures of the anterior column, the authors found no significant difference in operative time and intraoperative blood loss between the cases of V-type and combined approaches. In patients with two-column fractures accompanied with posterior wall lesion the time of surgery was significantly lower when using the Y-shaped approach as against the two different approaches.

  20. Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure

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    Reza Firoozabadi

    2015-09-01

    Full Text Available Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87 of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36 of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28 compared to 16 mm (11-22 in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.

  1. A Feasibility Study into the Use of Three-Dimensional Printer Modelling in Acetabular Fracture Surgery

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    A. W. Yu

    2015-01-01

    Full Text Available There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient’s unique anatomy can only lead to improved outcomes.

  2. A feasibility study into the use of three-dimensional printer modelling in acetabular fracture surgery.

    Science.gov (United States)

    Yu, A W; Duncan, J M; Daurka, J S; Lewis, A; Cobb, J

    2015-01-01

    There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient's unique anatomy can only lead to improved outcomes.

  3. Research on Transverse Acetabular Fracture Fixation Using Different Plate Attachment Methods

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    Gediminas Gaidulis

    2015-03-01

    Full Text Available The article deals with the problem of transverse acetabular fracture fixation using different plate attachment methods. A 3D model of pelvis and hip joint structure was created and the design of three different fixation plates using SolidWorks was made. The plates were fixed at distances of 10, 20 and 30 mm from the acetabulum. The model was meshed into finite elements, a static external load of 2500 N was added and the analysis of stress distribution in plates and fracture displacement was performed. The obtained results showed that fracture displacement was quite similar in all fixation methods. However, the maximal stress in the nearest from the acetabulum plate was higher than yield strength. Thus, this placement is not eligible. The plate fixed at a distance of 30 mm from the acetabulum appeared the most suitable because of the smallest and symmetrical stress distribution in the plate.

  4. [Reconstruction of complex acetabular fractures using the extensile kocher-langenbeck approach (modified maryland approach).].

    Science.gov (United States)

    Braun, W; Mayr, E; Rüter, A

    1997-06-01

    Approach to the essential bony parts of the pelvis which can be adapted to the fracture pattern and which causes minimal soft tissue damage. It allows exposure of the posterior and anterior columns and the roof of the acetabulum. Complex acetabular fractures such as 2-column fractures, T-fractures, displaced transverse fractures with posterior rim fragment, fractures of 1 column. Fractures which can be approached through smaller incisions, preexisting lesions of the superior gluteal artery, arterial occlusive diseases, particularly of the pelvis. Radiographs of the pelvis in anterior-posterior and two oblique news. Special radiographs and CT. Lateral decubitus with free draping of the leg. Endotracheal anaesthesia. Cell saver optional. T-shaped skin incision and gradual extension of the Kocher-Langenbeck approach depending on the fracture pattern. First extensile step: Transverse division of the fascia lata and osteotomy of the greater trochanter. Second extensile step: Osteotomy of part of the iliac crest and exposure of the outer and inner cortex of the iliac wing. Operated leg rests in a foam padded splint. Careful wound drainage, routine low dose radiation or indomethacin to prevent heterotopic ossification. CPM starting the 2nd postoperative day, mobilization starting the 2nd or 3rd day with partial weight bearing of 15 kg. Full weight bearing depends on fracture type and consolidation. Delayed wound healing with risk of infection. Injury to the superior gluteal artery with danger of necrosis of the abductor muscles. Injury through stretching of the sciatic nerve. Injury of the lateral femorocutaneous nerve. Seven patients with complex acetabular fractures were operated between June 1993 and January 1994. Use of the 1st extensile step was sufficient in 3 patients and 3 times all 4 steps were used. Postoperative necrosis of fatty tissue necessitated 2 revisions. All fractures consolidated. During the follow-up examination 1 case of heterotopic ossification was

  5. The Association of Femoral Neck Stress Fractures with Femoral Acetabular Impingement

    Science.gov (United States)

    Safran, Marc R.; Goldin, Michael; Anderson, Christian; Fredericson, Michael; Stevens, Kathryn J.

    2013-01-01

    Objectives: To determine if there is an increased incidence of femoral acetabular impingement (FAI) in patients presenting with stress fractures of the femoral neck. Methods: After IRB approval, the imaging studies of 25 athletes (22 females, 3 males, mean age 26, range 19 - 39 years) with femoral neck stress injuries were assessed for the presence of features suggesting FAI, including acetabular retroversion, coxa profunda, abnormal femoral head-neck junction, fibrocystic change, os acetabulae, labral tear and chondral injury. All subjects had to have an adequate AP Pelvis radiograph, a lateral radiograph of the affected hip, and an MRI of the affected hip. The alpha angle, anterior offset ratio, and center to edge (CE) angle were measured on radiographs. The grade of stress injury was determined on MR images. All images and measurements were made by a musculoskeletal fellowship trained radiologist, a fellowship trained orthopaedic surgeon, an orthopaedic sports medicine fellow and a physical medicine and rehabilitation resident. Charts were reviewed to determine treatment of the stress fracture, outcome and final follow up, as well as to determine if the patient had any further treatment for their hip. Results: Of the 25 hips (18 right, 7 left) with femoral neck stress reactions, 9 were grade 2 (bone marrow edema), 5 were grade 3 (high T2 and low T1 marrow signal), and 11 were grade 4 (stress fracture). Twenty patients (80%) had coxa profunda - where the floor of the cotyloid fossa touches or extends beyond the ilioischial line (incidence in general population is 15.2% of males, and 19.4% of females). Coxa profunda, defined by the floor of the cotyloid fossa touching or extending beyond the ilioischial line and a center edge angle of more than 35o, was present in 28% of subjects. Acetabular retroversion as assessed by the crossover sign was present in 42% (normal incidence is 5% of population). Center edge angle was greater than 35o in 20% and greater than 40 o

  6. Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

    Directory of Open Access Journals (Sweden)

    Haili Wang

    2012-01-01

    Conclusion: The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.

  7. Planning acetabular fracture reduction using patient-specific multibody simulation of the hip

    Science.gov (United States)

    Oliveri, Hadrien; Boudissa, Mehdi; Tonetti, Jerome; Chabanas, Matthieu

    2017-03-01

    Acetabular fractures are a challenge in orthopedic surgery. Computer-aided solutions were proposed to segment bone fragments, simulate the fracture reduction or design the osteosynthesis fixation plates. This paper addresses the simulation part, which is usually carried out by freely moving bone fragments with six degrees of freedom to reproduce the pre-fracture state. Instead we propose a different paradigm, closer to actual surgeon's requirements: to simulate the surgical procedure itself rather than the desired result. A simple, patient-specific, biomechanical multibody model is proposed, integrating the main ligaments and muscles of the hip joint while accounting for contacts between bone fragments. Main surgical tools and actions can be simulated, such as clamps, Schanz screws or traction of the femur. Simulations are computed interactively, which enables clinicians to evaluate different strategies for an optimal surgical planning. Six retrospective cases were studied, with simple and complex fracture patterns. After interactively building the models from preoperative CT, gestures from the surgical reports were reproduced. Results of the simulations could then be compared with postoperative CT data. A qualitative study shows the model behavior is excellent and the simulated reductions fit the observed data. A more quantitative analysis is currently being completed. Two cases are particularly significant, for which the surgical reduction actually failed. Simulations show it was indeed not possible to reduce these fractures with the chosen approach. Had our simulator being used, a better planning may have avoided a second surgery to these patients.

  8. Indirect reduction of posterior wall fragment using a suture anchor in acetabular posterior wall fracture with posterior labral root tear.

    Science.gov (United States)

    Yoo, Je-Hyun; Chang, Jun-Dong; Lee, Ho-Won

    2015-02-01

    Posterior wall fractures, which are the most common type of acetabulum fracture, are frequently accompanied with an avulsion tear of the posterior labral root as well as hip dislocation due to the injury mechanism. In the treatment of these fractures with an avulsed posterior labral root attached to posterior wall fragment, the use of a suture anchor can induce indirect reduction of a posterior wall fragment as well as direct repair of a labral root tear simultaneously. We describe the simple and efficient technique using a suture anchor in posterior wall acetabular fractures and surgical outcomes of two cases treated with this technique.

  9. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Directory of Open Access Journals (Sweden)

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  10. 髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折%Internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach

    Institute of Scientific and Technical Information of China (English)

    李连欣; 周东生; 杨永良; 郝振海; 王永会

    2012-01-01

    Objective To explore the clinical effect of internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach.Methods From June 2008 to June 2011,26 patients were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach.Sixteen cases were diagnosed as fractures of the acetabular anterior column,and ten as fractures of the pubic rami.The patient was positioned supine or lateral floating.The incision included two parts.The lateral part along the anterior one-third of the iliac crest about 3-5 cm.The insertion of the abdominal muscles and the origin of the iliacus were sharply incised from the crest.By subperiosteal dissection,the iliacus was elevated from the internal iliac fossa as far medially as to expose the anterior inferior iliac spine,iliopubic eminence and acetabular anterior column.The medial part of the incision was from the pubic tubercle transverse lateral extend 2-3 cm.Subperiosteal dissection to expose the superior pubic ramus.Two windows were dissected subperiosteal to connect through a tunnel along the anterior column of the acetabulum and pubic ramus.Fractures were reduced,and reconstruction plates were contoured and placed through the tunnel.Two or three screws were used at each window to fix the fractures.Results According to Matta evaluation system,anatomic reductions of the hip were in 13 cases,good in 11 and fair in 2 cases.Twenty-three patients were followed up from 6 to 30 months (mean,15.6 months).Hip functions were excellent in 13 patients,good in 6,and fair in 4 patients according to the D'Aubigne scores system.Pelvic functional results showed 12 were excellent,9 were good and 2 were fair according to Majeed scores system.No complications such as infection or deep venous thrombosis occurred.Conclusion This modified ilioinguinal approach,with less operation time and low rate of complications,is simple and minimally invasive.It is easy for

  11. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Institute of Scientific and Technical Information of China (English)

    Ashok S Gavaskar; Naveen Chowdary Tummala

    2012-01-01

    Total hip arthroplasty (THA) for an untreated acetabular fracture is technically challenging and the long-term result is not so favorable.A 45-year-old female patient with untreated column and comminuted posterior wall fracture of the acetabulum was treated in our institution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior column with cancellous grafting and cementless THA in a single stage.At 3 years' follow-up,the patient was independently mobile without limb length discrepancy.Radiological evaluation showed well integrated components and bone grafts.No evidence of aseptic loosening or osteolysis was found.This report aims to emphasize that bony acetabular reconstruction allows the use of primary hip components,which improves prosthesis longevity and preserves bone stock for a future revision.

  12. A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

    Directory of Open Access Journals (Sweden)

    Samet Karabulut

    2011-06-01

    Full Text Available Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN developed on her right femoral head, the range of motion (ROM of the hip was restricted and she had minimal pain on her right hip. J Clin Exp Invest 2011;2(2:228-31

  13. Should money follow the patient: Financial implication for being the National Centre for the Treatment and Management of Pelvic and Acetabular Fractures in Ireland.

    LENUS (Irish Health Repository)

    Kelly, M E

    2013-03-13

    BACKGROUND: Pelvic and acetabular fractures are complex injuries requiring specialist treatment. Our institution is the National Centre for Treatment and Management of these injuries. AIM: To audit all referrals to our institution over a 6-month period and calculate the cost incurred by being the national referral centre. METHODS: Retrospective review of database, and subsequent allocation of Casemix points to assess total cost of treatment for each patient referred to our institution. RESULTS: 103 patients referred with pelvic or acetabular fracture for operative management. The furthest referral distance was 181miles. Over-all, the length of stay was 15.4 days. The average inclusive cost for a referral to our unit for operative management was €16,302. CONCLUSION: Pelvic and acetabular fractures are complex injuries that require specialist referral unit management. However for these units to remain sustainable money needs to "follow the patient".

  14. Reprodutibilidade da classificação de Tile para fraturas do acetábulo Reproducibility of Tile's classification of acetabular fractures

    Directory of Open Access Journals (Sweden)

    Marcos Almeida Matos

    2006-01-01

    Full Text Available Classificar corretamente as fraturas acetabulares é crucial para bom planejamento pré-operatório e para redução cirúrgica eficiente. Entretanto, para cumprir seus objetivos, qualquer sistema de classificação deve ser simples e reprodutível. O objetivo deste artigo é avaliar a reprodutibilidade interobservador da classificação de Tile para fraturas do acetábulo. Foram utilizadas 30 imagens radiográficas de 10 fraturas acetabulares nas incidências de Judet, analisadas por 10 observadores, sendo cinco especialistas em cirurgia de quadril e cinco residentes do terceiro ano de ortopedia. A concordância global obtida foi de 72,44% com Kappa (K = 0,52 (0,48 entre residentes e 0,57 entre especialistas. Conclui-se que a classificação de Tile para fraturas acetabulares apresenta moderada concordância interobservador, não havendo diferença estatisticamente significante entre residentes e especialistas.Properly classifying acetabular fractures is crucial for a good preoperative planning and for an efficient surgical reduction. However, in order to accomplish its objectives, any classification system must be simple and reproducible. The objective of this article is to assess inter-observer reproducibility of Tile’s classification concerning acetabular fractures. Thirty X-ray images of 10 acetabular fractures at Judet planes were used and assessed by 10 observers, being five hip surgery experts and five 3rd-grade orthopaedic residents. The global consistency achieved was 72.44% to Kappa (K = 0.52 (0.48 among resident doctors and 0.57 among experts. It was concluded that the Tile’s classification of acetabular fractures reveals a moderate inter-observer consistency, with no statistically significant difference between resident doctors and experts.

  15. Femoral head ostectomy for the treatment of acetabular fracture and coxofemoral joint luxation in a Potbelly pig.

    Science.gov (United States)

    Smith, Joe S; Chigerwe, Munashe; Kanipe, Carly; Gray, Sarah

    2017-02-01

    To report the successful surgical treatment of a comminuted left acetabular fracture, a dorsally luxated left femoral head, and avulsion of the ligament of the femoral head by femoral head ostectomy (FHO) and physical therapy in a companion Potbelly pig. Case report. A 1-year-old, 13 kg, castrated male, companion Potbelly pig. The pig presented with a nonweight bearing left pelvic limb lameness of 3 weeks' duration that was noticed shortly after the pig got caught under a fence. Under general anesthesia a lateral approach was made to the fractured limb. A FHO was performed as described for dogs. Following surgery, a period of physical therapy was initiated based on protocols described for dogs. The canine surgical procedure with the approach modified for pigs was successfully performed in our pig. Following surgery, the pig was comfortable and weight bearing. A physical therapy regimen of supervised activity, stairs, and water therapy was used to rehabilitate the leg, as well as a weight management protocol to maintain ideal body condition. The owner was highly satisfied with the outcome. Telephone follow-up with the owner at 12 months after surgery revealed no impairment to movement, and the pig was maintaining normal ambulation without lameness. No complications were observed with this case. FHO, as described for dogs, provided a favorable outcome for hip luxation caused by acetabular fracture, luxation, and avulsion of the femoral head ligament in this small size Potbelly pig. © 2016 The American College of Veterinary Surgeons.

  16. Diagnosis and treatment for 60 cases of complex acetabular fractures at posterior wall%60例复杂髋臼后壁骨折的诊治

    Institute of Scientific and Technical Information of China (English)

    张昊; 胡亚威; 陈少初; 菅新民; 张弦; 周建华; 卢学有; 钱东阳

    2015-01-01

    unsatisfied reduction was 10.97%.The early postoperative complications were as follows: one case of sciatic nerve injury , one case of femoral nerve injury , one case of external iliac artery injury with thrombosis, and two cases of deep vein thrombosis .The late postoperative complications were as follows:three cases of heterotopic ossification and one case of femoral head necrosis .Conclusions The correct diagnosis of complex acetabular fractures at posterior wall depends on the pelvic anterior -posterior radiograph, obturator oblique radiograph , and iliac oblique radiograph , which are important for determination of the locations and types of acetabular fractures .CT scan can provide clear images of the fracture lines and bone fragments on the coronal section of acetabulum , it is of great importance for doctors to choose the surgical approaches and internal fixation methods in the treatment of complex acetabular fractures at posterior wall .

  17. Finite element analysis of the stability of combined plate internal fixation in posterior wall fractures of acetabulum.

    Science.gov (United States)

    Liu, Xi-Ming; Pan, Chang-Wu; Wang, Guo-Dong; Cai, Xian-Hua; Chen, Lei; Meng, Cheng-Fei; Huang, Jin-Cheng

    2015-01-01

    This study aims to explore the mechanical stability of combined plate internal fixation in posterior wall fractures of the acetabulum. The fracture and internal fixation models were established in this study and they were divided into four kinds of internal fixation models, finite element analysis was performed. The four groups were 2 mini-plates and 1 reconstruction plate fixation (A), Reconstruction plate internal fixation group (B), 2 screws internal fixation group (C) and mini-plates internal fixation group (D). The displacement of each node was measured and evaluated. There was no distortion in the geometric shape of the finite element model. The results of stress showed that it was less in the anterior pelvic ring and distributed uniform in labrum acetabulare; the stress was bigger in the upper and middle of sacroiliac joint and sciatic notch in sitting position. Combined plate internal fixation for posterior wall fractures of acetabular were stable and reliable, it is better than the other three methods.

  18. Total hip replacements done without cement after acetabular fractures: a 4- to 8-year follow-up study.

    Science.gov (United States)

    Huo, M H; Solberg, B D; Zatorski, L E; Keggi, K J

    1999-10-01

    Twenty-one patients (21 hips) underwent cementless total hip replacement surgeries for previous acetabular fractures. The mean age at the time of hip replacement was 52 years (range, 23-78 years). The mean follow-up was 65 months (range, 48-104 months). One hip required revision of the stem secondary to a periprosthetic femur fracture from a fall at 3 months after surgery. Good to excellent clinical rating was achieved and maintained in 19 hips. Radiographic evaluation demonstrated stable cup and stem fixation in 17 and 15 hips. Only 1 patient with radiographic loosening of the components was sufficiently symptomatic. The results in this series appeared slightly better than those reported previously in hip replacements done with cement at comparable medium-term follow-up. The mechanical failure rates remained high in this patient population: 19% for the cups and 29% for the stems.

  19. Modified Stoppa Approach versus Ilioinguinal Approach for Anterior Acetabular Fractures; A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Meena, Sanjay; Sharma, Pankaj Kumar; Mittal, Samarth; Sharma, Jyoti; Chowdhury, Buddhadev

    2017-01-01

    Introduction: Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss. Methods: Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs. Result: Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37), p=0. 90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91), p=0.73 (I2= 0%). The operative time was significantly shorter with modified Stoppa approach (MD = -48.79 (-80.29 to -17.30), p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15), p=0. 56, I2=0%) and blood loss (MD= -212.89 (-476.27 to 50.49) p=0. 06, I2=71%). Conclusion: Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal

  20. Should total hip arthroplasty be performed acutely in the treatment of acetabular fractures in elderly or used as a salvage procedure only?

    Directory of Open Access Journals (Sweden)

    Katharine Hamlin

    2017-01-01

    Full Text Available Background: Total hip arthroplasty (THA is now an increasingly common procedure for people sustaining acetabular fractures. The incidence of acetabular fractures among the elderly population is increasing, and contemporary treatment aims to avoid the risks of prolonged incumbency associated with poor bone stock for fixation or inability to comply with limited weightbearing in this patient group. The concept of acute hip arthroplasty as a treatment for acetabular fracture is, therefore, becoming more topical and relevant. Our systematic review investigates whether THAs for acetabular fractures should be performed acutely, with a short delay, or as a late procedure for posttraumatic osteoarthritis (PTOA if it develops. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed when undertaking this systematic review. Detailed searches were performed on three different databases, using keywords, such as “acetabular fracture,” “acetabular trauma,” “total hip arthroplasty,” “hip arthroplasty,” and “hip prosthesis.” Studies from 1975 to September 2016 were included in the study. All studies included in the review were independently critically appraised by two of the authors. Results: Forty three studies were included in this review. Only two of them actually compared acute and delayed THAs for acetabular fractures with the rest focusing on one or the other. Results were comparable between acute and late THAs in terms of aseptic loosening, operative time, blood loss, Harris Hip Score, and ability to mobilize postoperatively without aid. Complication rates, however, were much higher in the acute group. Conclusion: Evidence based on this topic is scarce and therefore we have to be cautious about drawing a definitive conclusion. The findings of this systematic review do suggest, however, that acute THAs should be considered in elderly patients, where fixation is not possible, or

  1. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children

    Energy Technology Data Exchange (ETDEWEB)

    Rubel, Ivan F.; Kloen, Peter; Helfet, David L. [Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY (United States); Potter, Hollis G. [MRI Department, Diagnostic Radiology, Hospital for Special Surgery, New York (United States)

    2002-06-01

    Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone. We present two cases of pediatric traumatic hip dislocation associated with posterior wall fractures of the acetabulum. In both cases, obvious postreduction instability was noted without conclusive findings of etiology on plain X-rays or CT scans. Magnetic resonance imaging (MRI) disclosed an extensive posterior wall traumatic involvement in both cases and helped to decide in favor of open reduction of the hip and internal fixation of the posterior wall fragment. (orig.)

  2. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute

    Directory of Open Access Journals (Sweden)

    Jan Svacina

    2016-01-01

    Full Text Available A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty.

  3. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute.

    Science.gov (United States)

    Svacina, Jan

    2016-01-01

    A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty.

  4. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute

    Science.gov (United States)

    2016-01-01

    A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty. PMID:27446621

  5. Classification and treatment of acetabular fractures%髋臼骨折的分类与治疗策略

    Institute of Scientific and Technical Information of China (English)

    曾令源

    2012-01-01

    Fracture of acetabulum is mostly caused by high energy trauma, which exists as a whole or a part of palvic fracture. Acetabulum is characterized by complex anatomical relationships irregular bone structures, which leads to the difficulties in surgery. The surgical approach is found to be closely related to the classification of cetabular fractures. And several factors are proved to influence the clinical efficacy. In this review, we present the progress on the classification and treatment of acetabular fractures.%髋臼为不规则骨,为丰厚软组织包裹,多为挤压或传导受力导致骨折,髋臼骨折与髋关节活动大有很大关联.髋臼的解剖关系复杂、骨性结构不规则,因而手术难度大.髋臼骨折的分类与手术入路的选择密切相关,此外,还有一些因素也会影响疗效.本文主要讨论髋臼骨折的分类及相应治疗的一些内容.

  6. Progress on treatment and research of quadrilateral plate fractures of acetabular%髋臼方形区骨折的治疗及研究进展

    Institute of Scientific and Technical Information of China (English)

    彭烨; 张立海; 唐佩福

    2015-01-01

    Acetabular is an important human joint for weight bearing. Quadrilateral plate is a crucial structure of medial acetabulum with special morphology and important function. Quadrilateral plate fractures are common fracture in acetabulum. Quadrilateral plate fracture is hard to expose and reduction because it is in the medial of acetabulum. At the same time ,the bone in the quadrilateral plate is not easy to fixed for thinning bones and adjacent to the articular cavity. The operator should know well about the anatomy and choose the suitable internal fixation. After quadrilateral plate fractures ,the femur head may⁃be displace medially even break into pelvis. That make reduction and treatment always be a challenge. With different kinds of fractures,the efficacy of treatment is not the same. This paper intend to review the relation of anatomic features,approaches, internal fixations,key point of treatment and efficacy.%髋臼是人体的重要承重关节,髋臼方形区是髋臼内侧壁的重要结构,具有特殊的形态结构和重要功能。方形区骨折是髋臼骨折中常遇到的骨折,由于髋臼方形区处于骨盆内侧,所以手术中的显露及复位十分困难。同时,髋臼方形区骨质较薄较难固定,外侧有髋关节,选择合适的内固定和对相关解剖的了解十分重要。方形区骨折后,股骨头容易向内侧移位,甚至突入盆腔造成嵌顿,其复位和治疗一直是骨科中的难点。对于方形区骨折不同的治疗方法,其疗效也不一。本文就方形区的解剖学特点、手术入路选择、内固定治疗方式、治疗要点和疗效等做一综述。

  7. Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2016-01-01

    Conclusion: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.

  8. Osteocondroma acetabular Acetabular osteochondroma

    Directory of Open Access Journals (Sweden)

    Reynaldo Jesus Garcia

    2005-01-01

    Full Text Available Apresentamos o relato de um caso de osteocondroma solitário acetabular, tumor ósseo comum em diversas regiões do esqueleto porém raro nesta localização. O tratamento realizado foi a ressecção do tumor por uma via posterior ao quadril e o paciente evoluiu com resolução do quadro clínico.This is a case report of a patient with a intra-articular hip osteochondroma, an extremely rare location for this kind of lesion. The patient was treated with resection of the lesion and presented a very good evolution with total recovery of the hip movements.

  9. 髋臼骨折并发症的研究进展%The Evolution of Research on the Complication of Acetabular Fracture

    Institute of Scientific and Technical Information of China (English)

    季良全; 彭吾训

    2014-01-01

    Acetabular fracture is a kind of high-energy traumatic fracture.With the development of modern transportation and industry,it has dramatical y increased and experienced an increasingly complex trend.The anatomical structure of acetabulum is intricate and the anatomical reduction is of greater dif iculty than general.Furthermore,Acetabular fracture belongs to intra-articular fracture and often gives rise to complication,making it more intricately complex.The thesis reviews the research literatures in this filed of study.%髋臼骨折是一种高能量创伤骨折,随着现代交通及工业的发展而日渐增多,并呈现出复杂程度增加的趋势。髋臼解剖结构复杂,解剖复位难度较一般骨折大,且髋臼骨折属关节内骨折,由此导致的并发症较为复杂。本文就相关文献予以综述。

  10. One stage total hip arthroplasty for acetabular fractures%Ⅰ期全髋关节置换治疗髋臼骨折

    Institute of Scientific and Technical Information of China (English)

    王子明; 孙红振; 王爱民; 杜全印; 吴思宇; 赵玉峰; 唐颖

    2008-01-01

    目的 探讨髋臼骨折后Ⅰ期全髋关节置换(total hip arthroplasty,THA)的手术适应证和手术方法,观察其临床疗效.方法 对11例髋臼骨折患者行Ⅰ期THA.其中前柱骨折3例,后壁骨折1例,后柱骨折2例,后柱合并后壁骨折2例,横形骨折1例,横形合并后壁骨折1例,两柱骨折1例.伤后8~37 d(平均24 d)接受THA.对新鲜髋臼骨折患者,先用重建钢板或螺钉固定骨折以恢复髋臼肇的形态,将切下的股骨头制成颗粒状或块状植于髋臼内后安置臼杯.陈旧性髋臼骨折有节段性髋臼骨缺损者,将切下的股骨头制成大块状进行髋臼内结构性植骨后再安置臼杯.结果 术后3个月完全负重,无人工关节脱位.随访时间6~45个月,平均28个月.Harris评分平均78分.髋关节屈伸平均活动度为95°.X线片示1例出现髋臼松动及骨溶解征象.结论 髋臼骨折移位明显,关节软骨面损伤严重,错过了手术复位时机,可以Ⅰ期行THA.如能创造稳定的髋臼杯结构,近期临床效果满意.%Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected

  11. Kocher-Langenback Approach for Treatment of Acetabular Fractures%Kocher-Langenback入路手术治疗髋臼骨折

    Institute of Scientific and Technical Information of China (English)

    史彤; 冯建立; 席志彬; 杨伟正

    2011-01-01

    Objective To summarize the operative method and clinical effect on acetabular fractures.Methods From January 2004 to June 2009, Kocher-Langenbeck approach were adopted in 22 cases of acetabular fracture treated operatively, including 15 cases of posterior wall fracture, 4 cases of posterior column plus posterior wall fracture, 2 cases of transverse fracture, 1 case of transverse with posterior wall fracture.Results Twenty cases were anatomically reduced, 1 case was satisfactorily reduced, 1 cases was only joint contour reduced which was unsatisfied.The excellent and good rate of clinical effect was 95.45% in those cases which had been continuously fellowed up.Complcation was observed in 1 case with incomplete traction injury of the sciatic nerve.Conclusion For fracture of the acetabulum, satisfactory reduction and clinical effect can be obtained with single approach.%目的:总结髋臼骨折的手术方法和治疗效果.方法:在26例髋臼骨折病人中,22例采用Kocher-Langenback入路治疗.结果:经12~36个月平均15个月随访,解剖复位20例,复位满意1例,不满意1例,临床效果优良率为95.45%,并发坐骨神经不全性牵拉损伤1例.结论:采用Kocher-Langenback入路手术治疗涉及髋臼后壁或后柱的骨折,可取得满意的骨折复位和临床疗效.

  12. Bilateral central acetabular fracture dislocation in a young patient due to seizure activity:a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Umesh Kumar Meena; Devi Sahai Meena; Prateek Behera; Om Singh Meel

    2014-01-01

    Various musculoskeletal injuries are well known complications of epilepsy either because of direct trauma or because of unbalanced forceful muscle contraction. We report a case of non-traumatic bilateral central acetabular fracture dislocation due to seizure activity induced by neurocysticercosis of the brain, which was managed conservatively and obtained reasonable good outcome. This case highlights the importance of proper evaluation in young non-osteoporotic patients who have experienced an epileptic attack without any previous history. It is also imperative to mention that these patients should be thoroughly examined neurologically to find out the exact etiology and should be treated accordingly to prevent future seizure activity.

  13. The Anterior Intrapelvic Approach for Acetabular Fractures Using Approach-Specific Instruments and an Anatomical-Preshaped 3-Dimensional Suprapectineal Plate.

    Science.gov (United States)

    Gras, Florian; Marintschev, Ivan; Grossterlinden, Lars; Rossmann, Markus; Graul, Isabel; Hofmann, Gunther O; Rueger, Johannes M; Lehmann, Wolfgang

    2017-07-01

    Anatomical acetabular plates the anterior intrapelvic approach (AIP) were recently introduced to fix acetabular fractures through the intrapelvic approach. Therefore, we asked the following: (1) Does the preshaped 3-dimensional suprapectineal plate interfere with or even impair the fracture reduction quality? (2) How often does the AIP approach need to be extended by the first (lateral) window of the ilioinguinal approach? Observational case series. Two Level 1 trauma centers. Patients with unstable acetabular fractures in 2014. Fracture fixation with anatomical-preshaped, 3-dimensional suprapectineal plates through the AIP approach ± the first window of the ilioinguinal approach. Fracture reduction results were measured in computed tomography scans and graded according to the Matta quality of reduction. Intraoperative parameters and perioperative complications were recorded. Radiological results (according to Matta) and functional outcome (modified Merle d'Aubigné score) were evaluated at 1-year follow-up. Thirty patients (9 women + 21 men; mean age ± SE: 64 ± 8 years) were included. The intrapelvic approach was solely used in 19 cases, and in 11 cases, an additional extension with the first window of the ilioinguinal approach (preferential for 2-column fractures) was performed. The mean operating time was 202 ± 59 minutes; the fluoroscopic time was 66 ± 48 seconds. Fracture gaps and steps in preoperative versus postoperative computed tomography scans were 12.4 ± 9.8 versus 2.0 ± 1.5 and 6.0 ± 5.5 versus 1.3 ± 1.7 mm, respectively. At 13.4 ± 2.9 months follow-up, the Matta grading was excellent in 50%, good in 25%, fair in 11%, and poor in 14% of cases. The modified Merle d'Aubigné score was excellent in 17%, good in 37%, fair in 33%, and poor in 13% of cases. The AIP approach using approach-specific instruments and an anatomical-preshaped, 3-dimensional suprapectineal plate became the standard procedure in our departments. Radiological and functional

  14. Unusual combination of posterior femoral head dislocation with anterior and posterior wall fractures in the ipsilateral acetabulum.

    Science.gov (United States)

    Chen, Wei; Su, Yanling; Zhang, Yingze; Zhang, Qi; Zheng, Zhanle; Pan, Jinshe

    2010-06-09

    Although hip dislocation combined with acetabular fracture is not an uncommon injury, anterior acetabular wall fractures rarely occur in patients who have posterior fracture-dislocations of the hip. This article presents a unique case of anterior and posterior wall fractures of the ipsilateral acetabulum in a patient who sustained traumatic posterior hip dislocation that resulted from a high-speed motor vehicle accident. The initial imaging evaluation, which did not include the obturator oblique view, revealed no concomitant anterior acetabular wall fracture. Repeated manipulative reductions were unsuccessful in reducing the displaced hip joint. Pelvic computed tomography (CT) scans revealed the initially missed anterior acetabular wall fracture fragments incarcerated in the left hip joint in addition to the hip dislocation and the posterior acetabular wall fracture. The incarcerated bone fragments lay between the anterior wall and the femoral head, and between the posterior wall and the femoral head, which appeared to derive from both anterior and posterior acetabular walls, respectively. Open reduction and internal fixation was performed to manage the posterior dislocation and associated acetabular fractures. Intraoperatively, the major anterior wall fragment was used to reconstruct the defected posterior wall. This case highlights the necessity of suspicion and pre- and postoperative monitoring of the obturator oblique view and CT scans to detect the potentially existing anterior acetabular wall fracture. Early surgical intervention is important to guarantee satisfactory outcomes of such complex fracture-dislocation injuries.

  15. 髋臼骨折的治疗%Diagnosis and management of acetabular fracture

    Institute of Scientific and Technical Information of China (English)

    孙俊英

    2001-01-01

    @@ 解剖复位、有效内固定和早期功能锻练早已成为移位关节骨折的治疗原则.然而这一原则能否适用于髋臼骨折(Acetabulum fracture,下称AC)曾有争论.反对者认为AC的X线表现与疗效并不密切相关,只复位股骨头,不解剖复位骨折,仍可取得满意疗效.相反,某些切开解剖复位者,因手术创伤导致的患病率增加,功能并不满意.60年代始,Judet系统研究AC后认为,缺乏统一合理的分类是导致手术和非手术疗效缺乏可比性的关键,鉴此提出了AC的Judet分类.此后,Letournel又对此作了简化和完善,使其更为合理.最近20年的研究则证实,AC的复位质量与临床疗效密切相关,关节骨折的治疗原则同样适用于移位AC.

  16. Acetabular fractures in the elderly treated with a primary Burch-Schneider reinforcement ring, autologous bone graft, and a total hip arthroplasty: a prospective study with a 4-year follow-up.

    Science.gov (United States)

    Enocson, Anders; Blomfeldt, Richard

    2014-06-01

    To investigate the clinical and radiologic outcomes in elderly patients suffering from an acetabular fracture operated with an acute primary acetabular reinforcement ring, autologous bone graft, and a total hip arthroplasty (THA). Prospective cohort study. Tertiary care university hospital. Fifteen elderly patients (7 women) with a mean age of 76 years and a displaced acetabular fracture after a low-energy trauma were included. The fractures involved the anterior column, but no patients with associated both column fractures were included. All the patients were able to walk independently before the fracture occurred. Primary operation with a Burch-Schneider reinforcement ring, autologous bone graft, and a THA. The patients were reviewed at 4, 12, 24, and 48 months after the fracture occurred. The outcome assessments included complications, reoperations, activity of daily living function, functional scores (Harris hip score and short musculoskeletal function assessment), health-related quality of life [EuroQol (EQ-5D) index score], and radiologic evaluation. There were no prosthetic dislocations, periprosthetic fractures, deep infections, or other adverse events. There were no radiologic signs of loosening of the reinforcement ring or the prosthesis components at any of the follow up sessions, and the autologous bone graft was well incorporated in all the patients at the final follow-up. At 48 months, the mean Harris hip score was 88, the mean short musculoskeletal function assessment dysfunction score was 30, the bother score was 25, and the mean EQ-5D index score was 0.65. All the patients were able to walk independently at the final follow-up. Treatment of displaced anterior column, anterior column posterior hemitransverse and transverse acetabular fractures in elderly patients using a primary reinforcement ring, autologous bone graft, and a THA seems to be a safe option with good functional and radiologic outcomes. Therapeutic Level IV. See Instructions for

  17. Acetabular roof arc angles and anatomic biomechanical superior acetabular weight bearing area

    Directory of Open Access Journals (Sweden)

    Thossart Harnroongroj

    2014-01-01

    Full Text Available Background: Acetabular fracture involves whether superior articular weight bearing area and stability of the hip are assessed by acetabular roof arc angles comprising medial, anterior and posterior. Many previous studies, based on clinical, biomechanics and anatomic superior articular surface of acetabulum showed different degrees of the angles. Anatomic biomechanical superior acetabular weight bearing area (ABSAWBA of the femoral head can be identified as radiographic subchondral bone density at superior acetabular dome. The fracture passes through ABSAWBA creating traumatic hip arthritis. Therefore, acetabular roof arc angles of ABSAWBA were studied in order to find out that the most appropriate degrees of recommended acetabular roof arc angles in the previous studies had no ABSAWBA involvement. Materials and Methods: ABSAWBA of femoral head was identified 68 acetabular fractures and 13 isolated pelvic fractures without unstable pelvic ring injury were enrolled. Acetabular roof arc angle was measured on anteroposterior, obturator and iliac oblique view radiographs of normal contralateral acetabulum using programmatic automation controller digital system and measurement tools. Results: Average medial, anterior and posterior acetabular roof arc angles of the ABSAWBA of 94 normal acetabulum were 39.09 (7.41, 42.49 (8.15 and 55.26 (10.08 degrees, respectively. Conclusions: Less than 39°, 42° and 55° of medial, anterior and posterior acetabular roof arc angles involve ABSAWBA of the femoral head. Application of the study results showed that 45°, 45° and 62° from the previous studies are the most appropriate medial, anterior and posterior acetabular roof arc angles without involvement of the ABSAWBA respectively.

  18. 三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较%Three-dimensional memory fixationversusreconstruction titanium plate to repair posterior wall acetabular fracture with posterior dislocation

    Institute of Scientific and Technical Information of China (English)

    梁云扬

    2015-01-01

    通过对髋臼三维记忆内固定系统在髋臼后壁骨折伴髋臼关节后脱位中临床应用效果的分析,了解其治疗髋臼后壁骨折伴髋臼关节后脱位的可行性与特点。研究发现,其在固定时间及术后功能恢复等方面较之重建钛板内固定都具有明显的应用优势。%BACKGROUND:Posterior wal fractures of the acetabulum with posterior dislocation of the acetabular joint mostly require the operation of open reduction and internal fixation. Different materials can be chosen for internal fixation operation. OBJECTIVE: To explore the effect of acetabular three-dimensional memory fixation system on acetabular posterior wal fractures accompanying the acetabulum joint dislocation. METHODS: A retrospective analysis was performed on clinical data of 92 cases of acetabular posterior wal fracture and dislocation at the Heze Municipal Hospital of Shandong Province from February 2010 to February 2014. Al patients received the operation of open reduction and internal fixation. They were divided into three-dimensional memory fixation group (45 cases) and reconstruction titanium plate group (47 cases) according to different fixators. Al patients were folowed up for 12 months after fixation. RESULTS AND CONCLUSION:The operation time and intraoperative blood loss were significantly longer or higher in the reconstruction titanium plate group than in the three-dimensional memory fixation group (P < 0.05). Harris score was significantly greater in the three-dimensional memory fixation group than in the reconstruction titanium plate group during final folow-up (P < 0.05). Thromboembolic complications or deep infection were not detected after fixation in both groups. These findings confirm that three-dimensional memory fixation system obtained good effects in the treatment of the posterior wal fractures of the acetabulum with posterior dislocation.

  19. Acetabular fractures--Risk factors for a negative outcome of the surgical management%髋臼骨折--手术治疗效果欠佳的不利因素

    Institute of Scientific and Technical Information of China (English)

    Beate P. Hanson; David L. Helfet; Suthorn Bavonratanavech; Ian Harris; 陈国奋; 顾立强

    2004-01-01

    现有文献中没有确定性的治疗髋臼移位骨折的最佳方法.一般情况下倾向于开放复位内固定.但是,由于缺少不同特定内固定物间的比较,因此难以做出推荐.报道一致认为,导致结果差和一般的潜在不利因素包括老龄、术后复位不良、严重的骨折、股骨头损伤,以及延迟处理.%The optimal method of managing displaced acetabular fractures is not established in the literature.It may be that open reduction and internal fixation in general is universally preferred;however,specific types of hardware have not been compared and therefore recommendations cannot be made. Potential risk factors consistently reported to be associated with poor to fair outcomes include older age, poor post operative reduction, more severe fracture characteristics, femoral head injury, and a delay in treatment.

  20. C形臂X线透视导航下微创经皮拉力螺钉治疗髋臼前柱骨折%Treatment of anterior acetabular column fracture with minimally invasive percutaneous lag screws by C-arm X-ray fluoroscopy-based navigation

    Institute of Scientific and Technical Information of China (English)

    司庆华; 唐佩福; 丁珮; 胡磊; 樊喻波; 张立海; 彭晔; 袁新成; 董天祥; 娄昕

    2013-01-01

      目的探讨C型臂X线机透视导航下使用微创经皮拉力螺钉内固定治疗髋臼前柱骨折的方法及疗效.方法对2009年3月-2011年9月,在我院创伤骨科住院的8例无移位或轻度移位的髋臼前柱骨折患者,应用C形臂X线透视导航,用微创经皮拉力螺钉治疗髋臼前柱骨折.按Nakatani分型:Ⅰ型4例,Ⅱ型3例,Ⅲ型1例.受伤致手术时间为2~7 d.结果8例患者,男5例,女3例,年龄19~69岁,共置入10枚髋臼前柱经皮螺钉,其中2例为双侧髋臼前柱骨折,其余6例为单侧髋臼前柱骨折,各置入1枚螺钉.术后8例全部获得随访,随访时间10~26个月.8例全部骨性愈合,1例遗留轻度移位,无血管神经损伤等并发症.结论 C型臂X线机透视导航下使用微创经皮拉力螺钉内固定治疗髋臼前柱骨折可提高螺钉的精确度,有利于功能康复.%Objective To study the treatment of anterior acetabular column fractures with minimally invasive percutaneous lag screws by C-arm X-ray fluoroscopy-based navigation. Methods Eight patients with no or mild shift of anterior acetabular column fractures were treated with minimally invasive percutaneous lag screw by C-arm X-ray fluoroscopy- based navigation in our department from March 2009 to September 2011. The fractures were classified as typeⅠin 4 patients, typeⅡin 3 patients, and typeⅢin 1 patient according to Nakatani classification. The time from fracture to operation was 2~7 days. Results Of the 8 patients with 10 screws inserted, 5 were males and 3 were females aged 19~69 years, 2 were diagnosed with bilateral anterior acetabular column fracture and 6 with unilateral anterior acetabular column fracture with 1 screw inserted, respectively. The patients were followed up for 10~26 months, during which their fractures were healed with no complications such as vascular and nerve injury except for mild shift in 1 patient. Conclusion Internal fixation of anterior acetabular column fractures with

  1. Operative treatment of displaced acetabular fractures: a systematic review%移位性髋臼骨折手术治疗的系统评价

    Institute of Scientific and Technical Information of China (English)

    吴刚; 王光林; 薛建利; 杨天府; 方跃; 刘雷

    2009-01-01

    Objective To systematically review the published articles available on management for the displaced acetabular fractures. Methods MEDLINE, EMBASE, CBM and Cochrane Database were searched for the articles on management of displaced acetabular fractures in the past 40 years. Manual searches of the bibliographic sections of electronically identified papers were done to identify further papers. Meticulous data extraction and meta-analysis were performed according to preset protocol. Results Of 869 citations initially identified, 72 papers which involved a total of 6509 patients with 6549 acetabular fractures met all eligibility criteria. Reduction was anatomical or good in 87.6% of the patients, and poor in 13.0%. An incidence of iatrogenic nerve palsy was 6.0%. Deep venous thrombosis (DVT) and pulmonary embolism (PE) had an overall incidence of 3.9%. The incidence of local wound infections was 4. 2%. The heterotopic ossifi-cation (HO) was seen in 26.9% of the patients. The overall incidence of osteoarthritis (OA) was 18.0%. The score to assess the functional results, 46.6% of the patients were graded as excellent, 32.4% as good, 11.6% as fair, and 9. 5% as poor. Using the Harris Hip Score (HHS), 48.4% of the patients had an ex-cellent result, 26.9% were graded as good, 10.7% as fair, and 14.0% as poor. 85.5% of the patients with satisfactory reduction had an excellent or good functional result, while 63.7% of the patients without satis-factory reduction did. The most common cause was road traffic accident. The most common fracture types were fractures of the posterior wall and both columns as well as transverse ones associated with posterior wall. Conclusions Operative management of displaced acetabular fractures can have satisfactory functional out-comes. Reduction quality may be the major influence on functional outcome. The most common long-term complications are osteoarthritis and heterotopic ossification.%目的 采用循证医学研究方法,系统评价移位

  2. Anatomical Variance in Acetabular Anteversion Does Not Predict Hip Fracture Patterns in the Elderly: A Retrospective Study in 135 Patients

    OpenAIRE

    Kamath, Megan Y.; Coleman, Nathan W.; Belkoff, Stephen M.; Mears, Simon C.

    2011-01-01

    It has been suggested that variances in the anatomy of the acetabulum determine the type of hip fracture in elderly patients. Based on this concept, an overly anteverted acetabulum would lead to impingement of the femoral neck against the posterior rim of the acetabulum, causing a femoral neck fracture, whereas with a retroverted acetabulum, external rotation of the hip would be limited by the capsular tissues attached to the trochanteric region, causing a trochanteric fracture. To test the h...

  3. Análise do colapso segmentar da cabeça femoral nas fraturas do acetábulo tratadas cirurgicamente Analysis of the segmental impaction of femoral head following an acetabular fracture surgically managed

    Directory of Open Access Journals (Sweden)

    Rodrigo Pereira Guimarães

    2009-10-01

    Full Text Available OBJETIVO: Correlacionar a evolução radiográfica pós-operatória com as variáveis que acompanham as fraturas do acetábulo, a fim de definir o que tem valor preditivo no aparecimento do colapso segmentar da cabeça femoral. MÉTODOS: Realizada análise retrospectiva de prontuários de pacientes submetidos à cirurgia de redução aberta e fixação interna do acetábulo. Em aproximadamente 35 anos, 596 pacientes foram tratados por fratura do acetábulo; 267 foram acompanhados pelo menos por dois anos. Os demais foram excluídos por não ter sido acompanhados pelo tempo mínimo, não haver dados suficientes no prontuário ou ter sido submetidos a tratamento não operatório. O acompanhamento dos pacientes foi feito por um de três cirurgiões do grupo, utilizando a escala clínica de Merle d'Aubigné e Postel e estudos radiológicos. RESULTADOS: Somente duas variáveis estudadas, idade e qualidade da redução pós-operatória, apresentaram correlação estatisticamente significante com o colapso da cabeça femoral. CONCLUSÕES: A qualidade da redução, anatômica ou com desvio residual de até dois milímetros, apresenta evolução radiográfica satisfatória, diminuindo a probabilidade do colapso segmentar da cabeça femoral, achado que tem significância estatística.OBJECTIVE: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. METHODS: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The

  4. Early postoperative acetabular discontinuity after total hip arthroplasty.

    Science.gov (United States)

    Desai, Gaurav; Ries, Michael D

    2011-12-01

    Periprosthetic acetabular fracture is a rare complication after total hip arthroplasty (THA). However, we have treated 2 patients with acute postoperative acetabular discontinuity that occurred 2 and 3 weeks after primary THA. Both fractures were in elderly osteoporotic female patients with minimal trauma and may have developed from unrecognized intraoperative fractures. Pelvic stability was restored with acetabular revision using medial morselized bone grafting and a cemented reconstruction cage. This report demonstrates that early postoperative periprosthetic acetabular discontinuity after THA is a risk in elderly patients with severe osteoporosis and that salvage of acetabular fixation can be achieved with cemented cage reconstruction and medial morselized bone grafting. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. The application of 3D printing technique in the research of acetabular fractures%3D打印应用于髋臼骨折数字化设计的实验研究

    Institute of Scientific and Technical Information of China (English)

    吴章林; 林海滨; 张国栋; 陆俭军; 陈宣煌; 黄华军; 黄文华

    2014-01-01

    Objective To evaluate the digital design of acetabular fractures and the feasibility of the implementation, then using the 3D printing technique to verify the results. Methods Fifty-two patients with acetabular fractures were enrolled in this study. Data of lamellar CT scanning were imported into Mimics14.0 software for 3D anatomical modeling and virtual fracture reduction. Then the default embedded steel plate location was optimized , the screw path evaluated,and the screw length measured. 3D printing technique was used to print the bone. Plates were bended based on the printing bones. Internal fixation implants were simulated based on all the printed bones and bended plates. Finally, the real operation was compared with virtual preoperative design in terms of the fixation position of plates, the direction and the length of screws. Results In the study, 61 plates and 424 screws were planted. The position of plates and the direction of screws were in high accordance with the digital design. The length of screws are compared with Paired-samples t Test and P=0.325. Conclusion Firstly, the combination of the digital design and 3D printing technique have a good application in the bending of the plates and surgery simulation before operation. The real operation is quite consistent with the simulated results. Secondly, plate bending before the real operation has a certain value in the guidance of fracture reduction.%目的:探讨髋臼骨折数字化设计及实施的可行性方案并以3D打印技术进行验证。方法采集52例临床髋臼骨折薄层CT扫描数据,在Mimics14.0中进行三维建模和虚拟骨折复位并在复位模型上优化预设植入钢板位置和虚拟钉道模拟、测量钉道长度,三维切割预设植入钢板部位骨块并3D打印,据此进行钢板折弯。将所有骨折块进行3D打印为实体模型结合折弯钢板进行内固定植入模拟。将钢板现实位置、螺钉方向和长度同数字化

  6. Anterior internal fixation to treat vertical unstable pelvic fracture

    Institute of Scientific and Technical Information of China (English)

    王世松; 张鹏程; 杜敦进; 杨泗华

    2002-01-01

    With the Chinese development of industry, agriculture and communication, various traffic and work related accidents are increasing, leading to an increase in pelvic fractures. Among the different kinds of fractures, pelvic fracture is the third largest cause of death.1 The treatment of pelvic fractures is a “hot spot” and a difficult point in orthopedic surgery. Since 1998 we have treated 20 patients with vertical unstable pelvic fracture using anterior internal fixation. Satisfactory results have been obtained.

  7. Propensity for hip dislocation in normal gait loading versus sit-to-stand maneuvers in posterior wall acetabular fractures.

    Science.gov (United States)

    Marmor, Meir; McDonald, Erik; Buckley, Jenni M; Matityahu, Amir

    2013-09-01

    Treatment of posterior wall (PW) fractures of the acetabulum is guided by the size of the broken wall fragment and by hip instability. Biomechanical testing of hip instability typically is done by simulating the single-leg-stance (SLS) phase of gait, but this does not represent daily activities, such as sit-to-stand (STS) motion. We conducted a study to examine and compare hip instability after PW fractures in SLS and STS loading. We hypothesized that wall fragment size and distance from the dome (DFD) of the acetabulum to the simulated fracture would correlate with hip instability and, in the presence of a PW fracture, the hip would be more unstable during STS loading than during SLS loading. Incremental PW osteotomies were made in 6 cadaveric acetabula. After each osteotomy, a 1200-N load was applied to the acetabulum to simulate SLS and STS loading until dislocation occurred. All hip joints in the cadaveric models were more unstable in STS loading than in SLS loading. PW fragments at time of dislocation were larger (Pfracture size of 33% or more and a DFD of 20 mm or less.

  8. APPLICATION OF ACETABULAR TRIDIMENSIONAL MEMORY ALLOY-FIXATION SYSTEM IN TREATMENT OF OLD ACETABULAR POSTERIOR WALL FRACTURE WITH BONE DEFECT%髋臼镍钛记忆合金三维内固定系统治疗陈旧性髋臼后壁骨折合并骨缺损

    Institute of Scientific and Technical Information of China (English)

    曹烈虎; 鲍广全; 张春才; 刘欣伟; 牛云飞; 许硕贵; 苏佳灿

    2011-01-01

    Objective To investigate the effectiveness of acetabular tridimensional memory alloy-fixation system (ATMFS) combined with autologous iliac bone in the treatment of old acetabular posterior wall fracture with bone defect. Methods Between January 2002 and February 2009, 17 patients with old acetabular posterior wall fracture and bone defect were treated, including 11 males and 6 females with an average age of 41.7 years (range, 20-60 years). The time from fracture to admission was 14-180 days (mean, 63 days). The displacement of the acetabular articular surface was more than or equal to 3 mm. According to the America Association of Orthopedic Surgeon (AAOS) acetabular fracture and defect classification standard, there were 4 cases of type I, 6 cases of type II, 5 cases of type III, and 2 cases of type IV. After the residual fracture fragments of the acetabular posterior wall and soft tissue hyperplasia were removed, the femoral head was reducted, and posterior wall defect was repaired with autologous iliac bone graft; ATMFS was used to fix acetabular posterior wall and artificial capsular ligament to reconstruct the hip so as to prevent re-dislocation of the femoral head. Results According to Matta imaging assessment standard, the results were excellent in 8 cases, good in 6 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 82.3%. All incisions healed by first intention, and no sciatic nerve injury occurred. All patients were followed up 1-8 years (mean, 3.9 years). The mean time of fracture union was 3.6 months (range, 2-6 months). Avascular necrosis of femoral head occurred in 1 case, heterotopic ossification around the acetabulum in 1 case. According to Merle d'Aubign6-Postel scoring system evaluation, the clinical results were excellent in 9 cases, good in 6 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 88.2%. Conclusion ATMFS combined with autologous iliac bone graft and artificial ligament

  9. Early clinical research of total hip arthroplasty for the treatment of old acetabular fractures%人工全髋关节置换治疗陈旧性髋臼骨折早期临床研究

    Institute of Scientific and Technical Information of China (English)

    赏后来; 赵建宁; 王与荣; 郭亭; 周利武; 程秀红; 周娟

    2012-01-01

    目的:分析人工全髋关节置换(THA)治疗陈旧性髋臼骨折的早期临床疗效.方法:自2007年1月至2010年6月采用THA治疗陈旧性髋臼骨折13例(13髋),其中男10例,女3例.10例髋臼骨折曾行单纯内固定治疗,3例曾行保守治疗.采用髋关节功能Harris评分评价疗效.结果:术后13例全部得到随访,持续1年,分别拍摄患侧髋关节正侧位X线片,对患侧髋关节功能进行Harris评分.术后随访1年,未见假体松动征象,Harris评分平均(83.38±3.33)分,较术前(37.19±20.12)分明显提高.结论:陈旧性髋臼骨折因骨折畸形愈合,内固定失败后骨折再次移位,大面积不规则骨缺损等问题,治疗难度大,术中恢复解剖位置困难,THA是治疗陈旧性髋臼骨折有效手术方法.但较普通全髋关节置换,需很强手术经验和技巧.%Objective: To analyze the early clinical effects of total hip arthroplasty (THA) for the treatment of old acetabular fractures. Methods: From January 2007 to June 2010, thirteen patients with old acetabular fractures were reviewed, including 10 males and 3 females. Ten patients were treated with internal fixation and conservative treatment had been used in three patients. The average Harris Hip Score was used to evaluate therapeutic effects. Results: After operation,all thirteen patients were followed up for one year. Hip X-ray films were taken and prosthesis loosening was not seen on any of the films at the 1st year after operation. The Harris Hip Score improved from preoperative (37.19?0.12) to postoperative (83.38?.33) .there was statistically significant difference. Conclusion; For reasons of malunion or failure of internal fixation, large and various bone defect,it's difficult to reach the anatomical reduction. THA is a good treatment method,but it needs rich skills and experience compared with ordinary operation.

  10. 腹股沟韧带下入路治疗髋臼前柱合并前壁骨折%Modified subinguinal approach for treatment of acetabular anterior column and wall fractures

    Institute of Scientific and Technical Information of China (English)

    高峰; 秦晓东; 李翔; 方永祥; 杨峰

    2016-01-01

    Objective To discuss the efficacy of the modified subinguinal approach for the treatment of acetabular anterior column and wall fractures.Methods A clinical retrospective study was performed of the 5 patients who had been treated at our department from January 2011 to April 2015 for acetabular anterior column and wall fractures and conformed to follow-ups.They were 3 males and 2 females,aged from 19 to 45 years (mean,35.6 years).The duration from injury to surgery averaged 7.6 days (range,from 4 to 10 days).The subinguinal ligament approach was adopted in the 5 cases,through which the inguinal ligament was preserved intact after sharp dissection of its insertion at the anterior superior iliac spine and medial-upper advancement,the advantage of expanded exposure of "the first window" by the Farid sub-ilioinguinal approach was retained,and additional lesions due to iliac osteotomy were avoided.The operation time,intraoperative bleeding,postoperative reduction and time for fracture union were documented.Merle d' Aubigne and Postel scoring system was used to assess the hip joint function of the affected limb at the final follow-ups.Results The operation time ranged from 110 to 150 minutes (mean,125 minutes);the intraoperative bleeding ranged from 415 to 550 mL (mean,450.2 mL).By the Matta's criteria,the postoperative reduction was rated as excellent in 4 cases and good in one.The 5 patients were followed up for an average of 32.4 months (range,from 6 to 43 months).Their fractures united clinically after an average of 4.6 months (range,from 3 to 6 months).The hip joint function was rated as excellent in 2 and good in 3 by the Merle d' Aubigne and Postel scoring system at the final follow-ups.Follow-ups observed no serious complications like inguinal hernia,internal fixation failure,myositis ossificans,or avascular necrosis of the femoral head.Conclusions As the modified subinguinal approach can provide a broad surgical exposure,lead to minimal injury to the inguinal

  11. 合并后壁骨折的复杂性髋臼骨折手术疗效分析%Analysis of Operative Treatment for Complex Acetabular Fractures Involving the Posterior Wall

    Institute of Scientific and Technical Information of China (English)

    孟纬; 潘昊鹏; 吕庆生; 朱伟

    2015-01-01

    目的:对手术治疗合并后壁骨折的复合髋臼骨折进行回顾性研究,评价其治疗效果。方法随访2003年8月至2013年8月采用切开复位内固定治疗的59例患者,其中横断伴后壁骨折41例,后柱伴后壁骨折18例。58例患者采用Kocher-Langenbeck 入路,1例患者采用联合入路( K-L 入路联合髂腹股沟入路)。采用改良的 Merle d′Aubigné和Postel评分系统评价临床效果,用Matta放射学标准评价影像学结果。结果59例患者平均随访4.3年(2.0~8.8年)。最终影像学结果:优23例(39%),良22例(37%),可10例(17%),差4例(7%),优良率76%。最终临床效果:优21例(36%),良26例(44%),可9例(15%),差3例(5%),优良率80%。结论对合并后壁骨折的复合髋臼骨折,切开复位内固定治疗可以获得满意效果。根据本组患者的治疗经验,对这类骨折推选双钢板固定。%Objective To evaluate the results of patients with operatively treated complex acetabular fractures involving the posterior wall retrospectively. Methods We reviewed fifty-nine patients who undurent open reduction and internal fixation of an unilateral fracture of the acetabulum between August 2003 to August 2013. Forty-one patients were diagnosed as trans-verse plus posterior wall fracture and eighteen patients were diagnosed as posterior column plus posterior wall fracture. The functional outcome was evaluated using a modification of the clinical grading system developed by Merled′Aubigné and Postel. The radiographs were graded according to the criteria described by Matta. Results Fifty-nine patients were followed for a mean of 4. 3 years(range,2. 0~8. 8 years). The radiographic result was excellent in twenty-three patients(39%),good in twenty-two(37%),fair in ten(17%),and poor in four(7%). The clinical outcome at the time of final follow-up was graded as excellent in twenty-one patients(36

  12. Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report.

    Science.gov (United States)

    Kircher, Jörn; Bader, Rainer; Schroeder, Bettina; Mittelmeier, Wolfram

    2009-09-01

    Improvements of ceramic components and design changes have reduced failure rates over the past 30 years in total hip arthroplasty. We present a series of n = 11 cases with ceramic failure out of n = 113 implantations, from which n = 66 were ceramic-on-ceramic (n = 50 with ceramic insert with sandwich in polyethylene and n = 16 with directly fixed ceramic inlay) and n = 47 ceramic on polyethylene bearings, between 1999 and 2001 after introduction of a new implantation system to the market. The overall fracture rate of ceramic for the whole series (n = 113) was 9.7%. For the combination ceramic head with UHMW-PE (n = 47) the fracture rate was 2.1%. For the combination ceramic with ceramic (n = 66) the fracture rate was 15.2%. For the combination ceramic with ceramic sandwich in PE (n = 50) the failure rate was 18%. Only three patients experienced a trauma. Demography of patients (age, gender, body weight and BMI) was not statistically different between patients with failed ceramics and the rest of the patients making patient-specific risk factors unlikely to be an explanation for the failures. Retrospective X-ray analysis of the cup positioning did not show significant difference between failed and non-failed implants in terms of mean cup inclination and version making also operation-specific factors unlikely to be the only reason of this high failure rate. Therefore, manufacturer-specific factors such as design features may have contributed to this high failure rate. Further analysis of the whole series with biomechanical testing of the retrieved material needs to be performed.

  13. Surgical treatment of unstable pelvic fractures combined with acetabular fractures%不稳定骨盆骨折合并髋臼骨折手术治疗的疗效分析

    Institute of Scientific and Technical Information of China (English)

    王陶; 王军; 李宗原; 刘刚

    2015-01-01

    目的:探讨不稳定骨盆骨折合并髋臼骨折的治疗策略及临床疗效。方法:2007年1月至2013年6月收治32例不稳定骨盆骨折合并髋臼骨折患者,男18例,女14例;年龄18~62岁,平均38岁。Tile骨盆骨折分型:B1型11例,B2.1型8例,B2.2型7例,C1.1型3例,C1.2型2例,C3型1例。Judet-Letournel髋臼骨折分型:前柱骨折1例,横形骨折8例,横形加后壁骨折6例,“T”形骨折1例,前柱加后半横形骨折5例,双柱骨折11例。早期处理其他合并6.5 h,平均3 h;术中失血450~3200 ml,平均1200 ml。有2例肥胖患者切口发生脂肪液化,换药后愈合,无切口感染病例。1例失访,31例获得随访,随访时间6~42个月,平均23个月。骨盆骨折愈合时间8~18周,平均10.6周。按照Matta和Tornetta的评分标准评价复位情况,优15例,良14例,可1例,差1例。Majeed功能评分为83.65±7.67,优15例,良12例,可4例。髋臼骨折愈合时间8~16周,平均10.2周。采用Matta评定标准评估术后复位质量,优15例,良12例,差4例。按Brooker标准评价异位骨化,Ⅰ度4例,Ⅱ度1例。无股骨头坏死及骨折不愈合发生,5例并有神经损伤者4~6个月后均完全恢复。结论:不稳定骨盆骨折合并髋臼骨折患者早期病情危重,运用损伤控制理念及时抢救生命为主。后期把握手术时机,治疗时髋臼骨折尽量解剖复位,骨盆骨折以重建稳定为主,手术复位顺序先固定骨盆后环,根据病情选择合适的手术入路及固定方式。%Objective:To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Methods:Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old(means 38

  14. Clinical applications for multiplanar- and three-dimensional-reconstructions by helical-CT for the diagnosis of acetabular fractures; Klinischer Einsatz multiplanarer und 3D-Rekonstruktionen der Spiral-CT in der Diagnostik der Azetabulumfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Stroszczynski, C. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Stoeckle, U. [Unfallchirurgische Klinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Wellmann, A. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Beier, J. [Deutsches Herzzentrum Berlin, Virchow-Klinikum, Abt. Innere Medizin und Kardiologie (Germany); Wicht, L. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Hoffmann, R. [Unfallchirurgische Klinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik im Virchow-Klinikum, Medizinische Fakultaet der Humboldt-Universitaet, Berlin (Germany)

    1996-03-01

    This review describes recent visualizations of computed tomography for the diagnosis of acetabular fractures. The techniques of conventional and helical-CT for the imaging of the acetabulum are compared. Furthermore, the different methods of multiplaner and three-dimensional reconstructions e.g. shaded surface display, maximum intensity projection, and volume rendering are presented. Figures of multiplanar and three-dimensional imaging for fractures of the pelvis is discussed. (orig.) [Deutsch] Es wird eine Uebersicht moderner computertomographischer Darstellungsmethoden der Azetabulumfrakturen vorgestellt. Auf die einzelnen Charaktersitika der konventionellen und Spiral-CT-Technik wird eingegangen, weiterhin werden die multiplanaren und verschiedenen 3dimensionalen Rekonstruktionsverfahren Shaded-Surface-Display (SSD), Maximum-Intensitaetsprojektion (MIP) und Volume-Rendering (VR) beschrieben und jeweils anhand von Abbildungen erlaeutert. Darueber hinaus wird das diagnostische Potential der einzelnen Methoden diskutiert. (orig.)

  15. Virtual fracture reduction of the acetabulum using a rigid body biomechanical model

    OpenAIRE

    Boudissa, Mehdi; Chabanas, Matthieu; Oliveri, Hadrien; Tonetti, Jérôme

    2014-01-01

    International audience; Acetabular fractures are a challenge in orthopaedic surgery. A simple rigid body biomechanical model of the hip is proposed to simulate the fracture reduction. The action of surgical tools can be simulated interactively, which enables clinicians to evaluate different strategies for a better surgical planning.

  16. Loosening After Acetabular Revision

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.;

    2014-01-01

    The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years)...

  17. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss?

    Science.gov (United States)

    Berasi, Carl C; Berend, Keith R; Adams, Joanne B; Ruh, Erin L; Lombardi, Adolph V

    2015-02-01

    's surgeon to determine whether migration, fracture of fixation screws, or continued bone loss had occurred. There have been four subsequent surgical interventions: two failures secondary to sepsis, and one stem revision and one open reduction internal fixation for periprosthetic femoral fracture. There were two minor complications managed nonoperatively, but all of the components were noted to be well-fixed with no obvious migration or loosening observed on the most recent radiographs. Harris hip scores improved from a mean of 42 (SD, ±16) before surgery to 65 (SD, ±18) at latest followup (pacetabular triflange components represent yet another tool in the reconstructive surgeon's armamentarium. These devices can be helpful in situations of catastrophic bone loss. Level IV, therapeutic study.

  18. Periprosthetic fracture of the acetabulum after total hip arthroplasty.

    Science.gov (United States)

    Peterson, C A; Lewallen, D G

    1996-08-01

    Eleven patients who had sustained a periprosthetic fracture of the acetabulum at a mean of 6.2 years (range, one month to thirteen years) after a total hip arthroplasty were managed at our institution between 1985 and 1991. Five patients had a fracture of the medial wall; three, a fracture of the posterior column; two, a transverse fracture; and one, a fracture of the anterior column. Six fractures were displaced by two millimeters or more. Eight fractures were caused by blunt trauma or a fall, and three occurred spontaneously. A fracture was classified as type 1 if the acetabular component was clinically and radiographically stable (eight patients) and as type 2 if the component was unstable (three patients). One patient, who had a displaced type-2 fracture of the posterior column, died of an associated intrapelvic vascular injury. The other two patients who had a type-2 fracture were managed with revision of the acetabular component without supplemental plate fixation, immediately after the diagnosis of the fracture. The eight patients who had a type-1 fracture initially were managed with limitation of weight-bearing or modification of activity; in six of these patients, the fracture united without additional treatment. The ten surviving patients were followed for a mean of sixty-two months after the fracture. Eight of these patients-including four in whom a type-1 fracture had united after non-operative treatment-had a revision of the acetabular component because of pain, loosening, or non-union by the time of the most recent follow-up. Two patients (one of whom had a type-1 fracture and the other, a type-2 fracture) had multiple revisions of the acetabular component; both had supplemental internal fixation with a plate. All ten patients ultimately had a stable, functioning prosthesis. We conclude that periprosthetic acetabular fractures are associated with a poor prognosis with regard to the survival of the acetabular component but that it is possible to

  19. Monolithic zirconia dental crowns. Internal fit, margin quality, fracture mode and load at fracture.

    Science.gov (United States)

    Schriwer, Christian; Skjold, Anneli; Gjerdet, Nils Roar; Øilo, Marit

    2017-09-01

    Dental all-ceramic restorations of zirconia, with and without an aesthetic veneering layer, have become a viable alternative to conventional metal-ceramic restorations. The aim of this study was to evaluate whether factors of the production methods or the material compositions affect load at fracture, fracture modes, internal fit or crown margins of monolithic zirconia crowns. Sixty crowns made from six different commercially available dental zirconias were produced to a model tooth with a shallow circumferential chamfer preparation. Internal fit was assessed by the replica method. The crown margin quality was assessed by light microscopy on an ordinal scale. The cemented crowns were loaded centrally in the occlusal fossa with a horizontal steel cylinder with a diameter of 13mm at 0.5mm/min until fracture. Fractographic analysis was performed on the fractured crowns. There were statistically significant differences among the groups regarding crown margins, internal fit and load at fracture (p<0.05, Kruskall Wallis). Fracture analyses revealed that all fractures started cervically and propagated to the occlusal surface similar to clinically observed fractures. There was statistically significant correlation between margin quality and load at fracture (Spearman's rank correlation, p<0,05). Production method and material composition of monolithic zirconia crowns affect internal fit, crown margin quality and the load at fracture. The hard-machined Y-TZP zirconia crowns had the best margin quality and the highest load at fracture. Reduction of margin flaws will improve fracture strength of monolithic zirconia crowns and thereby increase clinical success. Copyright © 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  20. Efficacy of three methods of internal fixation on femoralneck fracture

    Institute of Scientific and Technical Information of China (English)

    闫洪印; 陈扬; 肖建德; 李振宇; 龚敏; 马若凡; 刘尚礼

    2002-01-01

    @@ From 1990 to 2000, we used Hansson pin, AOhollow-pulling screw, and bendable screw to treat150 cases of fresh femoral neck fracture and theresult was analysed to compare the efficacy of the threemethods of internal fixation.

  1. Establishment of classified pelvic and acetabular fractures and their significance%骨盆髋臼骨折三维数字化分型系统的建立及其意义

    Institute of Scientific and Technical Information of China (English)

    王会祥; 汪方; 王秋根; 林艳萍; 陈豪; 陶星光

    2013-01-01

    目的 建立骨盆、髋臼骨折三维数字化分型系统,评价其对骨科临床及教学的指导意义.方法 将一名健康男性志愿者CT扫描所得数据转换成DICOM格式并导入Mimics10.01软件中进行处理,分别重建骨盆、髋臼模型,同时模拟出国际内固定研究学会(A0)分型中各型骨盆、髋臼骨折,对各骨折块予以不同颜色渲染,并将完成制作的骨折三维模型以标准三维图形(STL)文件格式保存.利用视觉化图像工具库(VTK)及跨平台C+ +图形用户界面应用程序开发框架(Qt)等软件开发工具,完成骨盆、髋臼骨折三维数字化分型软件开发.10名骨科医生及20名医学生分别将三维数字化骨盆、髋臼骨折AO分型图谱和传统的二维分型图谱与患者影像学资料进行对比,并给予初步评价.结果 骨盆、髋臼骨折三维数字化分型软件可实现对骨折三维模型的旋转及放缩等操作,从任意角度观察骨折模型.9名骨科医生及18名医学生评价提示,三维数字化骨折分型系统与传统的二维平面分型系统相比,利于对骨盆、髋臼骨折AO分型的理解和判断.结论 骨盆、髋臼骨折三维数字化分型系统具有逼真、直观、立体、动态等特点,对于骨科临床及医学教学具有积极意义.%Objective To establish three-dimensional (3D) digital classification models of pelvic and acetabular fractures and evaluate its significance in orthopaedic clinical and teaching work. Methods Pelvic of a healthy male volunteer was scanned with CT, and the resulting data in DICOM format was imported to Mimics10. 01 software to reconstruct the model of the pelvis and acetabulum respectively. Based on the standards of AO/ASIF classification of pelvic and acetabular fractures, various types of fractures were simulated. The fracture fragments were displayed with different colors. The completed fracture models were saved in STL format. By use of VTK and Qt softwares, the software

  2. Rationales for the Bernese approaches in acetabular surgery.

    Science.gov (United States)

    Keel, M J B; Ecker, T M; Siebenrock, K-A; Bastian, J D

    2012-10-01

    To present two new approaches to acetabular surgery that were established in Berne, and which aim at enhanced visualization and anatomical reconstruction of acetabular fractures. The trochanteric flip osteotomy allows for surgical hip dislocation, and was introduced as a posterior approach for acetabular fracture management involving the posterior column and wall. For acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach is described. Full exposure of the hip joint, as provided by the trochanteric flip osteotomy, facilitates anatomical reduction of acetabular or femoral head fractures and safe positioning of the anterior column screw in transverse or T-shaped fractures. Additionally, the approach enables osteochondral transplantation as a salvage procedure for severe chondral femoral head damage and osteoplasty of an associated inadequate offset at the femoral head-neck junction. The Pararectus approach allows anatomical restoration with minimal access morbidity, and combines advantages of the ilioinguinal and modified Stoppa approaches. Utilization of the trochanteric flip osteotomy eases visualization of the superior aspect of the acetabulum, and enables the evaluation and treatment of chondral lesions of the femoral head or acetabulum and labral tears. Displaced fractures of the anterior column with a medialized quadrilateral plate can be addressed successfully through the Pararectus approach, in which surgical access is associated with minimal morbidity. However, long-term results following the two presented Bernese approaches are needed to confirm that in the treatment of complex acetabular fractures the rate of poor results in almost one-third of all cases (as currently yielded using traditional approaches) might be reduced by the utilization of the presented novel approaches.

  3. Study on the Surgical Approaches for Patients with Involved Double Columns(wall) Acetabular Fractures%累及双柱(壁)髋臼骨折手术入路的选择

    Institute of Scientific and Technical Information of China (English)

    吴玉仙; 黄智勇

    2015-01-01

    目的:探讨累及双柱(壁)的髋臼骨折手术路径的选择及其对治疗效果的影响。方法选取青岛市骨伤医院2010年1月至2013年1月收治的39例累及双柱(壁)髋臼骨折患者为研究对象,根据手术方式不同将患者分为单一入路组(11例)和联合入路组(28例),比较两组患者的治疗效果、术中出血量及手术时间。结果术后,联合入路组优良率显著高于单一入路组(92.9%比63.6%),两组患者疗效比较差异有统计学意义( Z=3.45,P<0.05),但两组手术时间及术中出血量比较差异无统计学意义( P>0.05)。结论对于累及双柱(壁)的髋臼骨折手术入路的选择应根据骨折类型和合并症确定,科学选择的手术入路对于提高手术效果具有十分重要的意义。%Objective To investigate the influence of the selection of surgical approaches for patients with involved double columns(wall) acetabular fracture on the therapeutic effect.Methods A total of 39 patients with involved double columns(wall) acetabular fracture admitted in Qingdao Orthopedics Hospital from Jan.2010 to Jan.2013 was selected as the research objects .According to the surgical approach,patients were divided into single approach group and combined approach group,the treatment effects,intraoperative bleeding amount and operation time of the two groups were compared.Results After surgery,the excellent and good rates of the combined approach group was significantly higher than that of the single approach group (92.9% vs 63.6%),the treatment effects of the two groups had statistically significant differences (Z =3.45,P0.05).Conclusion The surgical approaches for patients with involved double columns( wall) acetabular fracture should be selected according to the types of fracture and complications,scientific selection of surgical approach has great importance in improving the surgical effect.

  4. Application of 3D Printing Technology in the Pre-operative Evaluation of Acetabular Fractures%3D打印技术在髋臼骨折术前评估中的应用

    Institute of Scientific and Technical Information of China (English)

    王庆; 安林; 薛波; 叶鹏翰; 徐荣明

    2016-01-01

    目的:探讨3D打印技术在髋臼骨折术前评估的临床应用价值。方法整群选取2014年1月—2015年6月对该院收治的7例髋臼骨折患者进行螺旋CT扫描,将其DICOM数据输入计算机中。应用3D打印技术打印骨折模型,将骨折模型与CT 3维重建影像进行比较,制定手术方案,随后实施手术,术后进行影像学检查,观察复位效果。与既往仅根据x线及CT 3维重建影像进行术前计划者对比术后复位效果。结果7例随访X线及CT显示关节面解剖复位5例,满意复位2例。与3维重建影像相比,可以更直观观察骨折块移位情况,在模型上可以模拟骨折复位情况,使术前计划更完善。结论3D打印技术应用有助于术者对髋臼骨折的理解和术前计划的制定,提高骨折复位质量。%Objective To explore the value of three dimension 3D printing technology in the pre-operation evaluation of ac-etabular fractures. Methods Convenient selection from January 2014 to June 2015, spiral CT scan was performed in 7 pa-tients with acetabular fracture. DICOM data were imported into Mimics software. The fracture models were printed out by 3D printing technology. Models and 3D reconstructed images were compared respectively. Operative planning was worked out, and then the operation was implemented. Postoperative reduction quality was assessed on radiographs and CT scan by observers. The results were compared with the planning that made on the basis of imaging. Results The follow up CT scan showed that 5 patients achieved anatomic reduction of articular surface, and 2 patients achieved satisfactory results. Com-parative result shows that surgeons with 3D technology can observe fractures visually and operations may be stimulated on modes. So pre-operative planning can be improved. Conclusion The 3D printing technology can help surgeons to under-stand about acetabular facture, and may be a powerful tool to work out preoperative

  5. Virtual operation planning in orthopedic surgery for acetabular fractures based on real CT data%基于真实CT数据骨科虚拟手术计划在髋臼骨折手术中的运用

    Institute of Scientific and Technical Information of China (English)

    汪光晔; 张春才; 许硕贵; 薜双桃; 林清高

    2011-01-01

    BACKGROUND: Virtual operation planning can help surgeons to improve the accuracy of orthopedic operations. OBJECTIVE:To test the feasibility and clinical value of preoperative virtual surgical planning in pelvis and acetabular fractures using Mimics software based on an interactive virtual reality-style environment.METHODS: Thirteen patients with pelvis and acetabular fractures were scanned with spiral CT preoperatively. The real data from CT in DICOM format were transformed into Mimics software. With segmentation process, each fracture segment became a separate object. Bone fragments could be moved and rotated in all three planes and reduction was performed Then we performed all the steps of the surgical procedure.RESULTS AND CONCLUSION: The median time needed to segment the osseous parts of an entire pelvis and to extract a surface model was 45 minutes (ranging 30 to 70 minutes), and the median time for fracture reduction was 28 minutes (ranging 16 to 45 minutes). The planned approach was followed in 12 of the 13 cases, the planned fixation was followed completely in 12 cases and partially in 1 cases. The screw count was identical to the planned operation in 10 cases, the screw length was Identical in 8 cases, and fixation plate count was Identical in 11 cases. Postoperative congruence of the acetabular joint surface as determined according to Matta in the follow-up CT was anatomic in 6 cases (46%) and satisfactory In 7 cases (54%). There was no case with inadvertent penetration of the hip joint Virtual operation planning in orthopedic surgery is helpful for enacting accurate operation program and providing data reference for actual operation, which brings significant value and new opportunities in clinical practice.%背景:骨科虚拟手术计划有助于提高外科医生的手术精确性.目的:探索计算机术前模拟手术技术在骨盆、髋臼骨折的治疗中的应用方法及临床价值.方法:对13例骨盆及髋臼骨折患者进行螺旋CT影

  6. Comparison of the Therapeutic Effect of Modified Stoppa Approach and Rectus Lateral Approach for the Treatment of Acetabular Fracture Combined with Ipsilateral Pelvic Fracture%改良stoppa切口入路与腹直肌外侧入路治疗合并骨盆骨折的髋臼骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    邵晏清; 熊然; 张潇; 杨晓东; 夏广; 樊仕才

    2016-01-01

    Objective To compare the curative effect of the modified stoppa incision and rectus lateral incision approach in treatment of acetabular fracture combined with ipsilateral pelvic fracture .Methods A retrospective analysis of the clinical data of 29 patients with acetabular fracture combined with ipsilateral pel-vic fracture treated in Southern Medical University Third Hospital from Mar .2011 to Apr.2014 was done, including 18 cases of lateral rectus incision approach(group A),11 cases of modified stoppa incision ap-proach(group B).The surgical exposure time,intraoperative blood loss,the fracture recovery and the postop-erative complications of the two groups were compared.Results Surgical exposure time in group A,B were (17.4 ±3.6) min,(16.9 ±4.4) min respectively; postoperative hip joint function score were (16.8 ± 2.7),(17.3 ±2.2) respectively,the differences had no statistical significance(P >0.05);intraoperative blood loss of group A was less than that in group B[(627 ±26) mL vs (742 ±40) mL],the difference was statistically significant(P0.05);A组术中出血量少于B组[(627 ±26) mL比(742 ±40) mL],差异有统计学意义(P0.05 ). 结论 经腹直肌外侧切口入路能充分显露髋臼前柱和四方体,能正视下复位并固定髋臼骨折,且手术显露简单、损伤小,手术并发症少,是治疗髋臼前方骨折尤其是累及四方体骨折的理想手术入路.

  7. 髋臼骨折病态肥胖对内固定术后并发症的影响%Acetabular fractures Impact of morbid obesity on complications afier fixation

    Institute of Scientific and Technical Information of China (English)

    Andrea C Skelly

    2011-01-01

    SummaryThree retrospective cohort studies of patients with acetabular fractures examined the impact of morbid obesity on patient complications after operative fracture fixation.The morbidly obese patient appears to have an elevated risk of more perioperative blood loss and of wound infection. While a higher rate of nerve palsy and pulmonary embolism was reported among morbidly obese patients compared with those in other weight categories in all studies, statistical significance was not achieved.One study reported increased risk of deep vein thrombosis (DVT) for obese patients compared with normal-weight patients.3项回顾性队列研究试图阐明髋臼骨折内固定术后,患者合并病态肥胖对术后并发症的影响。研究显示病态肥胖的患者术中失血量和伤口感染率更高。虽然与其他体质量的患者相比,病态肥胖的患者出现神经麻痹和肺栓塞的几率更高,但差异无统计学意义。1项研究报道,与正常体质量患者相比,肥胖患者深静脉血栓形成(DVT)的发生率更高。

  8. 髋臼横行骨折采用前后柱拉力螺钉结合重建钢板固定疗效分析%Analysis of the Effect of the Acetabular Transverse Fracture Using the Lag Screw of the Acetabulum and the Reconstruction Plate With the Reconstruction Plate

    Institute of Scientific and Technical Information of China (English)

    张立峰; 冯卫; 包道日娜; 冬梅; 佟雁翔

    2015-01-01

    Objective To investigate the clinical effect of the application of the acetabular transverse fracture in the treatment of the acetabular fracture and the reconstruction of the plate fixation with the lag screw of the acetabulum. Methods 50 cases of patients with transverse acetabular fracture were selected,and subject to acetabular posterior column lag screw combined with reconstruction plate fixation treatment,Bleeding volume,operation time, the acetabulum repositioning and hip joint function recovery after surgical of patients were observed. Results The average operation time was 3.5 hours, the average amount of bleeding was 950ml, according to Matta reduction, 25 cases of anatomic reduction, satisfactory reduction in 21 cases, 4 cases of unsatisfactory reduction, and the excellent and good rate of hip joint function was 86.0%. Conclusion The clinical effect of the acetabular transverse fracture patients with the acetabular anterior and posterior column lag screw combined with the reconstruction plate fixation is worthy of promotion.%目的:探讨对髋臼横行骨折患者应用髋臼前后柱拉力螺钉结合重建钢板固定治疗的临床疗效。方法选取髋臼横行骨折患者50例,对其进行髋臼前后柱拉力螺钉结合重建钢板固定手术治疗,观察患者手术时出血量、手术时间等,手术治疗后患者髋臼复位情况以及髋关节功能恢复情况。结果平均手术时间为3.5小时,平均出血量为950 ml,根据 matta 复位,25例解剖复位,21例满意复位,4例复位不满意,髋关节功能优良率为86.0%。结论对髋臼横行骨折患者采取髋臼前后柱拉力螺钉结合重建钢板固定手术治疗临床疗效突出。

  9. 移位髋臼骨折合并不稳定型骨盆后环损伤的临床特征及复位顺序%The clinical features and reduction sequence of displaced acetabular fractures associated with unstable posterior pelvic ring injuries

    Institute of Scientific and Technical Information of China (English)

    贾健; 郭志强; 武长林; 李卫哲; 田维; 黄洪超; 马宝通; 张铁良; 裴福兴

    2008-01-01

    目的 探讨移位髋臼骨折(displaced acetabular fracture,DAF)合并不稳定型骨盆后环损伤(posterior pelvic injury,PPI)的临床特征及复位顺序.方法 1997年3月至2007年3月,资料完整的DAF合并PPI患者39例,合并同侧PPI 25例、对侧9例、双侧5例.根据AO/OTA分型方法,髋臼A型骨折9例,B型25例,C型5例;骨盆后环B型损伤31例,C型8例.DAF与PPI同期切开复位内固定33例,分期手术3例,另3例PPI行非手术治疗.术中首先复位DAF 10例,首先复位PPI 18例,DAF与PPI同时复位11例.结果 术后随访12~120个月,平均33.7个月.根据Matta的评价标准,DAF解剖复位27例、复位满意4例、不满意8例.根据Meats的评价标准,PPI解剖复位24例、复位满意8例、不满意7例.其中因PPI移位而影响DAF满意复位者7例.DAF术后Matta功能评分为4~18分,平均14.7分.PPI术后Majeed疗效评分为51~100分,平均87.8分.以两个损伤部位的最低评分作为总体治疗结果,优25例、良3例、可2例、差9例.结论 在处理累及髋臼双柱的DAF合并PPI时,PPI的准确复位是DAF获得满意复位的解剖基础,DAF的损伤类型及其复位质量是决定远期疗效的主要因素.%Objective To explore the chnical features and reduction sequence of displaced acetabu- lar fractures (DAF) associated with unstable posterior pelvic injuries (PPI). Methods Thirty-nine patients with DAF combined PPI were treated from March 1997 to March 2007. The acetabular fractures with ipsilat- eral pelvic ring injuries were in 25 cases, contralateral injuries in 9, and both injuries in 5. According to AO/OTA classification, the partial intra-articular acetabular fractures affected a single column were in 9 cases, both-column in 25, complete acetabular fractures affected both-column in 5. The PP1 rotationally un- stable injuries were in 31 cases and rotationally combined vertically unstable type in 8. The open reduction and internal fixation of both injured pelvic ring and

  10. Outcome and complications of constrained acetabular components.

    Science.gov (United States)

    Yang, Cao; Goodman, Stuart B

    2009-02-01

    Constrained acetabular liners were developed for the surgical treatment of recurrent instability by holding the femoral head captive within the socket. This article summarizes the data describing constrained component designs, indications, outcome, and complications. Different designs accept head sizes of varying diameter and have differing amounts of rim elevation and offset, allowing slight variations in the range of movement allowed. Complications of constrained acetabular components can be divided into three categories. The first category is directly related to the constraining mechanism such as dislocation, head dissociation from the stem, liner dissociation from the acetabular device, and impingement with or without locking ring breakage. The second category is related to increased constraint such as aseptic component loosening and osteolysis and periprosthetic fracture. The third category includes those cases not associated with increased constraint such as infection, deep vein thrombosis, and periprosthetic fracture. This device is effective at achieving hip stability, but the complications related to the constraining mechanism and increased constraint are of concern. These devices should be used as a salvage measure for the treatment of severe instability.

  11. Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Iori Takigami

    2011-01-01

    Full Text Available Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA, typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

  12. Functional Outcome of Internal Fixation of Radial and Ulna Fracture

    Directory of Open Access Journals (Sweden)

    mehrdad Mansouri

    2006-02-01

    Conclusion: Anatomic reduction and internal fixation is the standard method for treatment of fractures by displacing radios and ulna in adults. According to results, it seems more intension to motions specially pronation and muscle strengthening foream after surgery will have affect on improving patients’ function specially pronation and Grip strength.

  13. RESORBABLE HIGH-STRENGTH ROD FOR FRACTURE INTERNAL FIXATION

    Institute of Scientific and Technical Information of China (English)

    杨团民; 刘淼; 杨爱玲; 石宗利; 邱希江; 李毅; 同志超; 韩月

    2004-01-01

    Objective To find an ideal biomaterial for internal fixation. Methods Forty rabbits with fracture of the femur diaphysis (superiorcondyle) were treated by intramedullary nailing of femur with composites rod of resorbable DL-polylactic acid (PDLLA)-calcium metaphosphate (CMP), while steinmann's pin as control. The fracture healing, the material degradation and its mechanical properties were studied by X-ray films, macroscopic, microscopic and electron microscopic observations. Results No significant inflammatory reaction was found, and all the osteotomies were healed, while material was resorbed. Conclusion The PDLLA-CMP has excellent biocompatibility and mechanical properties, and it can be a promising implant material in orthopaedics surgery.

  14. Internal Fixation of Open Ankle Fracture. Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodríguez

    2014-10-01

    Full Text Available Open ankle fracture is sporadically seen in the orthopedic practice. Its clinical course is subject to multiple factors, showing a propensity to cause ankle osteoarthritis over the years. Two cases treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos are presented. The patients underwent emergency surgical treatment consisting of surgical cleaning of the open wound, reduction of the dislocation and internal fixation of the fracture. These cases are presented due to the infrequency of this type of ankle injury and its importance for the medical staff, especially orthopedic doctors.

  15. Minimally invasive plate internal fixation for calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    SHAN Shu-lan; XU Jun-ling; YAO Shu-zhang; YU Guo-sheng; LIU Yu-qin

    2010-01-01

    Objective: To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.Methods: Manual reduction, rectification of deformity,and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.Results: All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.Conclusion: Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation,good recovery, and rare complications in the treatment of intraarticular fractures.

  16. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    Science.gov (United States)

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai

    2011-07-01

    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  17. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

  18. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Directory of Open Access Journals (Sweden)

    Jaiswal Atin

    2013-12-01

    Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal

  19. Reconstruction of internal orbital fractures with Vitallium mesh.

    Science.gov (United States)

    Sargent, L A; Fulks, K D

    1991-07-01

    Trauma to the face frequently results in internal orbital fractures that may produce large orbital defects involving multiple walls. Accurate anatomic reconstruction of the bony orbit is essential to maintain normal appearance and function of the eye following such injuries. Autogenous bone grafts do not always produce predictable long-term support of the globe. Displacement and varying amounts of bone-graft resorption can lead to enophthalmos. This study examines the use of Vitallium mesh in the acute reconstruction of internal orbital defects. Fifty-four patients with 66 orbits underwent reconstruction of internal orbital defects with Vitallium mesh. Associated fractures were anatomically reduced and rigidly fixed. Forty-six patients and 57 orbits had adequate follow-up for analysis of results. The average follow-up was 9 months, with 85 percent of the patients followed 6 months or longer. There were no postoperative orbital infections, and none of the Vitallium mesh required removal. Large internal orbital defects can be reconstructed using Vitallium mesh with good results and little risk of infection. Vitallium mesh appears to be well tolerated in spite of free communication with the sinuses. Stable reconstruction of the internal orbit can be achieved and predictable eye position maintained without donor-site morbidity.

  20. The medium term outcome of the Omnifit constrained acetabular cup.

    Science.gov (United States)

    Bigsby, Ewan; Whitehouse, Michael R; Bannister, Gordon C; Blom, Ashley W

    2012-01-01

    Recurrent dislocation requiring revision surgery occurs in approximately 4% of primary total hip arthroplasties (THAs). To reduce this risk, or to treat those patients who recurrently dislocate, a constrained acetabular component may be used, however there are concerns over the success of such components due to increased mechanical stresses. The purpose of this study was to analyse the survivorship and radiological results for the Omnifit constrained acetabular component, providing a longer patient reported outcome follow-up than previous studies. 117 patients (median age 82 years) underwent a THA with an Omnifit constrained acetabular component. Of these, 45 were primary replacements and 72 were revisions. Survivorship analysis was performed and patients were assessed both radiologically and functionally. At follow-up, 53 patients (45.3%) had died at a median time of 33 months from operation. The median overall follow-up was 7.0 (5.5-8.2) years. Survivors (median age 83 years) reported a median Oxford Hip Score (OHS) of 16.6 (0-48), 87.8% were satisfied with their surgery. 45 (91.8%) of the acetabular components were stable radiologically, 48 (96%) of the femoral components were stable (5 uncemented, 43 cemented) and two possibly unstable. Four of the 117 patients underwent further surgery. Only one required revision of the prosthesis and this was for a periprosthetic fracture. In the medium term the Omnifit constrained acetabular component prevents dislocation and does not cause excessive loosening of either the acetabular or femoral components in our patient population. Our results support the use of the Omnifit constrained acetabular component in elderly patients at risk of dislocation with low functional demand.

  1. 多层螺旋CT多模式重组在复杂髋臼骨折术前检查中的应用%The preoperative application of multi slice CT with three-dimensional reconstruction in complex acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    陈木养; 黄伟坚; 余洪希; 王东

    2016-01-01

    Objective To evaluate the value of volume scanning method, multiplanar reconstruction (MPR), surface shaded display (SSD), and volume reconstruction (VR) techniques in the preoperative examination of complex acetabular fractures. Methods Fifty-eight cases with ancetabular fractures were all accepted CT volume scanning , and MPR were done in all cases. In addition, case-control analysis were done with conventional acetabular CT imagings. Results Coronal plane of MPR, surface shaded display (SSD) combined with VR imaging, could display the acetabular fractures clearly, in accordance with the operations, and its diagnostic accuracy was significantly higher than conventional CT scan. The two sets of data had significances difference (P<0.05) in displaying fracture type, the length of the fracture lines, the shapes and direction of the fracture, the sizes of fracture pieces, the spatial location, the degree of fracture displacement and the joint dislocation classification. Conclusion Multi slice CT (MSCT) volume scanning, MPR, SSD and VR techniques have good display abilities of acetabular fractures , their performance are close to the pathological anatomy. They are considered to be the ideal imaging methods to know about the complex acetabular fractures and its microscopic structures.%目的:利用多层螺旋CT的容积扫描方法和多平面重建(MPR)、表面遮盖法(SSD)及容积再现(VR)技术,评价其在复杂性髋臼骨折术前检查中的应用价值。方法选取58例患者的损伤髋臼进行多层螺旋CT容积扫描,所得原始数据做数字化三维重组处理,并与常规髋臼CT平扫图像进行对照分析。结果 MPR冠状面、SSD重建结合VR成像,能清晰显示58例髋臼骨折情况,与手术相符,诊断正确率明显高于常规CT平扫。在显示骨折分型、骨折线的长短、形态、走向,骨折片大小、空间位置以及骨折移位程度和关节脱位分类征象方面,2组

  2. Port catheter fracture and migration in Internal Jugular Vein.

    Science.gov (United States)

    Doley, Rudra Prasad; Brar, Preetinder; Chaudhary, Sanchit; Bedi, Rajeev; Swami, Adarsh Chander; Wig, Jai Dev

    2012-01-01

    Central venous access devices for chemotherapy are being used extensively in patients with cancer. Spontaneous fracture and migration of the catheter is uncommon. We present the uncommon occurrence of a fracture and spontaneous migration of the fragment into the internal jugular vein as a delayed complication of a central venous access catheter implanted for chemotherapy administration. A patient with Ewing's sarcoma of the humerus with metastasis in the lungs underwent placement of a totally implantable venous access device. The port was in place for 1 year. The patient presented with pain in the right side of the neck. A chest X-ray demonstrated complete transection of the catheter and migration of the catheter fragment in the internal jugular vein. Both the migrated catheter fragment and the proximal part of the catheter were retrieved surgically. He had an uneventful recovery. Catheter fracture remains a potential complication, which must be recognized and treated promptly. Periodic chest imaging is recommended for detection and timely removal of the catheter.

  3. 3D打印技术在复杂髋臼骨折治疗中的应用%3D printing used in treatment of complex acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    张国明; 周东生; 贺宇; 王伯珉; 李连欣; 李庆虎; 余也

    2016-01-01

    Objective To evaluate 3D printing used in the treatment of complex acetabular fractures.Methods Between January 2009 and December 2013,121 patients with complex acetabular fracture were treated at our department.3D printing was used in surgical planning in 53 of them,including 36 males and 17 females with an average age of 41.2 ± 10.4 years (3D group).The other 68 patients received conventional surgery without use of 3D printing,including 42 males and 26 females with an average age of 42.6 ± 8.9 years (conventional group).By the Judet-Letournel classification system,there were respectively 7 and 9 T-type fractures,4 and 6 posterior column with posterior wall fractures,21 and 28 transverse and posterior wall fractures,5 and 6 anterior with the second half transverse fractures,and 16 and 19 double column fractures.Surgical time,blood loss,transfusion,fluoroscopy times and complications were recorded in the 2 groups.At the final follow-ups,the clinical results were assessed by Merle D'Aubigné & Postel scoring and the radiographic results were assessed by Matta records.The 2 groups were similar in preoperative demographic data (P > 0.05).Results In the 3D and conventional groups,respectively,surgical time was 3.5 ±O.9 hours versus 4.5 ± 1.1 hours,blood loss was 1,200.2 ±232.8 mL versus 1,550.4 ±211.6 mL,transfusion was 8.9 ± 3.8 U versus 12.3 ± 2.9 U,and fluoroscopy times were 8.7 ± 2.1 versus 11.9 ± 2.4.The differences between the 2 groups were statistically significant (P < 0.05).The 3D and conventional groups were respectively followed up for 20.3 and 37.8 months on average.All the acetabular fractures healed.The time from surgery to full-weight-bearing walking averaged 3.5 months.Iatrogenic ischiadic nerve injury occurred in 5 and 7 cases and superficial infection in 3 and 5 cases in the 3D and conventional groups,respectively.No iatrogenic vascular injury,nonunion,or implant failure occurred in the 2 groups.By the Merle D' Aubigné & Postel records

  4. Periprosthetic fractures of the acetabulum.

    Science.gov (United States)

    Helfet, David L; Ali, Arif

    2004-01-01

    Periprosthetic fractures of the acetabulum after total hip arthroplasty are uncommon, but are increasing in number and severity. These fractures may occur intraoperatively, during the perioperative period, or many years after the total hip arthroplasty. Periprosthetic fractures of the acetabulum vary in severity and may involve stress fractures of the pubis or medial wall, significant bone loss secondary to osteolysis and subsequent loss of column integrity, or complete pelvic discontinuity. Treatment differs depending on the complexity of the fracture and the stability of the acetabular prosthesis. Surgical treatment for an unstable acetabulum should stabilize the bony columns of the acetabulum, provide bone grafting of defects, and should maintain adequate bone stock for replacement of a stable acetabular implant. Strict adherence to the principles of fracture surgery is required to achieve bony union of the acetabular columns and provide a stable environment for reimplantation of an acetabular component.

  5. Late sciatic nerve axonotmesis following acetabular reconstruction plate.

    Science.gov (United States)

    Moreta, J; Foruria, X; Labayru, F

    2016-01-01

    Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Open reduction and internal fixation of proximal humerus fractures.

    Science.gov (United States)

    Drosdowech, Darren S; Faber, Kenneth J; Athwal, George S

    2008-10-01

    Open reduction of proximal humeral fractures has the advantage of providing direct control over each fracture fragment and permitting anatomic reduction and fixation with advanced devices. Modern fixed-angle locking plates designed specifically for proximal humerus fractures have allowed the expansion of surgical indications permitting surgeons to address more complicated fractures. Advanced preoperative imaging and fluoroscopy allow a better understanding of fracture patterns and permit the surgeon to use this knowledge intraoperatively. Research is required to further validate fracture classification systems, to develop surgical guidelines for decision making, and to compare the outcomes of the various treatments options for proximal humerus fractures.

  7. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  8. Internal fixation of mandibular angle fractures: a meta-analysis.

    Science.gov (United States)

    Regev, Eran; Shiff, Jacob S; Kiss, Alex; Fialkov, Jeffrey A

    2010-06-01

    The degree of rigidity of internal fixation required for the treatment of mandibular angle fractures has long been at the center of debate in the literature. A statistical comparison between rigid fixation and monocortical fixation has been difficult because of multiple terms, definitions, and technical variations. The purpose of this study was to use the meta-analysis tool to combine information from multiple studies and to compare complication rates for different fixation methods. An English language literature search was conducted for articles on mandibular angle fractures. Information was collected on four variables of interest: compression/noncompression technique, monocortical/bicortical screws, number of plates, and location of plates. Five outcome rates were analyzed: infection, reoperation, hardware removal, malunion, and nonunion. Meta-analyses were run using Comprehensive Meta Analysis, version 2.2.03. Twenty-four studies with relevant data on the variables and outcomes of interest met the inclusion criteria. Significantly higher rates of infection, reoperation, and hardware removal were found for compression compared with noncompression, two plates compared with one plate, and for plates located on both the inferior and superior borders as compared with superior or inferior only. There were also significantly higher infection rates for bicortical screws compared with monocortical screws and higher malunion rates for compression compared with noncompression plating techniques. The results of this meta-analysis found lower complication rates with the use of noncompression, monocortical, and single-plate fixation, supporting the trend toward a single, superiorly placed, monocortical miniplate for fixation of mandibular angle fractures.

  9. Early results of the use of oblong S-ROM cementless acetabular component

    Directory of Open Access Journals (Sweden)

    Popović Zoran

    2003-01-01

    Full Text Available Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method statisfactory in certain types of bone defefects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.

  10. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

    LENUS (Irish Health Repository)

    Brennan, S A

    2009-04-01

    PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

  11. 髋臼横行骨折两种内固定方式的有限元分析%Finite element analysis of two kinds of internal fixation methods for acetabulum transverse fracture

    Institute of Scientific and Technical Information of China (English)

    王庆; 薛波; 安林; 毛伟民; 叶鹏翰

    2016-01-01

    Objective To compare the biomechanical property of two kinds of internal fixation methods for acetabulum transverse fracture.Methods The model of acetabular fractures was established by finite element analysis method and using computer software to simulate the fixed mode of conventional posterior two steel plate and stoppa two steel plate in the inner side of the square area of the road. The biomechanical property of two kinds of internal fixation methods was compared.ResultsIt was very close of the total displacement of fracture between two fixed form, which showed that there was a similar total fixed effect of acetabular fracture between two fixed form. The difference between the displacement of fracture between two fixed form was very small, which showed that there was a similar fixed effect in front and back, internal and external and up and down two fixed form. ConclusionThere is no significant difference between the biomechanics of two kinds of internal fixation. The internal fixation with two plates from posterior approach may be substituted by stoppa approach.%目的:比较髋臼横行骨折两种内固定方式的生物力学性能。方法利用有限元分析方法,使用计算机软件建立髋臼骨折模型。模拟常规后路两块钢板及Stoppa入路四方区内侧两块钢板固定方式,比较两种固定方式的生物力学性能。结果两种固定方式中骨折块的总位移非常接近,表明这两种固定方式对这类髋臼骨折总的固定效果基本一致。此外,两种固定方式中骨折块之间的各方向的相对位移及其位移之差非常小,表明两种固定方式在前后、内外及上下方向的固定效果也基本一致。结论两种固定方式生物力学性能没有差别,Stoppa入路四方区内侧两块钢板固定方式可代替常规后路两块钢板进行髋臼横行骨折的固定。

  12. Evaluating the effect of internal aperture variability on transport in kilometer scale discrete fracture networks

    Science.gov (United States)

    Makedonska, Nataliia; Hyman, Jeffrey D.; Karra, Satish; Painter, Scott L.; Gable, Carl W.; Viswanathan, Hari S.

    2016-08-01

    The apertures of natural fractures in fractured rock are highly heterogeneous. However, in-fracture aperture variability is often neglected in flow and transport modeling and individual fractures are assumed to have uniform aperture distribution. The relative importance of in-fracture variability in flow and transport modeling within kilometer-scale field-scale fracture networks has been under a matter of debate for a long time because the flow in each single fracture is controlled not only by in-fracture variability but also by boundary conditions. Computational limitations have previously prohibited researchers from investigating the relative importance of in-fracture variability in flow and transport modeling within large-scale fracture networks. We address this question by incorporating internal heterogeneity of individual fractures into flow simulations within kilometer scale three-dimensional fracture networks, where fracture intensity, P32 (ratio between total fracture area and domain volume) is between 0.027 and 0.031 [1/m]. A recently developed discrete fracture network (DFN) simulation capability, dfnWorks, is used to generate DFNs that include in-fracture aperture variability represented by a stationary log-normal stochastic field with various correlation lengths and variances. The Lagrangian transport parameters, non-reacting travel time and cumulative retention, are calculated along particles streamlines. It is observed that due to local flow channeling early particle travel times are more sensitive to in-fracture variability than the tails of travel time distributions, where no significant effect of the in-fracture transmissivity variations and spatial correlation length is observed.

  13. Predicting fractures in an international cohort using risk factor algorithms without BMD.

    Science.gov (United States)

    Sambrook, Philip N; Flahive, Julie; Hooven, Fred H; Boonen, Steven; Chapurlat, Roland; Lindsay, Robert; Nguyen, Tuan V; Díez-Perez, Adolfo; Pfeilschifter, Johannes; Greenspan, Susan L; Hosmer, David; Netelenbos, J Coen; Adachi, Jonathan D; Watts, Nelson B; Cooper, Cyrus; Roux, Christian; Rossini, Maurizio; Siris, Ethel S; Silverman, Stuart; Saag, Kenneth G; Compston, Juliet E; LaCroix, Andrea; Gehlbach, Stephen

    2011-11-01

    Clinical risk factors are associated with increased probability of fracture in postmenopausal women. We sought to compare prediction models using self-reported clinical risk factors, excluding BMD, to predict incident fracture among postmenopausal women. The GLOW study enrolled women aged 55 years or older from 723 primary-care practices in 10 countries. The population comprised 19,586 women aged 60 years or older who were not receiving antiosteoporosis medication and were followed annually for 2 years. Self-administered questionnaires were used to collect data on characteristics, fracture risk factors, previous fractures, and health status. The main outcome measure compares the C index for models using the WHO Fracture Risk (FRAX), the Garvan Fracture Risk Calculator (FRC), and a simple model using age and prior fracture. Over 2 years, 880 women reported incident fractures including 69 hip fractures, 468 "major fractures" (as defined by FRAX), and 583 "osteoporotic fractures" (as defined by FRC). Using baseline clinical risk factors, both FRAX and FRC showed a moderate ability to correctly order hip fracture times (C index for hip fracture 0.78 and 0.76, respectively). C indices for "major" and "osteoporotic" fractures showed lower values, at 0.61 and 0.64. Neither algorithm was better than the model based on age + fracture history alone (C index for hip fracture 0.78). In conclusion, estimation of fracture risk in an international primary-care population of postmenopausal women can be made using clinical risk factors alone without BMD. However, more sophisticated models incorporating multiple clinical risk factors including falls were not superior to more parsimonious models in predicting future fracture in this population.

  14. Hand fractures and their management: an international view.

    Science.gov (United States)

    Bernstein, Michael L; Chung, Kevin C

    2006-11-01

    Fractures of the bones of the hand are among the commonest fractures in humans, but their management varies widely in the different regions of the world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Developing countries are more likely to apply less expensive methods of managing hand fractures. The treatment of these injuries will fall somewhere along a continuum that parallels the historical development of hand fracture management. This paper will review the history of phalangeal and metacarpal fracture management to infer global differences in the treatment of hand fractures. An overview of how different health care systems are likely to manage these injuries will assist health care providers in choosing the most appropriate treatment method.

  15. Osteoarthritis of the hip joint in elderly patients is most commonly atrophic, with low parameters of acetabular dysplasia and possible involvement of osteoporosis.

    Science.gov (United States)

    Ishidou, Yasuhiro; Matsuyama, Kanehiro; Sakuma, Daisuke; Setoguchi, Takao; Nagano, Satoshi; Kawamura, Ichiro; Maeda, Shingo; Komiya, Setsuro

    2017-12-01

    As elderly patients with hip osteoarthritis aged, acetabular dysplasia parameters decreased (Sharp's angle, acetabular roof obliquity angle, and acetabular head index) and the incidence of the atrophic type increased. Vertebral body fracture was more frequent in the atrophic type, suggesting the involvement of osteoporosis at the onset of hip osteoarthritis. Osteoarthritis (OA) is associated with increased bone formation at a local site. However, excessive bone resorption has also been found to occur in the early stages of OA. Osteoporosis may be involved in the onset of OA in elderly patients. We conducted a cross-sectional radiographic study of patients with hip OA and examined the association between age and factors of acetabular dysplasia (Sharp's angle, acetabular roof obliquity angle, and acetabular head index) as well as the osteoblastic response to determine the potential involvement of osteoporosis. This study included 366 patients (58 men, 308 women) who had undergone total hip arthroplasty for the diagnosis of hip OA. We measured the parameters of acetabular dysplasia using preoperative frontal X-ray images and evaluated each patient according to Bombelli classification of OA (hypertrophic, normotrophic, or atrophic type). As the patients aged, the parameters of acetabular dysplasia decreased. The incidence of the atrophic type of OA was significantly higher in older patients. Vertebral body fractures were more frequent in the atrophic type than in the other types. Additionally, the index of acetabular dysplasia was lower in the atrophic type. By contrast, the hypertrophic type was present in relatively younger patients and was associated with an increased index of acetabular dysplasia. In elderly patients with hip OA, the parameters of acetabular dysplasia decreased and the incidence of the atrophic type increased as the patients aged. The frequency of vertebral body fracture was high in patients with the atrophic type, suggesting the involvement of

  16. 前路钛板加方形区螺钉治疗髋臼双柱骨折的坐位生物力学分析%Biomechanical analysis of sitting position in both-column acetabular fractures fixed by anterior plate-screws in quadrilateral area

    Institute of Scientific and Technical Information of China (English)

    吴咏德; 蔡贤华; 刘曦明; 张红喜

    2013-01-01

    目的 探讨前路钛板加方形区螺钉治疗髋臼双柱骨折早期取坐位的可能性.方法 取成年防腐保湿处理的全骨盆标本6具,保留韧带及髋关节囊,制作单侧髋臼高位双柱骨折模型,随机先后采用前路钛板加方形区螺钉(B组)或常规钛板加1/3管型钛板(C组)内固定,固定标本于ZWICKZ100电子万能材料试验机上,模拟坐立位以400~700N加载,采用循环多次测量的方法,每组含标本6具,先后测定完整骨盆(A组)、B组及C组后柱内壁横向位移、骨盆轴向位移,计算骨盆轴向刚度.结果 随着载荷增加,位移:A组0.05),骨盆轴向位移及刚度有统计学差异(P0.05) ,while the difference of the axial displacement and the stiffness in pelvis were markedly significant (P <0.01).Conclusion The both-eolumn acetabular fractures fixed by anterior titanium plate-screws in quadrilateral area or the conventional 1/3 tube type titanium plate has the ideal internal result which allows patients to take the seat early ,but "anterior titanium plate-screws in quadrilateral area" is better than the conventional 1/3 tube type titanium plate on the stability of the hip joint ,which is close to the stability of normal pelvis.Sitting early is more secure and reliable in anterior titanium plate -screws in quadrilateral area.

  17. Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort

    DEFF Research Database (Denmark)

    Borges, Álvaro H; Hoy, Jennifer F; Florence, Eric

    2017-01-01

    fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed. Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70...... months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y...

  18. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Kenyu; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-01-15

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

  19. Clinical Analysis of Internal Fixation Treatment of Intra-articular Calcaneal Fractures with Titanium Plate.

    Science.gov (United States)

    Chen, Xiao-Dong; Zhang, Chang-Chun; Li, Zhao-Cheng; Zhang, Heng; Zhou, Xin-She; Deng, Min

    2015-05-01

    To explore the clinical effect of internal fixation treatment of intra-articular calcaneal fractures with titanium plate, we used open reduction and internal fixation with titanium plate to 48 treated feet from 42 patients with intra-articular calcaneal fractures. The efficacy of surgical treatment was evaluated based on assessment of pain, function, and line of force aspects according to the American Orthopedic Foot and Ankle Society scoring system. Our data show that internal fixation with titanium plate is an effective treatment for calcaneal fractures. It provides satisfactory reduction, reliable fixation, and early rehabilitation.

  20. Internal Fixation of Femoral Neck Fractures : Treatment and effects

    NARCIS (Netherlands)

    S.M. Zielinski (Stephanie)

    2015-01-01

    markdownabstract__Abstract__ This thesis consists of three parts. Part 1 described aspects of the organization of trauma related trials. Part 2 analyzed the uniformity of current femoral neck fracture treatment and adherence to the Dutch guideline on hip fracture treatment. The implications of

  1. Experimental biomechanical analysis of standing position in both-column acetabular fractures fixed by anterior reconstruction plate combinated with trans-plate quadrilateral screws%前路钛板加方形区螺钉治疗髋臼双柱骨折的站立位力学分析

    Institute of Scientific and Technical Information of China (English)

    蔡贤华; 吴咏德; 刘曦明; 张红喜

    2013-01-01

    [目的]探讨前路特殊塑形钛板加方形区螺钉治疗髋臼双柱骨折早期站立的可能性.[方法]选取成年防腐保湿处理的全骨盆标本6具,保留韧带及髋关节囊,制作单侧髋臼高位双柱骨折模型,随机先后采用前路特殊塑形钛板加方形区螺钉(B组)及常规塑形钛板加1/3管型钛板(C组)内固定,固定标本于ZWICKZ100电子万能材料试验机上,模拟站立位以400~700 N垂直加载,分别测定完整骨盆(A组)、B组及C组后柱内壁横向位移、髋臼顶纵向位移,并计算刚度.[结果]随着载荷增加,各位移值呈逐渐增加的线性关系,且A组<B组<C组;在生理负荷600N载荷下,横向与纵向位移值均为C组>B组>A组、刚度为C组>B组>A组,C组与B组、A组与C组间差异明显(P<0.05),B组与A组差异无显著意义(P>0.05).[结论]站立位下,前路特殊塑形钛板加方形区螺钉较常规塑形钛板加1/3管型钛板内固定即刻力学性能更为可靠,稳定性与完整骨盆接近,这表明早期站立并不影响前路特殊塑形钛板加方形区螺钉内固定的稳定性.%[ Objective] To explore the standing possibility in the early after both - column acetabular fracture fixed by anterior specially - shaped reconstruction plate combinated with trans - plate quadrilateral screws on cadaver. [ Method] Six Chinese adult wetly pelvic specimens with their ligament and joint capsule of hip joint preserved with antisepsis were made into the model with high both-column acetabular fracture on one side. The fractures were fixed randomly by anterior specially-shaped titanium plate with quadrilateral screws( group B) or conventionally-shaped reconstruction titanium plate with 1/3 tubular titanium plate (group C). To imitate the static standing position of the patient,the specimen fixed on ZWICK-Z100 electronic universal material testing machine received the vertical loading from 400 N to 700 N to measure the transverse displacement of

  2. Options for acetabular fixation surfaces.

    Science.gov (United States)

    Klika, Alison K; Murray, Trevor G; Darwiche, Hussein; Barsoum, Wael K

    2007-01-01

    Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have

  3. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    NARCIS (Netherlands)

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  4. A proposal for an international brittle fracture acceptance criterion for nuclear material transport cask applications

    Energy Technology Data Exchange (ETDEWEB)

    Sorenson, K.B.; Salzbrenner, R.J.; Nickell, R.E.

    1989-01-01

    This paper presents a fundamental basis for a brittle fracture acceptance criterion, examine several existing criteria and propose examples for consideration as international brittle fracture acceptance criteria. The proposed criteria are intended to stimulate discussion in order to advance the development of a consensus approach. 8 refs., 1 fig., 1 tab.

  5. Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting

    Institute of Scientific and Technical Information of China (English)

    ZHAI Ji-liang; LIN Jin; JIN Jin; QIAN Wen-wei; WENG Xi-sheng

    2011-01-01

    Background Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.Methods This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky ⅡC, 6 were ⅢA, and 4 were ⅢB. The mean age at the time of surgery was 63.0 years (range, 46-78 years). During revision surgery, a reinforcement ring was implanted in 6patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9-71 months).Results The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit.The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes,debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification,aseptic loosening, or infection.Conclusion Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.

  6. Acute Stress Fracture of the Pelvis after Total Hip Arthroplasty: A Case Report.

    Science.gov (United States)

    Akinbo, Oluwaseun; Tyagi, Vineet

    2017-01-01

    Acute hip pain following total hip arthroplasty (THA) could have numerous causes to include stress fracture of the pelvis. Stress fractures of the pelvis are rare and have been reported to involve the medial wall and the pubic ramus. A unique case is presented demonstrating the clinical presentation and management of an acute stress fracture of ilium and anterior column following a THA. A 72-year-old man underwent an uncomplicated right THA. He was noted to have femoral head resorption and thin osteoporotic bone intraoperatively. He initially did well postoperatively and ambulating without pain or assistive devices. Within 1 month of surgery, he returned with acute right hip pain without any traumatic event. Radiographs showed migration of the acetabular component and computed tomography scan confirmed a fracture through the ilium. The patient underwent revision surgery, where the fracture was reduced and internal fixation was achieved with a reconstruction plate and acetabular cage construct. At 9 months postoperatively, the patient remained pain-free with full weight bearing and with stable radiographs. Elderly patients who undergo THA may have low bone mineral density. These patients can develop stress fractures in their pelvis after surgery. These fractures may involve the medial wall, posterior column, or posterior wall. In patients who develop atraumatic pain postoperatively, it is important to consider for potential stress fractures of the ilium and evaluate appropriately with imaging. In these cases, revision surgery can be necessary to provide fixation of the stress fracture.

  7. Open reduction and internal fixation of radial head fractures.

    Science.gov (United States)

    Iacobellis, C; Visentin, A; Aldegheri, R

    2012-05-01

    This study examines 32 patients operated for radial head fractures, mean age 48.7 years (range 26-76 years), Mason type II in 25 cases and Mason type III with 3 main fragments in 7 cases. Fractures were surgically reduced and fixed with Herbert's (12 cases) or Osteomed (20 cases) cannulated screws. The latter have a head that is prono-supination. In addition, suturing of the annular ligament and the joint capsule is made easier by the reduced invasiveness of screws. Screw treatment is effective in non-comminuted fractures of the radial head.

  8. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Institute of Scientific and Technical Information of China (English)

    Atin Jaiswal; Naiman Deepak Kachchhap; Rupak Chaterjee; Yashwant Singh Tanwar; Masood Habib; Satya Prakash Singh

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  9. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates.

    Science.gov (United States)

    Jaiswal, Atin; Kachchhap, Naiman Deepak; Chaterjee, Rupak; Tanwar, Yashwant Singh; Habib, Masood; Singh, Satya Prakash

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  10. OUTCOME ANALYSIS OF PROXIMAL HUMERUS FRACTURES TREATED BY MINIMAL INTERNAL FIXATION

    Directory of Open Access Journals (Sweden)

    Venkatesh Kumar

    2014-05-01

    Full Text Available The aim of the study was to evaluate the functional outcome in patients treated with proximal humeral fracture who were treated with minimally internal fixations like K-wires, osteosutures etc.

  11. Biomechanical evaluation of maxillary Lefort Ι fracture with bioabsorbable osteosynthesis internal fixation.

    Science.gov (United States)

    Wu, Wei; Zhou, Jiang; Xu, Chong-Tao; Zhang, Jie; Jin, Yan-Jiao; Sun, Geng-Lin

    2014-12-01

    The aim of this study was to apply biomechanical analysis model to evaluate the effects of bioabsorbable internal fixation devices on maxillary Lefort Ι fracture. CT scan technology and the finite element software (ansys) were used to establish three-dimensional finite element models of five resorbable internal fixation devices in maxillary Lefort Ι fractures. We used the model to calculate the stress of the upper jaw and internal fixation. We further analyzed the stability of fixation under four occlusions. The fixation using two bioabsorbable plates was not stable. The zygomaticomaxillary pillars fixation is more stable than other fixations. The stability of fracture fixation was influenced with the molar occlusion. The current study developed a functional three-dimensional finite element model of bioabsorbable internal fixation and compared the stability of five fixation methods for maxillary Lefort Ι fractures. The results would facilitate the application of bioabsorbable materials in dental clinic.

  12. Management of recurrent fracture of central incisor with internal resorption using light transmitting (luminex) post.

    Science.gov (United States)

    Hariharan, V S; Nandlal, B; Srilatha, K T

    2010-01-01

    The normal root canal anatomy may be altered in various pathological processes and making it very difficult and at times impossible to achieve ideal obturation by normal methods. Internal resorption is one among them. There are several treatment protocols advised for this pathological condition. A crown-root fracture is defined as a fracture involving enamel, dentin and cementum and accounts for 5% of all traumatic injuries to the permanent dentition. In anterior teeth, these fractures are usually caused by direct trauma and often complicated in fully erupted teeth. In cases where the fracture line extends down along the long axis of the root, extraction of the tooth is indicated. The purpose of this report is to present the use of light transmitting post system to reinforce the crown root fractured maxillary central incisor due to trauma and internal resorption.

  13. Management of recurrent fracture of central incisor with internal resorption using light transmitting (luminex post

    Directory of Open Access Journals (Sweden)

    Hariharan V

    2010-01-01

    Full Text Available The normal root canal anatomy may be altered in various pathological processes and making it very difficult and at times impossible to achieve ideal obturation by normal methods. Internal resorption is one among them. There are several treatment protocols advised for this pathological condition. A crown-root fracture is defined as a fracture involving enamel, dentin and cementum and accounts for 5% of all traumatic injuries to the permanent dentition. In anterior teeth, these fractures are usually caused by direct trauma and often complicated in fully erupted teeth. In cases where the fracture line extends down along the long axis of the root, extraction of the tooth is indicated. The purpose of this report is to present the use of light transmitting post system to reinforce the crown root fractured maxillary central incisor due to trauma and internal resorption.

  14. Biomechanical analysis of four types of internal fixation in subtrochanteric fracture models.

    Science.gov (United States)

    Wang, Jie; Ma, Xin-long; Ma, Jian-xiong; Xing, Dan; Yang, Yang; Zhu, Shao-wen; Ma, Bao-yi; Chen, Yang; Feng, Rui; Jia, Hao-bo; Yu, Jing-tao

    2014-05-01

    To compare the biomechanical properties of four types of internal fixation (proximal femoral nail [PFN], dynamic hip screw [DHS], dynamic condylar screw [DCS], and proximal femoral locking plate [PFLP]) for different types of subtrochanteric fractures. Thirty-two antiseptic femurs were randomly divided into four groups. After internal fixation had been implanted, different types of subtrochanteric fracture models were produced and each tested under vertical, torsional and vertical damage loads. The stiffness ratio of PFN in each fracture model and failure load were the highest in the four groups; however, the torsional stiffness ratio was the lowest. Tension strain ratios of DHS and DCS on the lateral side became compression strain ratios with restoration of the medial fragment. The stiffness ratio of DHS was lower than PFLP in each fracture model, torsional stiffness ratio was the highest in fracture models II to V and the failure load was lower only than PFN. The stiffness ratio and failure load of DCS were both the lowest, torsional stiffness ratio was similar to PFLP's in fracture models II to V. The stiffness ratio of PFLP was only lower than PFN's in each fracture model, but the failure load was lower than DHS's. Four types of internal fixation achieve better stabilities for type I subtrochanteric fractures. PFN and PFLP produce reliable stability in type IIIA subtrochanteric fractures. If the medial buttress is restored, DCS can be considered. For type IV subtrochanteric fractures, only PFN provides stable fixation. PFLP is suitable for comminuted fractures with large fragments. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  15. Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)

    LENUS (Irish Health Repository)

    Maher, Ann Butler

    2012-10-23

    The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):\\r\

  16. Treatment of stable and unstable intertrochanteric fractures with selfdynamisable internal fixator (concept of double dynamisation

    Directory of Open Access Journals (Sweden)

    Kostić Igor M.

    2015-01-01

    Full Text Available Bacground/Aim. Intertrochanteric fractures of the femur are the third most common fractures among all bone fractures. Today in everyday orthopedic practice a number of different methods of treatment of trochanteric fractures of the femur are applied. Despite the improvement in the development of new implants, the percentage of serious complications of the treatment of these fractures remains very high, varying from 10% to 20%. One of the most serious complications of internal fixation of intertrochanteric fractures is nonunion of fractures due to the lack of additional axial dynamisation of implants. The aim of this study was to determine the efficacy of double dynamisation in stable and unstable intertrochanteric fractures treatment using the self dynamisable internal fixator. Methods. During the period from 2000 to 2009 we analyzed the use of selfdynamisable internal fixator (SIF implant in the treatment of 247 patients with stable and unstable intertrochanteric fractures. Fracture types were classified according to the AO Fracture Classification/Orthopaedic Trauma Association Scheme. Salvati and Wilson scoring systems were used for functional assessment considering pain, walking ability and hip movements of operated patients. Results. Of the total number of treated patients, 134 were males and 113 females, aged 19 to 90 (average 49.6 years. More than a half of the patients were older than 50 years. Monitoring of the patients after the operation was carried out clinically and radiographically for a period of three to six months in all the patients, whereas a 2-year follow-up was conducted in 176 (71.2% patients. The average duration of surgery was 47 min, the average blood loss 145 mL, and the average fluoroscopy time was 16 sec (8-97 sec. The average time for union was 3.7 months (3-6.5 months. Double dynamisation (dynamisation along the neck and shaft of the femur was observed in 85 (34.4% patients, and was on average 4.3 mm (1.5-8 mm. All

  17. A new device for internal fixation of thoracolumbar and lumbar spine fractures: the 'fixateur interne'.

    Science.gov (United States)

    Dick, W; Kluger, P; Magerl, F; Woersdörfer, O; Zäch, G

    1985-08-01

    A new system of operative fixation of thoracolumbar and lumbar spine fractures is presented: the 'fixateur interne' (F.I.). From a posterior approach long Schanz screws are inserted through the pedicles into the body of the two vertebrae just adjacent to the lesion and connected by th threaded F.I. rods. By tightening the nuts the Schanz screws are fixed in all directions. The advantages of the F.I. system are: excellent reposition by the long lever-arm of the Schanz screws, immobilization of only two segments and therefore good mobility of the residual spine, stability against flexion forces better than is obtained with Harrington distraction rods, additional rotational stability, and fixation in lordosis or kyphosis as is desired. The F.I. does not act as a four point bending system like all other dorsal spine instrumentation systems, but provides stability in flexion by itself. Therefore it can be Used independently of the condition of all ligaments (including the anterior longitudinal ligament) and of the posterior wall of the fractured vertebrae, and there is no need to fix more than the two immediately adjacent vertebrae, thus avoiding the often painful and cumbersome iatrogenic loss of lumbar lordosis and of mobility and permitting early mobilization of the patient. Experience with the first 45 patients is very promising.

  18. Proceedings of the International Symposium on Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances

    Energy Technology Data Exchange (ETDEWEB)

    Faybishenko, B. (ed.)

    1999-02-01

    This publication contains extended abstracts of papers presented at the International Symposium ''Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances'' held at Ernest Orlando Lawrence Berkeley National Laboratory on February 10-12, 1999. This Symposium is organized in Honor of the 80th Birthday of Paul A. Witherspoon, who initiated some of the early investigations on flow and transport in fractured rocks at the University of California, Berkeley, and at Lawrence Berkeley National Laboratory. He is a key figure in the development of basic concepts, modeling, and field measurements of fluid flow and contaminant transport in fractured rock systems. The technical problems of assessing fluid flow, radionuclide transport, site characterization, modeling, and performance assessment in fractured rocks remain the most challenging aspects of subsurface flow and transport investigations. An understanding of these important aspects of hydrogeology is needed to assess disposal of nu clear wastes, development of geothermal resources, production of oil and gas resources, and remediation of contaminated sites. These Proceedings of more than 100 papers from 12 countries discuss recent scientific and practical developments and the status of our understanding of fluid flow and radionuclide transport in fractured rocks. The main topics of the papers are: Theoretical studies of fluid flow in fractured rocks; Multi-phase flow and reactive chemical transport in fractured rocks; Fracture/matrix interactions; Hydrogeological and transport testing; Fracture flow models; Vadose zone studies; Isotopic studies of flow in fractured systems; Fractures in geothermal systems; Remediation and colloid transport in fractured systems; and Nuclear waste disposal in fractured rocks.

  19. External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

    Directory of Open Access Journals (Sweden)

    Golubović Zoran

    2007-01-01

    Full Text Available Background/Aim. Intraarticular fractures of the tibial plafond (pilon fractures belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. Methods. The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Niš (1995-2004. Within the analyzed group there were 33 (70.2% males and 14 (29.8% females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitković" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. Conclusion. Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the treatment of fractures of the tibial plafond causing less complications than internal fixation. .

  20. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation

    Directory of Open Access Journals (Sweden)

    Keykhosro Mardanpour

    2013-07-01

    Full Text Available BACKGROUND: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHOD: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67. Twenty six patients were men (4patients with type B and 22 patients with type C fracture and 12 women (7 patients with type B and 5 patients with type C fracture. The commonest cause was a road traffic accident (N=37, about 97%. Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. the commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months.The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005. CONCLUSION: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks

  1. Penetration of a metallic femoral head through the acetabular shell.

    Science.gov (United States)

    Sherman, Robert A; Damron, Timothy A

    2009-10-01

    Extensive wear of a metal-on-polyethylene total hip arthroplasty may rarely result in erosion of the metal-backed acetabular shell and penetration of the femoral head. We report on the case of an 85-year-old man who presented to the emergency department with an apparent dislocated total hip. He subsequently was discovered to have a periprosthetic fracture after an attempt at closed reduction of what was only discovered intraoperatively to be an irreducible transacetabular component central dislocation. Recognition of this rare complication may change clinical outcome.

  2. [Implant materials for the internal fixation of midfacial fractures].

    Science.gov (United States)

    Stuck, B A; Heller, T

    2011-11-01

    The material used for osteosynthesis plays a crucial role in the management of facial fractures. Plates need to be flexible enough to be bent and should not be palpable through the skin, while ensuring stable fixation und adequate biocompatibility. Although stainless steel was initially the material of choice, titanium has become the standard material due to its superior biocompatibility. While the explantation of titanium plates and screws appears unnecessary in general, it should be considered in cases of dislocation, cosmetic concerns, pain and infection. Due to their limited initial stability and a potential increase in local complications, resorbable materials based on polymeric lactose are used with caution in midfacial fractures in adults. Our own retrospective study comparing the postoperative complications after fixation of lateral midfacial fractures with titanium and resorbable systems demonstrated a low complication rate for both systems (7-8%) and no statistically significant difference between the two. The appropriate material for fixation should be selected based on the localization and severity of the fracture, the experience of the surgeon as well as on the age and overall condition of the patient.

  3. 全髋关节置换与髋关节表面置换治疗髋臼骨折后骨关节炎的疗效研究%Study on the Curative Effect of Total Hip Replacement and Hip Resurfacing for Osteoarthritis after Acetabular Fracture

    Institute of Scientific and Technical Information of China (English)

    张勇

    2012-01-01

    Objective To compare clinical curative effect of total hip replacement and hip resurfacing for osteoarthritis after acetabular fracture. Methods 61 patients( 61 hips ) with osteoarthritis after acetabular fractures from Heze Municipal Hospital during January 2008 to May 2010 were randomly divided into total hip replacement group( 31 cases )and hip resurfacing group( 30 cases ),hip function were evaluated after the operation. Results Follow-up time was 9 months to 5. 5 years, hip activities of all patients have improved markedly, pain symptoms disappeared or improved obviously, no complications of neurovascular injury, prosthesis loosening, joint dislocation, lower extremity deep vein thrombosis, and femoral neck fracture occurred. In total hip replacement group 3 hips were with X-ray bright area,l hip was with a focal bone dissolving. Hip resurfacing group hip flexion activities degree was greater than total hip replacement group, the difference was statistically significant P <0. 05 ). Conclusion Hip resurfacing can be chosen for younger patients or elder patients with higher requirement for activity to treat osteoarthritis after acetabular fractures, which may improve postoperative joint function significantly, and realize better degrees of hip flexion and extension activities.%目的 比较全髋关节置换和髋关节表面置换对髋臼骨折后骨关节炎的临床疗效.方法 将菏泽市立医院2008年1月至2010年5月收治的髋臼骨折后创伤性关节炎患者61例(61髋)随机分为全髋关节置换组(31例)和髋关节表面置换组(30例),术后评定髋关节功能.结果 随访时间为9个月至5.5年,所有患者髋关节活动显著改善,疼痛症状消失或明显好转,无神经血管损伤、假体松动、关节脱位、下肢深静脉血栓形成、股骨颈骨折等并发症发生.全髋关节置换组3髋有X线片透亮区,1髋有局灶性骨溶解.髋关节表面置换组术后髋关节屈伸活动度大于全髋关节置换

  4. [Periprosthetic Acetabulum Fractures].

    Science.gov (United States)

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G

    2016-12-01

    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered. Georg Thieme Verlag KG Stuttgart · New York.

  5. Periprosthetic fracture of the acetabulum during total hip arthroplasty in a patient with Paget's disease.

    Science.gov (United States)

    McGrory, B J

    1999-04-01

    The case of a patient with Paget's disease of the pelvis (acetabulum) who had an intraoperative posterior wall fracture during the insertion of a noncemented acetabular component into an under-reamed acetabular bed of sclerotic Pagetoid bone is reported. This unusual complication has not, to my knowledge, been previously reported. Patients with sclerotic bone, like those with osteoporotic bone, may also be at risk for periprosthetic acetabular fractures when an under-reaming technique is used.

  6. Open Reduction and Internal Fixation of a Fracture-dislocation of the Ankle

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodriguez

    2015-12-01

    Full Text Available Open reduction and internal fixation of the fracture-dislocation of the ankle with plates, screws and Kirschner wires is a well-defined treatment method. This paper presents the management of a fracture-dislocation of the right ankle in a 33-year-old female patient stabilized by using a one-third tubular plate, screws, and Kirschner wires with tension-band wires. Results were satisfactory.

  7. Numerical Simulation of Rock Fracturing under Uniaxial Compression Using Virtual Internal Bond Model

    Institute of Scientific and Technical Information of China (English)

    KE Chang-ren; JIANG Jun-ling; GE Xiu-run

    2009-01-01

    A multi-scale virtual internal bond (VIB) model for the isotropic materials has been recently proposed to describe the material deformation and fracturing. During the simulation process of material fracturing using VIB, the fracture criterion is directly built into the constitutive formulation of the material using the cohesive force law. Enlightened by the similarity of the damage constitutive model of rock under uniaxial compression and the cohesive force law of VIB, a VIB density function of rock under uniaxial compression is suggested. The elastic modulus tensor is formulated on the basis of the density function. Thus the complete deformation process of rock under the uniaxial compression is simulated.

  8. Image-guided percutaneous internal fixation of sacral fracture.

    Science.gov (United States)

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Using biomechanics to improve the surgical technique for internal fixation of intracapsular femoral neck fractures.

    Science.gov (United States)

    Wu, Chi-Chuan

    2010-01-01

    Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.

  10. Acetabular spacers in 2-stage hip revision: is it worth it? A single-centre retrospective study.

    Science.gov (United States)

    Burastero, Giorgio; Basso, Marco; Carrega, Giuliana; Cavagnaro, Luca; Chiarlone, Francesco; Salomone, Carlo; Papa, Gabriele; Felli, Lamberto

    2017-03-31

    The aim of this work is to evaluate an acetabular antibiotic loaded bone cement spacer in 2-stage revision surgery as a potential approach able to reduce complications during the inter-stage period (i.e. dislocation, acetabular wear), as well as simplify 2-stage hip revision surgery and improve hip biomechanics. We performed a retrospective comparative study and evaluated clinical, radiological and surgical data of 71 patients affected by periprosthetic hip infection who were treated with 2-stage exchange. 31 patients were treated using an acetabular spacer in addition to the femoral (group A) while 40 underwent a standard revision surgery (femoral spacer only, group B). Mean time of surgery for the first stage was 148 ± 59 minutes and 142 ± 45 minutes for group A and B respectively; we noted a statistically significant reduction (26 min, p = 0.015) in the same parameter for the second stage (83 ± 35 minutes for group A and 109 ± 36 minutes for group B). We observed the following interstage complications: 5 femoral spacer dislocations (1 for group A and 4 for group B); 1 spacer fracture (group B), 1 spacer fracture (group A), 2 periprosthetic fractures (group B) and 2 patients with acetabular spacer instability (group B). Additionally, we observed a significant improvement in leg length restoration for group A (p = 0.03). Our data show that the acetabular spacer technique is able to reduce the interstage complication rate and allow improved hip biomechanics restoration.

  11. Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial.

    Science.gov (United States)

    Mulders, Marjolein A M; Walenkamp, Monique M J; Goslings, J Carel; Schep, Niels W L

    2016-02-09

    Of all distal radius fractures, 25 % are complete articular fractures (AO/OTA type C fractures). Two thirds of those fractures are displaced and require reduction. According to several International Guidelines, adequately reduced intra-articular distal radius fractures are best treated non-operatively with plaster immobilisation, while surgical fixation is suggested only when the articular step exceeds 2 mm after reduction. However, these recommendations are based on studies that did not differentiate between intra- and extra-articular distal radius fractures. Thus, no clear consensus about the best treatment for patients with displaced intra-articular distal radius fractures can be reached. Despite the lack of evidence, an increase in internal fixation of intra-articular distal radius fractures has been observed over the last decade. The aim of this study is to determine the difference in functional outcome following open reduction and plate fixation compared with non-operative treatment with closed reduction and plaster immobilisation in patients with a displaced intra articular distal radius fracture. This multicentre randomised controlled trial will randomise between open reduction and internal plate fixation (intervention group) and closed reduction and plaster immobilisation (control group). All consecutive adult patients from 18 to 65 years with a displaced intra-articular distal radius fracture (AO/OTA type C), which has been adequately reduced at the Emergency Department according to the Dutch National Guidelines, are eligible for inclusion in this study. The primary outcome is function and pain of the wrist assessed with the Patient-Rated Wrist Evaluation score (PRWE). Secondary outcomes are the Disability of the Arm, Shoulder and Hand score (DASH), pain, quality of life (SF-36), range of motion, grip strength, radiological parameters, complications, crossovers and cost-effectiveness of both treatments. A total of 90 patients will be included in this

  12. Wave generation by fracture initiation and propagation in geomaterials with internal rotations

    Science.gov (United States)

    Esin, Maxim; Pasternak, Elena; Dyskin, Arcady; Xu, Yuan

    2016-04-01

    Crack or fracture initiation and propagation in geomaterials are sources of waves and is important in both stability and fracture (e.g. hydraulic fracture) monitoring. Many geomaterials consist of particles or other constituents capable of rotating with respect to each other, either due to the absence of the binder phase (fragmented materials) or due to extensive damage of the cement between the constituents inflicted by previous loading. In investigating the wave generated in fracturing it is important to distinguish between the cases when the fracture is instantaneously initiated to its full length or propagates from a smaller initial crack. We show by direct physical experiments and discrete element modelling of 2D arrangements of unbonded disks that under compressive load fractures are initiated instantaneously as a result of the material instability and localisation. Such fractures generate waves as a single impulse impact. When the fractures propagate, they produce a sequence of impulses associated with the propagation steps. This manifests itself as acoustic (microseismic) emission whose temporal pattern contains the information of the fracture geometry, such as fractal dimension of the fracture. The description of this process requires formulating criteria of crack growth capable of taking into account the internal rotations. We developed an analytical solution based on the Cosserat continuum where each point of body has three translational and three rotational degrees of freedom. When the Cosserat characteristic lengths are comparable with the grain sizes, the simplified equations of small-scale Cosserat continuum can be used. We established that the order of singularity of the main asymptotic term for moment stress is higher than the order of singularity for conventional stress. Therefore, the mutual rotation of particles and related bending and/or twisting of the bonds between the particles represent an unconventional mechanism of crack propagation.

  13. Residual intersegmental spinal mobility following limited pedicle fixation of thoracolumbar spine fractures with the fixateur interne.

    Science.gov (United States)

    Lindsey, R W; Dick, W; Nunchuck, S; Zach, G

    1993-03-15

    The Fixateur Interne has been proposed for limited pedicle fixation of thoracolumbar spine fractures with the assumption that motion in the nontraumatized spinal segments could be maintained. To date, no data exist that both localize and quantitate spinal mobility about the fractured vertebra. Voluntary maximum lateral flexion and extension radiographs were obtained on patients with unstable thoracolumbar spine fractures at a minimum of 2 years after Fixateur Interne instrumentation (implant was removed after 1 year). Residual intersegmental motion was measured at levels adjacent to both the vertebra fracture and the fixation. Fifty-nine patients were reviewed, and the posterior vertebral body angle demonstrated a mean total sagittal motion of 2.98 degrees. Cephalad and caudal to the fractured vertebra, a mean of 1.34 degrees and 3.08 degrees, respectively, of residual motion was noted; cephalad and caudal to the previously instrumented segment a mean of 3.22 degrees and 6.88 degrees, respectively, was measured. The authors conclude that residual mobility is most evident at the caudal end of the instrumented segment, removed from the fractured vertebra. The level with end plate disruption becomes essentially ankylosed, with or without a fusion.

  14. Inversion of the acetabular labrum triggers rapidly destructive osteoarthritis of the hip: representative case report and proposed etiology.

    Science.gov (United States)

    Fukui, Kiyokazu; Kaneuji, Ayumi; Fukushima, Mana; Matsumoto, Tadami

    2014-12-01

    The pathophysiology of rapidly destructive osteoarthritis (OA) of the hip is unknown. This study documented cases of inversion of the acetabular labrum, which has clinicoradiologic features similar to those of initial-stage rapidly destructive hip OA. Our study was based on a prospective review of data for 9 patients with rapidly destructive hip OA. Intraoperative findings showed that the anterosuperior portion of the acetabular labrum had inverted into the articular space, along with many fragments of articular cartilage, in all patients. Subchondral insufficiency fractures of the femoral heads were seen just under the inverted labra in 8 of the 9 patients. Inversion of the acetabular labrum may be involved in rapid joint-space narrowing and subchondral insufficiency fracture in rapidly destructive hip OA.

  15. Cup-cage construct for acute fractures of the acetabulum, re-defining indications.

    Science.gov (United States)

    Chana-Rodríguez, Francisco; Villanueva-Martínez, Manuel; Rojo-Manaute, Jose; Sanz-Ruíz, Pablo; Vaquero-Martín, Javier

    2012-12-01

    Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically, the areas of morsellised autograft that surrounded the cups were seen to have incorporated uniformly well, and the acetabular fractures were healed within six months after surgery. No mechanical failure, screw breakage, loosening, or migration was noticed. This novel indication of the cup-cage construction that uses revision techniques, for selected patients and fractures, to achieve an acute stable reconstruction, should be considered as an alternative reconstruction option in elderly patients presenting with acetabular fractures.

  16. Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

    Institute of Scientific and Technical Information of China (English)

    LIU Xian-zhe; YANG Shu-hua; XU Wei-hua; LIU Guo-hui; YANG Cao; LI Jin; YE Zhe-wei; LIU Yong; ZHANG Yu-kun

    2008-01-01

    Objective: To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty (THA) for acetabular reconstruction in patients with posttraumatic arthritis and bone loss afteracetabular fractures.Methods: Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department.There were 10 males and 5 females with mean age of 48.2 years (ranging from 36 to 73 years).Eight cases had the fracture at left hips,7 at right hips.The average age at injury was 28 years (ranging from 18 to 68 years).The mean follow-up period was 4.3 years (ranging from 2 to 7 years).Results: Compared with mean 42 points (ranging from 10 to 62) of the preoperative Harris score,the survival cases at the final follow-up had mean 84 points (ranging from 58 to 98).One patient had mild pain in the hip.No revision of the acetabular or femoral component was undertaken during the follow-up.Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side.All of them had a stable radiographic appearance.Progressive radiolucent fines were observed in I,III zones in 2 cases.One patient had a nonprogressive radiolucent fine in zone III.The cup prosthesis was obviously displaced (6 mm) in one patient,but had not been revised.Conclusion: Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture,which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.

  17. The societal costs of femoral neck fracture patients treated with internal fixation

    NARCIS (Netherlands)

    Zielinski, S.M.; Bouwmans, C.A.; Heetveld, M.J.; Bhandari, M.; Patka, P.; Lieshout, E.M. van; Kampen, A. van

    2014-01-01

    SUMMARY: The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are compa

  18. The societal costs of femoral neck fracture patients treated with internal fixation

    NARCIS (Netherlands)

    Zielinski, S.M.; Bouwmans, C.A.; Heetveld, M.J.; Bhandari, M.; Patka, P.; Lieshout, E.M. van; Kampen, A. van

    2014-01-01

    SUMMARY: The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were 19,425. Costs were higher for older, less healthy patients. Results are

  19. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence.

    Science.gov (United States)

    Yu, Jiajie; Zhang, Chao; Li, Ling; Kwong, Joey S W; Xue, Li; Zeng, Xiantao; Tang, Li; Li, Youping; Sun, Xin

    2015-12-11

    The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture.

  20. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistic...

  1. Stabilization of unstable pelvic fractures with a novel internal-external fixator

    Institute of Scientific and Technical Information of China (English)

    JIANG Zan-li; Gary Chen

    2011-01-01

    An internal-external fixator for stabilization in three cases with unstable pelvic fractures were reported.Compared with external fixation,the internal-external fixator,which is placed in the subcutaneous layer,decreased the risk of pin-track infection,pin site pain,and bowel obstruction; meanwhile,it had the advantage of external fixation:it was easy to apply,controlled damage,and resulted in minimal injury.

  2. The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty.

    Science.gov (United States)

    Maggs, J L; Smeatham, A; Whitehouse, S L; Charity, J; Timperley, A J; Gie, G A

    2016-03-01

    We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p acetabular components available for radiological evaluation. In 27 of these, the line was confined to zone 1. No component had migrated. Kaplan-Meier survivorship, with revision for aseptic loosening as the endpoint, was 100% at 12.5 years and for all causes was 97.8% (95% confidence interval 95.6 to 100) when 40 components remained at risk. The Exeter Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty. ©2016 The British Editorial Society of Bone & Joint Surgery.

  3. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

    Institute of Scientific and Technical Information of China (English)

    TONG Da-ke; JI Fang; CAI Xiao-bing

    2011-01-01

    Objective: To investigate the efficacy of the locking internal fixator (LIF), which includes the locking compression plate (LCP) and the less invasive stable system (LISS), in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the operation with LIF by the minimally invasive plate osteosynthesis (MIPO) technique. The data consisted of 43 proximal tibial fractures (type AO41C3) and 55 distal tibial fractures (type AO43C3). Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months). Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

  4. 经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折%Surgical treatment of complex acetabular fractures through the lateral-rectus approach with the pelvic reconstructive plate and antegrade posterior-column lag screw

    Institute of Scientific and Technical Information of China (English)

    张潇; 杨晓东; 夏广; 李涛; 王华; 熊然; 樊仕才

    2015-01-01

    Objective To evaluate the clinical value of the lateral-rectus approach with the pelvic recon-structive plate and antegrade posterior -column lag screw in the treatment of complex acetabular fractures .Meth-ods Between May 2012 and Jan.2014,9 patients with complex acetabular fractures were treated with pelvic recon-structive plate and antegrade posterior-column lag screw through the lateral-rectus approach . There were 6 males and 3 females,aged 27-74 years(mean,39 years).Fractures were caused by traffic accident in 5 cases,by falling in 2 cases,and by heavy crash in 2 cases.According to Letournel classification ,there were 2 cases of transverse frac-ture,4 cases of anterior column with posterior hemi-transverse lesion fracture,and 3 cases of both-column fracture with 1 case of central dislocation of hip joint .The operation time and blood loss were statistically analyzed .The pa-tients were evaluated clinically according to Merle d'Aubigne-Postel scoring system and X ray performance based on the criteria described by Matta .Results The average time of operation was 200 minutes ( 150-255 minutes );the average blood loss was 730ml(300-1250ml);the average follow up was 15.9 months(9-30 months);the clinical results were excellent in 5 patients,good in 2 and fair in 2.The radiological results were anatomical reduction in 5 patients,satisfactory in 3 and fair in 1.All the patients were healed within 3 months and there were no complications such as infection ,avascular necrosis of the femoral head ( ANFH) ,or heterotopic ossification .Conclusion The lat-eral-rectus approach is suitable for some complex acetabular fractures ,with advantages of the adequate exposure of quadrilateral surface and insertion of the posterior column antegrade lag screw .%目的:评价经腹直肌外侧切口入路以前柱重建钢板配合后柱顺行拉力螺钉内固定治疗复杂髋臼骨折的临床疗效。方法回顾性分析自2012年5月~2014年1月本科

  5. Optimization of acetabular component orientation using DOE

    Science.gov (United States)

    Krepelka, Mircea; Toth-Taşcǎu, Mirela

    2012-09-01

    Stress shielding is increasingly recognized as an important cause of acetabular component failure. Several studies have been focused on improving the acetabular component placement to reduce the risk of dislocation, impingement and range of motion but little is known of its influence on implant-bone interface pressures. This study employs experimental design, 3D reconstruction and FE simulation to identify the most significant factors for acetabular component behavior and predict the best configuration of acetabular spatial orientation angles within the constraints of the Lewinnek's safe zone in order to minimize peak contact pressures. Data analysis by response surface method revealed that the magnitude of periacetabular pressures was significantly reduced by the anteversion angle at its lowest value as well as the abduction angle located at the central point value, which corresponded to a 40° abduction and 5° anteversion of cup orientation.

  6. Quadrilateral plate fractures of the acetabulum: an update.

    Science.gov (United States)

    White, Grace; Kanakaris, Nikolaos K; Faour, Omar; Valverde, Jose Antonio; Martin, Miguel Angel; Giannoudis, Peter V

    2013-02-01

    Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century.

  7. AO fixateur interne in treating burst fractures of the thoracolumbar spine.

    Science.gov (United States)

    Liu, C L; Wang, S T; Lin, H J; Kao, H C; Yu, W K; Lo, W H

    1999-09-01

    A burst fracture of the thoracolumbar junction is an unstable spinal fracture, which is caused by high-energy trauma. There are many methods of treatment, both surgical and nonsurgical, in dealing with spinal burst fractures. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) Fixateur Interne (FI) system was introduced in 1985 for posterior spine surgery with a transpedicular screw system. From April, 1989, through December, 1994, we encountered 42 patients with 42 acute burst fractures of the spine; 26 were male and 16 were female, with an average age of 41.2 years. One fracture occurred on T11, seven on T12, 16 on L1, 11 on L2, one on L3, four on L4 and two on L5. According to the Denis classification, there were eight type A, 23 type B, five type C, three type D and three type E fractures. All of these patients received posterior reduction without decompression, posterior short segmental fixation with AO FI instrumentation and posterior fusion. After follow-up for an average of 66.1 months, all fractures were found to have united with residual back pain in only six patients; five patients, including one with nonunion, had back pain without the necessity of medication, and the other one had occasional back pain that was well controlled by medication. The immediate postoperative Cobb's angle improved by an average of 14.2 degrees, and there was an average loss of 3.3 degrees at final follow-up. All patients were neurologically intact at final follow-up except two patients, who were Frankel D. Seven patients had complications during follow-up; one experienced nonunion; four experienced screw breakage, one had screw pullout, and the other experienced breakage of the connecting rod. From our retrospective study, the outcome of burst fracture of the spine treated with AO FI instrumentation system was satisfactory.

  8. [Investigate progress of intraoperative periprosthetic fracture of total hip arthroplasty].

    Science.gov (United States)

    Cong, Yu; Zhao, Jian-ning

    2011-02-01

    One of the complications of total hip arthroplasty is intraoperative periprosthetic fracture. Periprosthetic fracture is divided into acetabular fracture and femoral fracture. Risk factors for intraoperative periprosthetic fracture include use of minimally invasive techniques, press-fit cementless stems, revision operations and osteoporosis. It has been recognized that treatment of intraoperative periprosthetic fractures should be based on the classification of the Vancouver system for intraoperative fractures.

  9. Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate

    Science.gov (United States)

    Santosha; Singh, Arambam Mahendra; Waikhom, Sanjib; Pakhrin, Vishal; Mukherjee, Sagnik; Debbarma, Rajkumar; Prashant, Prabhu Shrinivas

    2016-01-01

    Introduction Calcaneal fractures constitute the most common fractures in hindfoot. Lots of controversies exist in the management of calcaneal fractures but now-a-days, it is preferable to perform open reduction and internal fixation and early mobilizatation. Aim To evaluate the functional outcome after open reduction and internal fixation of displaced intra-articular fractures of the calcaneum by locking calcaneal plate. Materials and Methods The study was conducted in the Department of Orthopaedic Surgery from September 2013 to April 2016. Thirty intra-articular fractures of the calcaneum were treated by locking calcaneal plate. Patients were followed up for a period of 24 months. Bohler’s angle was measured in preoperative, immediate Post-operative period and after 2 years, follow-up was compared. Results were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results After 24 months of follow-up, all 24 patients were available for evaluation. Radiological union was achieved in a mean time of 12.5 weeks. Mean duration of hospital stay was 21 days. Bohler’s angle was significantly higher after 2 years of follow-up when compared with preoperative x-ray. According to the AOFAS, Ankle–Hind foot Scale outcome score results were excellent in 43.3% of the patients, good in 33.3%, fair in 10%, and poor in 13.3% of patients. The mean AOFAS score was 79.9 (Range 49-96). Conclusion Open reduction and internal fixation of intra-articular fractures of the calcaneum with locking calcaneal plate gives good results. Maintenance of calcaneal height and Bohler’s angle helps to decrease the incidence of subtalar arthritis. PMID:28208957

  10. A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures

    Science.gov (United States)

    Mavani, Kinjal J

    2016-01-01

    Introduction The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves “bridging” the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. Aim The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. Materials and Methods This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. Results At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. Conclusion The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of

  11. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

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    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

  12. Clinical effect of distal radius fracture treated with open reduction and internal plate fixation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Pei-xun; XUE Feng; DANG Yu; WANG Tian-bing; CHEN Jian-hai; XU Hai-lin; FU Zhong-guo; ZHANG Dian-ying; JIANG Bao-guo

    2012-01-01

    Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years (mean 57 years).Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days (mean 5 days).All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively (mean 22 months).The fractures healed within 10-18 weeks after operation (mean 12 weeks).During the last follow-up,the mean palmar tilt was (7.0±0.9)° and the mean ulnar variance was (21.0±4.2)°,showing significant difference when compared with preoperation ((-5.0±1.2)° and (8.0±3.8)°).The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open

  13. Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

    Institute of Scientific and Technical Information of China (English)

    钟来平; 陈关福

    2004-01-01

    Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures.Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation.Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation.Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar,sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

  14. Treatment of displaced radial head fractures by internal fixation with absorbable pins

    Institute of Scientific and Technical Information of China (English)

    HOU Zhen-hai; ZHOU Ji-hong; SHI Jian-guo; SHI Yi-bin; XIA Jun-jie; YAO Jun

    2006-01-01

    Objective: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures.Methods: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason types Ⅱ and Ⅲ) were treated with internal fixation by absorbable pins.The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey.Results: All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15°(0°-35°), and pronation and supination decreased by 10° (0°-30°) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey.Conclusions: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.

  15. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing.

    Science.gov (United States)

    Miller, Danielle L; Goswami, Tarun

    2007-12-01

    Metallic implants are often involved in the open reduction and internal fixation of fractures. Open reduction and internal fixation is commonly used in cases of trauma when the bone cannot be healed using external methods such as casting. The locking compression plate combines the conventional screw hole, which uses non-locking screws, with a locking screw hole, which uses locking head screws. This allows for more versatility in the application of the plate. There are many factors which affect the functionality of the plate (e.g., screw placement, screw choice, length of plate, distance from bone, etc.). This paper presents a review of the literature related to the biomechanics of locking compression plates and their use as internal fixators in fracture healing. Furthermore, this paper also addresses the materials used for locking compression plates and their mechanical behavior, parameters that control the overall success, as well as inherent bone quality results.

  16. [Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures].

    Science.gov (United States)

    Dong, Jian-Bin; Wang, Zhi-Yong; Lu, Hao; Tian, Yuan; Wang, Xin-Rui; Zhang, Zhi-Qiang

    2015-03-01

    To compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults. Reports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis. Seven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

  17. Acute fracture of the acetabulum secondary to a convulsive seizure 3 years after total hip arthroplasty.

    Science.gov (United States)

    Atilla, Bulent; Caglar, Omur; Akgun, Rahmi Can

    2008-03-01

    While aseptic loosening, osteolysis, and infection are the most common causes of failure after total hip arthroplasty (THA), late hip pain can also be the result of acetabular fracture related to trauma and resultant prosthetic failure. However, atraumatic fracture of the acetabulum around a well-fixed acetabular component is unusual. We present a patient with an acetabular fracture resulting from a generalized convulsive attack 3 years after an uncomplicated primary THA. A 33-year-old man presented with acute left hip pain. He had chronic renal insufficiency and had undergone bilateral THA due to avascular necrosis. The night prior to his admission, he suffered a generalized convulsive attack with severe extremity contractions. Afterwards, he had acute left groin pain and had difficulty walking. Physical examination revealed moderate left hip pain as well as a 1-cm shortening of the affected limb. Radiological examination demonstrated an acetabular fracture with medial wall comminution. The acetabular component had migrated medially and rotated horizontally. Revision of the acetabular component with a reinforcement ring and implantation of a cemented acetabular component was realized. Severe muscle spasms during generalized seizures are known to lead to various musculoskeletal injuries (fractures of the proximal humerus, femur, acetabulum, and dislocation of the shoulder). Seizures could also lead to acute periprosthetic fracture of the acetabulum in patients with osteopenia. Therefore careful reaming is required to avoid overmedialization of the acetabular component in those patients.

  18. Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures.

    Science.gov (United States)

    Norouzi, Masoud; Naderi, Mohammad Nasir; Komasi, Mehdi Hemmati; Sharifzadeh, Seyyed Reza; Shahrezaei, Mostafa; Eajazi, Alireza

    2012-05-01

    Proximal humerus fractures are accounting for 4-5% of all fractures with increasing incidence. Proximal Humeral Internal Locking System (PHILOS) plate is a new plate which permits early mobility and lowers the risk of complications. The aim of this study was to evaluate the functional outcome and the complication rate after using this plate. Between 2006-2008, 37 patients with displaced 2-, 3-, and 4-part fractures of the proximal humerus underwent surgery using PHILOS plate. The mean range of follow-up was 12 months. Twenty patients were aged 60 years and younger, and 17 were aged older than 60 years. The average American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was 77.62. According to Michener and colleagues classification, 5.4% of patients had an excellent outcome, 72.9% were minimally functionally limited, 16.2% were moderately functionally limited, and 5.4% were maximally functionally limited. The average ASES score between patients 60 years and older and those 60 years and younger was not different significantly. One patient developed avascular necrosis of the humeral head, 2 patients developed an infection, and no patients developed a nonunion. Fixation with PHILOS plate can be considered a good method with high union rates for this kind of fracture, especially in the older population with osteoporotic bone.

  19. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  20. Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation

    Directory of Open Access Journals (Sweden)

    El-Anwar, Mohammad Waheed

    2015-03-01

    Full Text Available Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery, and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization.

  1. A STUDY ON INTERNAL FIXATION OF COMPOUND FRACTURES OF TIBIA USING INTERLOCKING NAIL WITHOUT REAMING

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    Pradeep Chandra

    2016-06-01

    Full Text Available As one-third of the tibial surface is subcutaneous throughout its length, open fractures are commonly encountered in this bone. The factors which determine the outcome of these fractures are severity of the injury, indicated by the degree of initial displacement, comminution and soft tissue injury and the damage to the tibial blood supply. In open fractures not only is the endosteal circulation disrupted but also the periosteal circulation, because of periosteal stripping. The various available options of treatment such as conservative short leg or long leg casting, open reduction and internal fixation with plates and screws, intramedullary fixation (Including Ender pins, Intramedullary nails and Interlocking Intramedullary nails with reaming or without reaming and external fixation techniques have their own advantages and disadvantages. The present study was conducted in the Department of Orthopaedics, Gandhi Hospital, during the period from October 2013 to November 2015, to evaluate the results of internal fixation with interlocking intramedullary nailing without reaming in the treatment of the open fractures of tibia. In our study, we got 91% good-to-excellent results evaluated by Johner and Wruh criteria. We opine that closed unreamed interlocking intramedullary nailing yields good-to-excellent results in compound diaphyseal fractures of the tibia, as this technique allows a good control over the rotations with axial stability of the fracture, thus maintaining the length of the limb and enabling early joint motion. The endosteal blood supply is also well preserved. These factors help in lowering the rates of infection, malunions and non-unions.

  2. Internal Fixation of Transverse Patella Fractures Using Cannulated Cancellous Screws with Anterior Tension Band Wiring

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    Khan I

    2016-07-01

    Full Text Available Aims: To evaluate the effectiveness and safety of anterior tension band wiring technique using two cannulated cancellous screws in patients with transverse (AO34-C1 or transverse with mildly comminuted (AO34-C2 patellar fractures. Materials and Methods: This is a prospective study of 25 patients with transverse fracture or transverse fracture with mildly comminuted patella fractures. All the patients were treated with open reduction and internal fixation using two parallel cannulated screws and 18G stainless steel wire as per the tension band principle. Results: There were eighteen males (72% and seven females (28%. The age group ranged from 24 to 58 years, with mean age of 38 years. The most common mode of injury was fall (72% followed by road traffic accident (20% and violent quadriceps contraction (8%. Transverse fracture was present in 60% and transverse fracture with mild comminution in 40% of patients. Mean time to achieve union was 10.7 weeks (range 8-12 weeks. Mean ROM at three months was 113.8 degree (90-130 and at final follow up this improved to 125.4 degrees (range 100-140. There was one case of knee stiffness and no case of implant failure was observed. Patients were evaluated using Bostman scoring, the mean score at three months being 26.04 which improved to 27.36 at the end of final follow up at one year. Conclusion: Cannulated cancellous screws with anterior tension band wiring is a safe, reliable and reproducible method in management of transverse patellar fractures, with less chances of implant failure and soft tissue irritation.

  3. A new coal-permeability model: Internal swelling stress and fracture-matrix interaction

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.H.; Rutqvist, J.

    2009-10-01

    We have developed a new coal-permeability model for uniaxial strain and constant confining stress conditions. The model is unique in that it explicitly considers fracture-matrix interaction during coal deformation processes and is based on a newly proposed internal-swelling stress concept. This concept is used to account for the impact of matrix swelling (or shrinkage) on fracture-aperture changes resulting from partial separation of matrix blocks by fractures that do not completely cut through the whole matrix. The proposed permeability model is evaluated with data from three Valencia Canyon coalbed wells in the San Juan Basin, where increased permeability has been observed during CH{sub 4} gas production, as well as with published data from laboratory tests. Model results are generally in good agreement with observed permeability changes. The importance of fracture-matrix interaction in determining coal permeability, demonstrated in this work using relatively simple stress conditions, underscores the need for a dual-continuum (fracture and matrix) mechanical approach to rigorously capture coal-deformation processes under complex stress conditions, as well as the coupled flow and transport processes in coal seams.

  4. A RETROSPECTIVE STUDY OF PROXIMAL HUMERUS INTERNAL LOCKING SYSTEM PLATING FOR DISPLACED PROXIMAL HUMERUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Kumarswami Ramulu

    2016-05-01

    Full Text Available AIM The aim of the present study was to evaluate the functional outcome, benefits and complications of open reduction and internal fixation of displaced proximal humerus fractures with proximal humerus locking plate. METHODS We studied the functional outcome of 40 patients aged between 15 to 65 years from September 2013 to February 2015, who had displaced proximal humerus fracture and underwent PHILOS plate fixation for the same. Fractures were classified according to NEER’s and AO classification. Patients were followed up for a minimum period of 1 year. Functional outcomes and shoulder range of movement were assessed based on the Constant and Murley scoring system. RESULTS Patients were followed up for 12 months. All fractures healed satisfactorily; 12 weeks (27.5% was the most common union time (radiological finding in the study population followed by 8 weeks (22.5% and 10 weeks (20%. Avascular necrosis was noted in 1 patient, mild infection in 2 patients and stiffness in 2 patients. The mean Constant score at 6 weeks was 40.39, at 12 weeks was 59.24, at 6 months was 73.88 and at one year was 75.62. Constant score continues to improve till 1 year. CONCLUSION Proximal humerus locking plate gives a reliable, stable fixation for fractures of proximal humerus with a good radiological union and good functional outcome.

  5. CSNI Project for Fracture Analyses of Large-Scale International Reference Experiments (Project FALSIRE)

    Energy Technology Data Exchange (ETDEWEB)

    Bass, B.R.; Pugh, C.E.; Keeney-Walker, J. [Oak Ridge National Lab., TN (United States); Schulz, H.; Sievers, J. [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Koeln (Gemany)

    1993-06-01

    This report summarizes the recently completed Phase I of the Project for Fracture Analysis of Large-Scale International Reference Experiments (Project FALSIRE). Project FALSIRE was created by the Fracture Assessment Group (FAG) of Principal Working Group No. 3 (PWG/3) of the Organization for Economic Cooperation and Development (OECD)/Nuclear Energy Agency`s (NEA`s) Committee on the Safety of Nuclear Installations (CSNI). Motivation for the project was derived from recognition by the CSNI-PWG/3 that inconsistencies were being revealed in predictive capabilities of a variety of fracture assessment methods, especially in ductile fracture applications. As a consequence, the CSNI/FAG was formed to evaluate fracture prediction capabilities currently used in safety assessments of nuclear components. Members are from laboratories and research organizations in Western Europe, Japan, and the United States of America (USA). On behalf of the CSNI/FAG, the US Nuclear Regulatory Commission`s (NRC`s) Heavy-Section Steel Technology (HSST) Program at the Oak Ridge National Laboratory (ORNL) and the Gesellschaft fuer Anlagen--und Reaktorsicherheit (GRS), Koeln, Federal Republic of Germany (FRG) had responsibility for organization arrangements related to Project FALSIRE. The group is chaired by H. Schulz from GRS, Koeln, FRG.

  6. Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures

    DEFF Research Database (Denmark)

    Jacobsen, S; Honnens de Lichtenberg, M; Jensen, C M

    1994-01-01

    To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typica...... period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.......To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were...

  7. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

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    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  8. Free iliac crest grafts with periosteum for treatment of old acetabular defects

    Institute of Scientific and Technical Information of China (English)

    ZHAO De-wei; SUN Qiang; WANG Ben-jie; CUI Da-ping

    2006-01-01

    Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects.Methods: From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws.Results: Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases.Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.

  9. Distal radioulnar joint instability (Galeazzi type injury) after internal fixation in relation to the radius fracture pattern.

    Science.gov (United States)

    Korompilias, Anastasios V; Lykissas, Marios G; Kostas-Agnantis, Ioannis P; Beris, Alexandros E; Soucacos, Panayiotis N

    2011-05-01

    The purpose of this study was to classify Galeazzi type injuries and determine the association of residual instability after rigid fixation with the fracture pattern of the shaft of the radius, using a system that is based on anatomic landmarks of the radial shaft. The clinical records of 95 patients (72 men and 23 women) with Galeazzi type injuries requiring open reduction and internal fixation of the fractures were retrospectively reviewed. The mean follow-up was 6.8 years (range, 18 mo to 11 y) after injury. Sixty-nine fractures occurred in the distal third of the radial shaft (type I), 17 fractures were in the middle third (type II), and 9 fractures were in the proximal third of the shaft of the radius (type III). Gross instability of the distal radioulnar joint (DRUJ) was determined intraoperatively by manipulation after radial fixation as compared to the uninjured side. Forty patients had DRUJ instability after internal fixation and were treated with temporary pinning with a K-wire placed transversely proximal to the sigmoid notch. Distal radioulnar joint instability after internal fixation was recorded in 37 type I fractures, 2 type II fractures, and 1 type III fracture. Distal radioulnar joint instability following radial shaft fracture fixation is significantly higher in patients with type I fractures than in patients with type II or type III fractures. The location of the radius fracture can be sufficiently used for preoperative estimation of percentage chance of potential DRUJ instability after fracture fixation. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Comparison of Internal Fixations for Distal Clavicular Fractures Based on Loading Tests and Finite Element Analyses

    Directory of Open Access Journals (Sweden)

    Rina Sakai

    2014-01-01

    Full Text Available It is difficult to apply strong and stable internal fixation to a fracture of the distal end of the clavicle because it is unstable, the distal clavicle fragment is small, and the fractured region is near the acromioclavicular joint. In this study, to identify a superior internal fixation method for unstable distal clavicular fracture, we compared three types of internal fixation (tension band wiring, scorpion, and LCP clavicle hook plate. Firstly, loading tests were performed, in which fixations were evaluated using bending stiffness and torsional stiffness as indices, followed by finite element analysis to evaluate fixability using the stress and strain as indices. The bending and torsional stiffness were significantly higher in the artificial clavicles fixed with the two types of plate than in that fixed by tension band wiring (P<0.05. No marked stress concentration on the clavicle was noted in the scorpion because the arm plate did not interfere with the acromioclavicular joint, suggesting that favorable shoulder joint function can be achieved. The stability of fixation with the LCP clavicle hook plate and the scorpion was similar, and plate fixations were stronger than fixation by tension band wiring.

  11. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

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    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  12. Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures

    Science.gov (United States)

    Saltzman, Bryan M.; Erickson, Brandon J.; Harris, Joshua D.; Gupta, Anil K.; Mighell, Mark; Romeo, Anthony A.

    2016-01-01

    Background: Proximal humerus fractures are common problems plaguing the elderly population. Purpose: The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors’ preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests. Results: Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up. Conclusion: There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures. PMID:27504463

  13. Hip Arthroscopy for Incarcerated Acetabular Labrum following Reduction of Traumatic Hip Dislocation: Three Case Reports

    Science.gov (United States)

    Hwang, Jung-Mo; Lee, Woo-Yong; Noh, Chang-Kyun; Zheng, Long

    2016-01-01

    Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation. PMID:27777919

  14. [Results after internal fixation of humerus distal fractures in patients over than 65 years old].

    Science.gov (United States)

    Serrano-Mateo, L; Lopiz, Y; León-Serrano, C; García-Fernández, C; López-Durán-Stern, L; Marco, F

    2014-01-01

    Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  15. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis.

    Science.gov (United States)

    Metcalfe, David; Hickson, Craig J; McKee, Lesley; Griffin, Xavier L

    2015-12-01

    It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures. A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses. Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25-5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups. Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.

  16. Bisphosphonates and Nonhealing Femoral Fractures: Analysis of the FDA Adverse Event Reporting System (FAERS) and International Safety Efforts

    Science.gov (United States)

    Edwards, Beatrice J.; Bunta, Andrew D.; Lane, Joseph; Odvina, Clarita; Rao, D. Sudhaker; Raisch, Dennis W.; McKoy, June M.; Omar, Imran; Belknap, Steven M.; Garg, Vishvas; Hahr, Allison J.; Samaras, Athena T.; Fisher, Matthew J.; West, Dennis P.; Langman, Craig B.; Stern, Paula H.

    2013-01-01

    Background: In the United States, hip fracture rates have declined by 30% coincident with bisphosphonate use. However, bisphosphonates are associated with sporadic cases of atypical femoral fracture. Atypical femoral fractures are usually atraumatic, may be bilateral, are occasionally preceded by prodromal thigh pain, and may have delayed fracture-healing. This study assessed the occurrence of bisphosphonate-associated nonhealing femoral fractures through a review of data from the U.S. FDA (Food and Drug Administration) Adverse Event Reporting System (FAERS) (1996 to 2011), published case reports, and international safety efforts. Methods: We analyzed the FAERS database with use of the proportional reporting ratio (PRR) and empiric Bayesian geometric mean (EBGM) techniques to assess whether a safety signal existed. Additionally, we conducted a systematic literature review (1990 to February 2012). Results: The analysis of the FAERS database indicated a PRR of 4.51 (95% confidence interval [CI], 3.44 to 5.92) for bisphosphonate use and nonhealing femoral fractures. Most cases (n = 317) were attributed to use of alendronate (PRR = 3.32; 95% CI, 2.71 to 4.17). In 2008, international safety agencies issued warnings and required label changes. In 2010, the FDA issued a safety notification, and the American Society for Bone and Mineral Research (ASBMR) issued recommendations about bisphosphonate-associated atypical femoral fractures. Conclusions: Nonhealing femoral fractures are unusual adverse drug reactions associated with bisphosphonate use, as up to 26% of published cases of atypical femoral fractures exhibited delayed healing or nonhealing. PMID:23426763

  17. The use of a constrained acetabular component to treat instability after total hip arthroplasty.

    Science.gov (United States)

    Shrader, M Wade; Parvizi, Javad; Lewallen, David G

    2003-11-01

    Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat and may not be amenable to nonoperative management. The purpose of the present study was to evaluate the clinical and radiographic outcome associated with the use of a constrained acetabular component as a salvage treatment for instability after hip arthroplasty. We retrospectively reviewed the clinical and radiographic outcome of 110 arthroplasties, in 109 patients, that had been performed with use of a single design of constrained acetabular component. In seventy-nine hips the constrained component was implanted for the treatment of recurrent instability, and in thirty-one hips it was implanted because of absent or grossly deficient soft-tissue attachments that were believed to be associated with a high risk for subsequent instability. The constrained acetabular device eliminated or prevented hip instability in all patients except two, who continued to have sensations of subluxation. The mean Harris hip score improved significantly, from 62.7 points preoperatively to 76.4 points at the time of the latest follow-up (p acetabular component loosening, and one for a periprosthetic fracture of the femur. A constrained acetabular component reliably restores and maintains hip stability in patients with recalcitrant recurrent instability and can dependably prevent dislocation in those who are at high risk because of absent or deficient soft tissues about the hip. However, because of the early appearance of radiolucent lines around some components and concerns about long-term fixation, the use of these devices should be reserved for situations in which other methods are inadequate or have already failed.

  18. Isolated acetabular revision with femoral stem retention after bipolar hip arthroplasty.

    Science.gov (United States)

    Kaku, Nobuhiro; Tabata, Tomonori; Tagomori, Hiroaki; Tsumura, Hiroshi

    2017-03-01

    In bipolar hemiarthroplasty, migration of the outer cup component into the acetabular cup, with evidence of severe osteolysis in the acetabulum, commonly occurs without loosening of the femoral component. The merits of retaining the stable femoral component in these cases have been debated. Our study aimed to determine whether revision of the acetabular component in isolation could be successfully performed. The data of 54 patients (61 hips), 44 women, and 10 men, aged 67.7 (range 47-86) years at the time of the index revision, were analyzed. The average time from primary operation to revision surgery was 14.9 (range 1.0-27.0) years, with an average follow-up time after revision of 5.2 (range, 1.0-18.7) years. Indications for acetabular revision included migration of the outer cup component (N = 55), disassembly of the bipolar cup (N = 4), and recurrent dislocation (N = 2). Fixation of the femoral stem was cementless in 49 hips and cemented in 12. Bone grafting for osteolysis of the proximal femur around the stem was performed in six hips. An acetabular reinforcement ring with a cemented cup was used in 31 hips, with cementless cup fixation in 29 hips, and cemented cup in one case. On average, the Harris hip score improved from 57.0 ± 21.6 to 87.4 ± 6.40 points after revision. Two cases of femoral periprosthetic fracture were treated with osteosynthesis 3 year post-revision. There was no evidence of loosening of the femoral stem or subsidence, with a non-progressive radiolucent line acetabular revision can be reliably performed in cases of failed bipolar hemiarthroplasty with a well-fixed femoral component.

  19. Coralline hydroxyapatite in complex acetabular reconstruction.

    Science.gov (United States)

    Wasielewski, Ray C; Sheridan, Kate C; Lubbers, Melissa A

    2008-04-01

    This retrospective study examined whether a coralline hydroxyapatite bone graft substitute adequately repaired bone defects during complex acetabular reconstructions. Seventeen patients who underwent acetabular revision using Pro Osteon 500 were assessed to determine whether any cups required re-revision, whether bone had incorporated into the coralline hydroxyapatite grafts, and whether the coralline hydroxyapatite grafts resorbed with time. At latest follow-up, no cups required re-revision, but 1 had failed. Radiographic evidence of bone incorporation was observed in every coralline hydroxyapatite graft. Graft resorption was not observed.

  20. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Directory of Open Access Journals (Sweden)

    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  1. The analysis on high-energy trauma surgical in the treatment of 72 cases with acetabular fracture%高能量损伤髋臼骨折手术治疗72例分析

    Institute of Scientific and Technical Information of China (English)

    朱献忠

    2011-01-01

    目的:回顾性分析高能量髋臼骨折的手术效果.方法:根据72例高能量髋臼骨折分型,采用合适的手术人路、复位骨折并内固定.结果:全部顺利完成手术,64例获得随访,依Matta等标准:解剖复位46例,满意复位12例.复位不良6例,满意复位率为90.63%.参照 Ceunnar A 髋关节功能评分标准,优41例,良16例,可4例,差3例;优良率为89.06%.6例出现异位骨化,3例发生股骨头缺血坏死.结论:手术治疗高能量复杂髋臼骨折,术前认真阅读影像资料、选择合适的人路和固定方法,术后早期功能锻炼可取得较好的临床效果.%Objective: To analyze the effect on the operation of high-energy acetabulum fractures. Methods: According to 72 cases with the types of high-energy acetabulum fracture, appropriate surgical was adopted to approach the complex fracture and made an intemal fixation. Results: All operation completed successfully, 64 cases were obtained for follow-up,in accordance with standard: 46 cases with anatomical restoration, 12 cases in satisfaction restoration, 6 cases with reset bad, satisfied reset rate was 90.63%. Reference Ceunnar A hip function evaluation criterion, 41 cases were optimal, 16 cases were good, 4 cases less good, 3 cases was poor, good rate was 89.06%. 6 cases with heterotopic ossification, 3 cases with femoral head ischemic necrosis. Conclusion: Surgical to treatment high-energy complex acetabulum fractures with carefully read image data before operation, appropriate approaches and fixation method. .Patients sh o uldimake a early function exercise in order to acquire the better clinical effects.

  2. Explore Combined Anterior and Posterior Approach in Treatment of Complex Acetabular Fractures Nursing%前后联合入路治疗复杂型髋臼骨折的护理要点探讨

    Institute of Scientific and Technical Information of China (English)

    王文杰

    2015-01-01

    Objective To study the joint into the road before and after treatment modalities nursing key points of the acetabulum fracture and the results. Methods To select the joint into the road before and after treatment modalities of 48 patients with acetabulum fracture. It were randomly divided into observation group and control group, two groups of 24 each example, given targeted nursing intervention, the observation group patients give control group routine nursing intervention, patients with therapeutic efifcacy compared two groups of patients after treatment.Results The observation treatment group the total effective rate was 95.83%; control group total effective rate was 75.00%, two groups of data statistically signiifcant difference (P<0.05).Conclusion The treatment modalities for joint before and after entering the road of acetabulum fracture patients with targeted nursing, patient treatment effect is good, can effectively improve the success rate of the joint into the road before and after surgery to speed up the patients with fracture healing.%目的:研究前后联合入路治疗复杂型髋臼骨折的护理要点及效果。方法选取采用前后联合入路治疗的复杂型髋臼骨折患者48例,将其随机分为观察组与对照组,每组24例,给予观察组患者针对性护理干预,给予对照组患者常规护理干预,治疗后对比两组患者治疗效果。结果观察组的治疗总有效率为95.83%;对照组的治疗总有效率为75.00%,两组数据差异具有统计学意义(P<0.05)。结论对于前后联合入路治疗复杂型髋臼骨折的患者进行具有针对性的护理,患者治疗效果较好,能够有效的提高前后联合入路手术的成功率,加快患者骨折愈合速度。

  3. Open reduction and Internal Fixation of Displaced Proximal Humerus Fractures with AO Stainless Steel T-Plate

    Directory of Open Access Journals (Sweden)

    Hussain S

    2014-03-01

    Full Text Available Background: Proximal humeral fractures are considered the last unsolved fractures in orthopaedics. The treatment is controversial and various operative modalities have been reported in the literature. The aim of the present study was to evaluate functional outcome and complication rate after open reduction and internal fixation of displaced proximal humerus fractures by proximal humerus AO stainless steel Tplate. Twenty-five (25 patients with displaced proximal humerus fractures treated with proximal humerus T-plate between May 2005 and June 2008 were included in the study. Fractures were classified according to the Neer classification into displaced 2-part, 3-part, and 4-part fractures. Patients were followed-up for a minimum period of two years. Functional evaluation was done according to the Neer scoring system. Scores were compared with other studies in the literature using similar implant. Twenty patients had 2-part fracture, four had 3-part fracture, and one had 4-part fracture. Eighty-eight [88% (n = 22] patients had good to excellent result, eight [8% (n = 2] had fair, and four [4% (n = 1] had poor result. Difference in Neer’s score between 2-part and 3-part fractures was not significant. Complications encountered in this series were screw backout in 8% (n = 2, superficial infection in 12% (n= 3, and avascular necrosis in 4% (n = 1 of cases. We conclude that proximal humerus AO T- plate is a cheap and easily available implant, aspects which are particularly relevant in third world countries like India. It gives reliable fixation for 2-part and 3-part fractures. Its use in more complicated fracture patterns of 4-part fractures is not recommended.

  4. Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

    Institute of Scientific and Technical Information of China (English)

    Chaudhary Susheel; Sen Ramesh; Saini Uttam Chand; Soni Ashwani; Gahlot Nitesh; Singh Daljit

    2011-01-01

    management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

  5. STUDY OF FUNCTIONAL OUTCOME OF DISTAL FEMUR FRACTURES TREATED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Sahaya R

    2016-04-01

    Full Text Available BACKGROUND Distal femur fractures account for about 7% of all femur fractures. These fractures can lead to knee stiffness and have the tendency to collapse into varus. The management of distal femur fractures has seen a paradigm shift from nonoperative measures to biological fixation and evolution of modern implants like Locking Compression Plate has been used in current times. With the use of Locking Compression Plate double plating can be avoided. In our study, we have evaluated the short-term Functional Outcome of patients who underwent open reduction internal fixation with Locking Compression Plate using Sander’s criteria. Ours is both prospective and retrospective study of 20 patients with distal femur fractures treated operatively from April 2013 to October 2015. Our surgical modality of treatment is open reduction and internal fixation with locking compression plate using standard lateral approach. We have used AO classification to classify the distal femur fractures. With the results of our study, we have come to a conclusion that locking compression plate is a best option for both intra-articular and extra-articular distal femur fractures. It avoids the use of dual plating of distal femur which requires extensive soft tissue stripping in both sides, resulting in reduced blood supply, potential non-union and implant failure. Locking Compression Plate also helps in anatomical reduction of comminuted intra-articular fractures and it could also be used effectively in osteoporotic bone.

  6. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

    Science.gov (United States)

    Laflamme, G-Yves; Belzile, Etienne L; Fernandes, Julio C; Vendittoli, Pascal A; Hébert-Davies, Jonah

    2015-02-01

    Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. CT evaluation of acetabular dysplasta in adults.

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To evaluate methods of measurement by CT and their clinical significance for acetabular dysplasia(AD) in adults. Methods: CT imaging was examined and measured in 33 adult patients with AD, compared with the normal control group of 210 adults. Results: This study showed the results of AD patients

  8. The fixateur interne for stabilising fractures of the thoracolumbar and lumbar spine.

    Science.gov (United States)

    Sim, E; Stergar, P M

    1992-01-01

    Between 1986 and 1988, 27 patients with fractures of the thoracolumbar and lumbar spine were treated by fixateur interne (FI) instrumentation, and 24 were followed up for a mean of 25 months. Complications occurred in 13 cases, mostly due to loosening and corrosion. The results were compared with plate fixation. The radiological parameters and differences between the preoperative and postoperative indices were well within the normal range. The inferiority of FI instrumentation compared to plate fixation during follow up was mainly attributable to the complications. Reduction of the posterior wall fragments by the intact posterior longitudinal ligament was not consistent, so instrumented reduction is usually the method of choice.

  9. Diagnostic value of CT in pelvic fracture by trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kyung Sook; Kang, Hyun Il; Suh, Myung Ok; Lee, Yul; Chung, Soo Young; Bae, Sang Hoon; Yoon, Jong Sup [College of Medicine Hallym University, Choonchun (Korea, Republic of)

    1987-06-15

    In order to determine the diagnostic value of CT in pelvic trauma, esp. acetabular fracture, we analysed 32 cases of pelvic trauma with conventional radiographic and computed tomographic findings. The results were as follows : 1. There were 26 males and 6 female and peak age span was 4th decade. 2. In 32 cases of acetabular fractures, single column fracture were diagnosed in 20 cases and two column fracture in 12 cases by CT. Among single column fractures, anterior column fractures were 12 cases and posterior column fractures were 8 cases. Complex fracture was most common type in two column fractures. 3. In 32 cases of acetabular fractures diagnosed by CT, 18 cases could be detected by plain X-ray. 4. Intraarticular bony fragments were detected on CT in 11 cases and on plain X-ray in 2 cases. 5. Combined soft issue injuries were 13 cases of pelvic hematoma, 1 case of retroperitoneal hematoma and 2 cases of hemarthrosis. 6. CT was useful in acetabular injury to delineated the extent and type of fracture, localized intraarticular bony fragments, characterize joint dislocation and detect the combined soft tissue injury.

  10. Complications of total hip arthroplasty: periprosthetic fractures of the acetabulum.

    Science.gov (United States)

    Chitre, Amol; Wynn Jones, Henry; Shah, Nikhil; Clayson, Anthony

    2013-12-01

    Periprosthetic fractures of the acetabulum are a rare but potentially disastrous complication of total hip arthroplasty. Such fractures occur either as early perioperative complications or late complications when they are associated with either significant trauma or as a result of the loss of the structural integrity of the bone supporting the prosthesis, such as aseptic osteolysis. The incidence of such fractures appears to be increasing with the increased use of uncemented acetabular components. This article explores the current literature on the epidemiology, etiology, and classification of periprosthetic acetabular fractures as well as offering potential treatment strategies.

  11. Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle.

    Science.gov (United States)

    Aquilina, Peter; Chamoli, Uphar; Parr, William C H; Clausen, Philip D; Wroe, Stephen

    2013-06-01

    The most stable pattern of internal fixation for fractures of the mandibular condyle is a matter for ongoing discussion. In this study we investigated the stability of three commonly used patterns of plate fixation, and constructed finite element models of a simulated mandibular condylar fracture. The completed models were heterogeneous in the distribution of bony material properties, contained about 1.2 million elements, and incorporated simulated jaw-adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. This model was considerably larger and more complex than previous finite element models that have been used to analyse the biomechanical behaviour of differing plating techniques. The use of two parallel 2.0 titanium miniplates gave a more stable configuration with lower mean element stresses and displacements over the use of a single miniplate. In addition, a parallel orientation of two miniplates resulted in lower stresses and displacements than did the use of two miniplates in an offset pattern. The use of two parallel titanium plates resulted in a superior biomechanical result as defined by mean element stresses and relative movement between the fractured fragments in these finite element models.

  12. [Magnetic resonance tomography examination of thoracolumbar spinal fractures after fixateur interne stabilization].

    Science.gov (United States)

    Rudig, L; Runkel, M; Kreitner, K F; Seidel, T; Degreif, J

    1997-07-01

    To analyse the possible injuries of vertebral segments, especially the disc, after unstable thoracolumbar fractures stabilised with AO internal fixator, we performed magnetic resonance imaging (MRI) of the traumatised region after implant removal. There were two aspects of disc degeneration (DD):(1) biochemical changes and (2) structural damage. MRI detects biochemical processes as one aspect of DD that is often small even in the presence of greater structural damage of the nucleus pulposus caused by fracture. None of the patients presented with structural failure of the anulus fibrosus, which is the essential structural component of the vertebral segments with regard to stability. We observed biochemical changes more often in the lower of the two fracture-adjacent discs and alterations of discal shape more often in the upper of the two, whereas loss of height concerned both discs to approximately the same degree. The supporters of upper-disc resection in thoracolumbar fractures justify their procedure among other things with the structural disc damage, such as alteration of shape and loss of height (altogether more frequent in the upper disc). Our observations that a disc with a structurally altered nucleus pulposus can be biochemically intact and can show an intact anulus fibrosus are arguments in favour of disc preservation. With regard to the upper disc, the widespread opinion that complete and regular disc damage requires a resection has to be revised. The question of whether the lower disc should be resected more often because of its greater biochemical changes cannot be answered by the present study alone. Besides the excellent static information in all anatomical structures of the vertebral column available by MRI, a repeat examination in a prone position yields dynamic information on the spinal cord in the case of suspected dorsal adhesions.

  13. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

    Directory of Open Access Journals (Sweden)

    Fujioka Hiroyuki

    2012-12-01

    Full Text Available Abstract The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  14. Primary subtalar joint arthrodesis with internal and external fixation for the repair of a diabetic comminuted calcaneal fracture.

    Science.gov (United States)

    Facaros, Zacharia; Ramanujam, Crystal L; Zgonis, Thomas

    2011-01-01

    Comminuted, intra-articular calcaneal fractures can cause severe lower extremity impairment and have devastating effects on a patient's well being. Diabetes is a multisystem process that may cause neuropathy and loss of protective sensation further complicating the prognosis. Not all calcaneal fractures are created equal and when considering the patient's overall presentation and extent of injury, the combined approach of internal and external fixation for fracture reduction may be beneficial for restoration of anatomic alignment and function. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Enhancement of Apoptosis by Titanium Alloy Internal Fixations during Microwave Treatments for Fractures: An Animal Study.

    Directory of Open Access Journals (Sweden)

    Gang Wang

    Full Text Available Microwaves are used in one method of physical therapy and can increase muscle tissue temperature which is useful for improving muscle, tendon and bone injuries. In the study, we sought to determine whether titanium alloy internal fixations influence apoptosis in tissues subjected to microwave treatments at 2,450 MHz and 40 W during the healing of fractures because this issue is not yet fully understood.In this study, titanium alloy internal fixations were used to treat 3.0-mm transverse osteotomies in the middle of New Zealand rabbits' femurs. After the operation, 30-day microwave treatments were applied to the 3.0 mm transverse osteotomies 3 days after the operation. The changes in the temperatures of the muscle tissues in front of the implants or the 3.0 mm transverse osteotomies were measured during the microwave treatments. To characterize the effects of titanium alloy internal fixations on apoptosis in the muscles after microwave treatment, we performed TUNEL assays, fluorescent real-time (quantitative PCR, western blotting analyses, reactive oxygen species (ROS detection and transmission electron microscopy examinations.The temperatures were markedly increased in the animals with the titanium alloy implants. Apoptosis in the muscle cells of the implanted group was significantly more extensive than that in the non-implanted control group at different time points. Transmission electron microscopy examinations of the skeletal muscles of the implanted groups revealed muscular mitochondrial swelling, vacuolization. ROS, Bax and Hsp70 were up-regulated, and Bcl-2 was down-regulated in the implanted group.Our results suggest that titanium alloy internal fixations caused greater muscular tissue cell apoptosis following 2,450 MHz, 40 W microwave treatments in this rabbit femur fracture models.

  16. PREFACE: International Symposium on Dynamic Deformation and Fracture of Advanced Materials (D2FAM 2013)

    Science.gov (United States)

    Silberschmidt, Vadim V.

    2013-07-01

    Intensification of manufacturing processes and expansion of usability envelopes of modern components and structures in many cases result in dynamic loading regimes that cannot be resented adequately employing quasi-static formulations of respective problems of solid mechanics. Specific features of dynamic deformation, damage and fracture processes are linked to various factors, most important among them being: a transient character of load application; complex scenarios of propagation, attenuation and reflection of stress waves in real materials, components and structures; strain-rate sensitivity of materials properties; various thermo-mechanical regimes. All these factors make both experimental characterisation and theoretical (analytical and numerical) analysis of dynamic deformation and fracture rather challenging; for instance, besides dealing with a spatial realisation of these processes, their evolution with time should be also accounted for. To meet these challenges, an International Symposium on Dynamic Deformation and Fracture of Advanced Materials D2FAM 2013 was held on 9-11 September 2013 in Loughborough, UK. Its aim was to bring together specialists in mechanics of materials, applied mathematics, physics, continuum mechanics, materials science as well as various areas of engineering to discuss advances in experimental and theoretical analysis, and numerical simulations of dynamic mechanical phenomena. Some 50 papers presented at the Symposium by researchers from 12 countries covered various topics including: high-strain-rate loading and deformation; dynamic fracture; impact and blast loading; high-speed penetration; impact fatigue; damping properties of advanced materials; thermomechanics of dynamic loading; stress waves in micro-structured materials; simulation of failure mechanisms and damage accumulation; processes in materials under dynamic loading; a response of components and structures to harsh environment. The materials discussed at D2FAM 2013

  17. Treatment of Gustilo grade Ⅲ leg fractures by external fixation associated with limited internal fixation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-qiang; ZHENG Hong-yu; WANG Bing; HUANG He; HE Fei; ZHAO Xue-ling

    2010-01-01

    Objective: To explore the clinical ef-fects of external fixation associated with limited internal fixa-tion on treatment of Gustilo grade Ⅲ leg fractures.Methods: From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fiactures were emergently treated in our unit with external fixation frames.Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases.All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment.Limited internal fixation with plates and screws were per-formed on all the Gustilo Ilia cases and 10 Gustilo ⅢB cases at the first operation.But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD).Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation.Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.Results: The first operations were completed within 90-210 minutes (170 minutes on average).The blood trans-fusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included).All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average.The lower limb function was evaluated accord-ing to the comprehensive evaluation standards of leg func-tion one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.Conclusion: External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

  18. Computed tomography analysis of acetabular anteversion and abduction

    Energy Technology Data Exchange (ETDEWEB)

    Stem, Eric S. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); South Carolina Sports Medicine and Orthopaedic Center, North Charleston, SC (United States); O' Connor, Mary I. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); Kransdorf, Mark J. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Crook, Julia [Mayo Clinic, Biostatistic Unit, Jacksonville, FL (United States)

    2006-06-15

    The purpose of this study is to define the normal range of acetabular abduction and anteversion in relation to pelvic anatomy as depicted on conventional CT scan. We retrospectively reviewed 100 pelvic CT scans performed on patients presenting for evaluation of non-orthopaedic pathology. The study group consisted of 58 women and 42 men, aged between 18 and 88 years. Standard imaging protocol included an anteroposterior (AP) topogram with contiguous 5-mm thick axial images from the superior margin of the iliac crest to the lesser trochanter of the femur. The acetabular abduction was measured from the AP topogram by obtaining the angle between a line drawn from the acetabular teardrop to the lateral acetabular margin and a horizontal line between the ischial tuberosities. Acetabular anteversion was measured on axial images at the level of the mid-femoral head. We found the mean acetabular abduction to be 39 degrees (standard deviation 4 degrees, range 27 to 51 degrees) and the mean acetabular anteversion to be 23 degrees (standard deviation 5 degrees, range 12 to 39 degrees). Data suggests that acetabular anteversion may average 2.7 degrees lower in males than females and increase slightly with age, while abduction may tend to decrease with age. Ninety percent of patients had acetabular abduction between 31 and 46 degrees; the 90% central range for acetabular anteversion was estimated to be from 14 to 31 degrees. CT scanning is useful in accurately defining the normal range of acetabular abduction and antiversion. Knowledge of this normal anatomy will allow accurate assessment of acetabular component position as delineated on conventional CT scanning. (orig.)

  19. Meralgia paresthetica and femoral acetabular impingement: a possible association.

    Science.gov (United States)

    Ahmed, Aiesha

    2010-12-11

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies.

  20. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty.

    Science.gov (United States)

    Cooke, Christopher C; Hozack, William; Lavernia, Carlos; Sharkey, Peter; Shastri, Shani; Rothman, Richard H

    2003-10-01

    Fifty-eight patients received an Osteonics constrained acetabular implant for recurrent instability (46), girdlestone reimplant (8), correction of leg lengthening (3), and periprosthetic fracture (1). The constrained liner was inserted into a cementless shell (49), cemented into a pre-existing cementless shell (6), cemented into a cage (2), and cemented directly into the acetabular bone (1). Eight patients (13.8%) required reoperation for failure of the constrained implant. Type I failure (bone-prosthesis interface) occurred in 3 cases. Two cementless shells became loose, and in 1 patient, the constrained liner was cemented into an acetabular cage, which then failed by pivoting laterally about the superior fixation screws. Type II failure (liner locking mechanism) occurred in 2 cases. Type III failure (femoral head locking mechanism) occurred in 3 patients. Seven of the 8 failures occurred in patients with recurrent instability. Constrained liners are an effective method for treatment during revision total hip arthroplasty but should be used in select cases only.

  1. Fracture of the acetabulum in a 14-year-old patient: 20-year review

    OpenAIRE

    Sprenger, T.R.; Howard, F M

    2001-01-01

    A case report of 14-year old female with an acetabular fracture involving the anterior column and posterior column-posterior wall is presented here and the findings on 20-year follow-up are described.

  2. The quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties

    Directory of Open Access Journals (Sweden)

    Dennis Sansanovicz

    2017-01-01

    Full Text Available Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.

  3. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

    Directory of Open Access Journals (Sweden)

    Claudio Rafols

    2015-01-01

    Full Text Available This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI, which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson.

  4. [Osteosynthesis and cup revision in periprosthetic acetabulum fractures using a Kocher-Langenbeck approach].

    Science.gov (United States)

    Schwabe, P; Märdian, S; Perka, C; Schaser, K-D

    2016-04-01

    Reconstruction/stable fixation of the acetabular columns to create an adequate periacetabular requirement for the implantation of a revision cup. Displaced/nondisplaced fractures with involvement of the posterior column. Resulting instability of the cup in an adequate bone stock situation. Periprosthetic acetabulum fractures with inadequate bone stock. Extended periacetabular defects with loss of anchorage options. Isolated periprosthetic fractures of the anterior column. Septic loosening. Dorsal approach. Dislocation of hip. Mechanical testing of inlaying acetabular cup. With unstable cup situation explantation of the cup, fracture fixation of acetabulum with dorsal double plate osteosynthesis along the posterior column. Cup revision. Hip joint reposition. Early mobilization; partial weight bearing for 12 weeks. Thrombosis prophylaxis. Clinical and radiological follow-ups. Periprosthetic acetabular fracture in 17 patients with 9 fractures after primary total hip replacement (THR), 8 after revision THR. Fractures: 12 due to trauma, 5 spontaneously; 7 anterior column fractures, 5 transverse fractures, 4 posterior column fractures, 1 two column fracture after hemiendoprosthesis. 5 type 1 fractures and 12 type 2 fractures. Operatively treated cases (10/17) received 3 reinforcement ring, 2 pedestal cup, 1 standard revision cup, cup-1 cage construct, 1 ventral plate osteosynthesis, 1 dorsal plate osteosynthesis, and 1 dorsal plate osteosynthesis plus cup revision (10-month Harris Hip Score 78 points). Radiological follow-up for 10 patients: consolidation of fractures without dislocation and a fixed acetabular cup. No revision surgeries during follow-up; 2 hip dislocations, 1 transient sciatic nerve palsy.

  5. Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne.

    Science.gov (United States)

    Benson, D R; Burkus, J K; Montesano, P X; Sutherland, T B; McLain, R F

    1992-09-01

    Twenty-five consecutive patients with unstable thoracolumbar and lumbar burst fractures were surgically treated with the AO Fixateur Interne (Synthes USA, 1690 Russell Rd., Paoli, PA). Indications for surgery included a progressive neurologic deficit, spinal canal compromise greater than 50%, vertebral body collapse greater than 50%, or sagittal angulation greater than 20 degrees. Twenty males and five females ranging in age from 16 to 60 years (average 31) were treated surgically and prospectively followed. Twenty-one fractures occurred at the thoracolumbar junction (T10-L2) and 4 in the lumbar spine (L3-5). Twenty-four patients were followed for a minimum of 12 months, ranging from 12 to 38 months (average 22); one patient was lost to follow-up after 1 month postoperatively. Preoperatively, 12 patients had partial neurologic deficits; postoperatively, 11 improved at least 1 Frankel grade. Preoperatively, the 12 patients with partial neurologic deficits averaged 45 points (range 24-49) on the lower extremity motor index scale. After surgery, these patients improved an average of five points (range 1-23) on the motor index scale. Both patients with complete spinal cord injuries remained unchanged neurologically postoperatively; no patients deteriorated neurologically after surgery. The average preoperative sagittal kyphosis at the fracture site was +16 degrees (range +10 degrees to +31 degrees); the immediate postoperative sagittal angular correction averaged -4 degrees (lordosis) and ranged from +12 degrees (kyphosis) to -26 degrees (lordosis). At last follow-up, the sagittal angular correction remained unchanged in three patients and decreased in 21 patients to an average of +5 degrees (range +37 degrees to -14 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

  6. ACETABULAR ROTATION OSTEOTOMY IN THE TREATMENT OF ACETABULAR DYSPLASIA IN ADULTS

    Institute of Scientific and Technical Information of China (English)

    杨庆铭; 蒋垚; 孙争鸣; 钱不凡

    1993-01-01

    Acetabular dysplasia is one of the most important reasons for development ofsecondary osteoarthrosis of the hip joint. This paper introduced a method of modifiedWagner’s procedure, called acetabular rotation osteotomy for the treatment of severeacetabular dysplasia in ten adults patients. These were followed up for 1-4 years. Fivecriteria including pain, gait, range of motion, measurement of roentgenographic changees,and CT scan were evaluated. From the limited information of this paper, it showed thatin all cases pain improved and range of motion did not reduced significantly. Comparingthe pre- and post-operative x-ray films, CE angle increased and exceeded the normal val-ue. Tonnis hip value decreased and approached the normal value, anteversion of theacetabulum improved, and the percentage of acetabular coverage increased as well.

  7. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Institute of Scientific and Technical Information of China (English)

    Saurabh Jain; Anil Kumar Jain; Ish Kumar

    2013-01-01

    Objective:Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods:In this series,28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale.Results:At average follow-up of 14.5 months,average AOFAS score was 86.3 (range 66 to 97),with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler's angle,mean Gissane's angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion:Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome

  8. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital.

    Science.gov (United States)

    Shahid, Rizwan; Mushtaq, Abid; Northover, Julian; Maqsood, Mohammad

    2008-10-01

    Proximal humerus fractures have been a challenge to achieve stable fixation. PHILOS (Proximal Humerus internal locking system) is part of the latest generation of locking compression plates for proximal humeral fracture fixation. We aim to assess the clinical and functional outcome of proximal humeral fractures (2-part, 3-part and 4-part) treated with the PHILOS plate. We prospectively reviewed 50 patients who had a proximal humeral fracture treated with the PHILOS plate from September 2002 to September 2006 in our institution. Clinical outcome was measured using the patient-based Oxford shoulder and DASH scoring systems. Five patients died and four were lost to follow-up. Eleven patients had 2-part, eleven 3-part and eighteen 4-part fractures. Mean follow-up time was 21.7 months (range: 6-44 months). Radiological union was achieved within 8 weeks in 40/41 fractures; complications were noted in four cases. Better results were achieved in younger than in older patients, and in male than in female patients. The number of fracture fragments did not appear to affect the results, but associated dislocation of the humeral head was a pejorative factor. Our study has shown that the PHILOS plate is a reliable implant. A direct correlation was observed between Oxford shoulder and DASH scores.

  9. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren;

    2014-01-01

    Background and purpose - Internal fixation (IF) in femoral neck fractures has high reoperation rates and some predictors of failure are known, such as age, quality of reduction, and implant positioning. Finding new predictors of failure is an ongoing process, and in this study we evaluated...... the importance of low bone mineral density (BMD). Patients and methods - 140 consecutive patients (105 females, median age 80) treated with IF had a dual-energy X-ray absorptiometry (DXA) scan of the hip performed median 80 days after treatment. The patients' radiographs were evaluated for fracture displacement......, or new hip fracture). A stratified Cox regression model on fracture displacement was applied and adjusted for age, sex, quality of reduction, implant positioning, comorbidity, and walking disability. Results - 49 patients had a T-score below -2.5 (standard deviation from the young normal reference mean...

  10. Application of IMF screws to assist internal rigid fixation of jaw fractures: our experiences of 168 cases.

    Science.gov (United States)

    Bai, Zhenxi; Gao, Zhibiao; Xiao, Xia; Zhang, Wenjuan; Fan, Xing; Wang, Zhaoling

    2015-01-01

    Intermaxillary fixation (IMF) screws were first introduced to achieve IMF as a kind of bone borne appliance for jaw fractures in 1989. Because this method can overcome many disadvantages associated with tooth borne appliance, IMF screws have been popularly used for jaw fractures since then. From March 2011 to February 2014, we treated 168 cases with single or multiple jaw fractures by open reduction and a total of 705 IMF screws were intraoperatively applied in all the cases to achieve IMF and maintain dental occlusion as an adjuvant to open reduction. The numbers, implantation sites and complications of IMF screws were retrospectively analyzed. In our experience, we found that IMF screws were important to assist open reduction of jaw fractures but their roles should be objectively assessed and the reliability of open reduction and internal rigid fixation must be emphasized. Much attention should be paid when implanting.

  11. Pelvic and acetabular trauma care in Ireland: the past, present and future

    LENUS (Irish Health Repository)

    Queally, JM

    2017-08-01

    Pelvic injuries involve injury to the osseo-ligamentous ring structure of the pelvis or the acetabulum of either hip joint. They are typically caused by high-energy trauma and may be associated with significant morbidity or mortality at the time of injury due to excessive haemorrhage and associated abdominal, chest or head injuries with mortality rates of 8.6% to 19.1% reported for closed injuries and rates of up to 50% reported for open injuries1. Despite the severity of these injuries and the potential for poor long term outcomes, these injuries were managed with non-surgical treatment until the middle of the 20th century. Treatment typically involved prolonged bed rest, traction or compression devices, pelvic slings and spica casts with poor outcomes due to persistent pelvic deformity in pelvic injures and early osteoarthritis in acetabular fractures2,3. In the 1930’s, with the advent of radiography, significant progress was made in terms of understanding injury patterns, subsequent displacement and the significance of pelvic instability and deformity post injury. Along with the improved definitive management of pelvic injuries, similar progress was made with the immediate management of life-threatening haemodynamic instability and resuscitation with a significant improvement in mortality rate achieved over the past 50 years3,4. In contemporary trauma care, to ensure optimal outcomes, pelvic trauma is now considered a subspecialty practised in tertiary centres by fellowship trained specialists. Herein we describe the evolution of pelvic trauma care in Ireland over the past 30 years in an overall context of improved international paradigms of care and discuss potential future developments

  12. Retrospective comparison of percutaneous fixation and volar internal fixation of distal radius fractures.

    Science.gov (United States)

    Lozano-Calderón, Santiago A; Doornberg, Job N; Ring, David

    2008-06-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius.

  13. Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation.

    Science.gov (United States)

    Klein, S M; Prantl, L; Koller, M; Vykoukal, J; Dolderer, J H; Graf, S; Nerlich, M; Loibl, M; Geis, S

    2015-01-01

    Originally, the treatment method of choice for distal radial fractures (DRF) has been a non-operative approach with six to eight weeks of plaster casting. The introduction of volar locking plate systems at the beginning of the 21 st century has pushed trends towards open reduction and internal fixation (ORIF). While the introduction of fixed angle locking plates together with the increasing knowledge on wrist function and related variable outcomes has led to consensus that operative fixation in instable DRF is the treatment method of choice, there is no agreement on a postoperative care of these injuries. The authors will discuss the available evidence for current concepts of postoperative treatment of DRFs following fixed angle fixation under socioeconomical, biomechanical and burden of disease aspects. Further, relevant randomized controlled trials are evaluated with regard to applied postoperative treatment regimes and related risks for complications.

  14. Complications and functional outcome after internal fixation of dorsally displaced distal radial fractures

    DEFF Research Database (Denmark)

    Bove, Jeppe; Viberg, Bjarke; Greisen, Pernille

    -ray images showed 14 cases of too radi- al plate placement and 1 one forgotten tower. Conclusion: The literature describes an overall complication frequency between 0 and 27%, with a lower frequency of secondary procedures compared to this study. There is still a need for further studies......Background: Recently there has been an increasing interest in open reduction and internal fixation of distal radius fractures. Even so further studies are still needed. Purpose: To document the functional outcome and identify complica- tions among patients treated with a volar locking plate (DVR......-locking plate, DePuy Orthopaedics) newly introduced in our department. Methods: The study was designed as a historical cohort study. 37 females and 6 males with a mean (CI) age of 72,6 (69,5-75,6) were included. 35 received 6 months follow up (median 6,4) and 30 received 1 year follow up (median 14,0). Outcome...

  15. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis.

  16. Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits.

    Science.gov (United States)

    Hochuli-Vieira, E; Cabrini Gabrielli, M A; Pereira-Filho, V A; Gabrielli, M F R; Padilha, J G

    2005-03-01

    The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I-rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period.

  17. Are Biodegradable Plates Applicable in Endoscope-Assisted Open Reduction and Internal Fixation of Mandibular Subcondyle Fractures?

    Science.gov (United States)

    Son, Jang-Ho; Ha, Jinhee; Cho, Yeong-Cheol; Sung, Iel-Yong

    2017-08-01

    To investigate whether biodegradable plates are applicable in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondyle fractures. This retrospective case-series study included patients with mandibular subcondyle fractures treated with EAORIF using an unsintered hydroxyapatite particles/poly-l-lactide biodegradable plate system, with at least 6 months of clinical follow-up data available. The outcome variables were fracture healing with postoperative stability and postoperative complications. Other variables included age, gender, fracture site, cause of injury, accompanying mandibular fracture, total follow-up period, fracture classification, extent of displacement, preoperative status of occlusion, preoperative mandibular movements, fixation materials in accompanying mandibular fracture, location and number of fixation plates, periods of intermaxillary fixation/elastic bands, and postoperative mandibular movements. Fracture healing in these patients was assessed by comparing the immediate postoperative cone-beam computed tomography (CBCT) images with those obtained at least 3 months after surgery. A total of 11 patients, 9 male and 2 female, with a mean ± standard deviation age of 35.3 ± 15.9 years, were included. The mean follow-up period was 18.8 ± 7.8 months. Four patients had an accompanying mandibular fracture. Two 4-hole, 2.0-mm biodegradable plates were fixed with 6-mm screws along the posterior border of the mandibular ramus and near the sigmoid notch. Complete bone formation around the fracture lines or fading of the fracture lines, with no change in the position of the fractured segments, was observed on the postoperative CBCT images at 3 months. With the exception of 2 patients, no patient complained of plate palpability, deviation in occlusion, or discomfort during the postoperative follow-up period. EAORIF using biodegradable plates for mandible subcondylar fractures is a stable and reliable method, with

  18. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    Science.gov (United States)

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome.

    Science.gov (United States)

    Papakostidis, Costas; Panagiotopoulos, Andreas; Piccioli, Andrea; Giannoudis, Peter V

    2015-03-01

    The aim of the present study was to evaluate the effect of timing of internal fixation of intracapsular fractures of the neck of femur on the development of late complications, particularly osteonecrosis of femoral head (ONFH) and non-union. We undertook a systematic review of the literature adhering to the PRISMA guidelines. There were 7 eligible reports for the final analysis. The methodological quality of component studies was assessed with the Coleman Methodology Score (CMS). Each included study was assigned a score independently by the two reviewers. The final score of each individual study constituted the average value of the scores given by the two reviewers. The agreement between the two assessors was tested with intraclass correlation coefficient (ICC). The CMS ranged from 37 to 64 within component studies (mean: 46.5, SD: 10.8, median: 41). The ICC was 0.94 (95% CI: 0.69-0.99), implying a nearly perfect agreement between the two assessors. Based on the available data regarding the timing of operative fixation of the femoral neck fractures, 4 discreet pairs of comparison groups could be created: (1) fractures fixed within 6h from injury versus fractures fixed after 6h from injury; (2) fractures fixed within 12h versus after 12h; (3) fractures fixed within 24h versus after 24h; and (4) fractures fixed within 6h versus after 24h. Outcome measures were analyzed within each one of the above pairs of treatment groups. The following subgroups analyses were a priori decided: (1) initial fracture displacement (displaced vs. undisplaced fractures); (2) fixation method (cannulated screws vs. sliding hip screw); (3) quality of reduction (anatomic vs non-anatomic reduction). This study failed to prove any essential association between timing of NOF fracture internal fixation and incidence of AVN. With respect to non-union though, it indicated that delay of internal fixation of more than 24h could increase substantially the odds of non-union. Copyright © 2015 Elsevier

  20. Periprosthetic fractures evaluation and treatment.

    Science.gov (United States)

    Masri, Bassam A; Meek, R M Dominic; Duncan, Clive P

    2004-03-01

    Periprosthetic fracture is a serious complication of total hip arthroplasty (THA) that can be difficult to treat, and can be potentially fraught with complications. The incidence of such fractures is increasing, especially after the use of cementless revision arthroplasty. The prevention of these fractures is achieved by understanding the risk factors involved. If the risks are not understood, the best outcome is achieved when the surgeon has a thorough understanding of the principles of treatment of these fractures and has access to various fixation and prosthetic devices, and allograft bone when necessary. Acetabular fractures are rare and relatively little has been reported on their treatment. Periprosthetic femoral fracture treatment is based on the site of fracture, implant stability, and bone stock. The Vancouver classification offers a reproducible description of these factors with the subsequently easy formation of a treatment plan.

  1. Acute periprosthetic fracture of the acetabulum associated with osteolytic pelvic lesions: a report of 3 cases.

    Science.gov (United States)

    Sánchez-Sotelo, J; McGrory, B J; Berry, D J

    2000-01-01

    Three cases of acute acetabular fracture around uncemented porous-coated acetabular components associated with osteolytic lesions of the pelvis are reported. In each case, the fracture occurred through an area of severe osteolysis that contributed to the structural failure of the pelvis. None of the fractures were associated with significant trauma, and none of the implants demonstrated evidence of loosening before the fracture. When marked pelvic osteolysis develops around the acetabular component of a total hip arthroplasty, the possibility of pelvic fracture must be considered. Total hip arthroplasty patients with osteolysis should be followed with radiographs at regular and frequent intervals. When osteolysis progresses, early intervention should be strongly considered because appropriate treatment may prevent fracture occurrence.

  2. Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2017-03-01

    Full Text Available Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant. Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01. Open fractures were only observed in patients with a four-part fracture (P=0.018. No significant differences were noticed regarding gender, cause, and side of the fracture. The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006. Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.

  3. Internal Fixation of Unstable Pelvic Ring Injuries via the Modified Stoppa Approach

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    TK Ong

    2011-03-01

    Full Text Available BACKGROUND: The modified Stoppa approach was first described in 1993 by Hirvensalo as an alternative to the ilioinguinal approach for treatment of pelvic ring fracture. METHODS: This is a retrospective study of 5 patients with unstable pelvic fracture treated with internal fixation using the modified Stoppa approach. Residual displacement of the pelvic ring was measured and graded using the methods described by Matta and Lindahl. Functional outcomes were assessed using the modified Merle D’ Aubigne and Postel Hip scoring system. RESULTS: Of all patients with Type C pelvic injury, three had concomitant acetabular fracture. The mean Injury Severity Score (ISS score was 39. Anatomic reduction of the pelvic ring was achieved in 3 patients and good reduction in 2 patients. Three patients had good functional outcomes. One patient had superficial wound infection. Three patients had erectile dysfunction. CONCLUSION: The modified Stoppa approach is appropriate for internal fixation of unstable pelvic ring injury.

  4. Hip and pelvic fractures and sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    蒋电明; 余学东; 安洪; 梁勇; 梁安霖

    2002-01-01

    Objective: To investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury. Methods: From January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation. Results: Preoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. Sciatic nerve function improved within 3-6 months after surgery in 11 patients. Conclusions: Hip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.

  5. Posterior dislocation of hip with ipsilateral intertrochanteric fracture: A report of two cases

    Directory of Open Access Journals (Sweden)

    Rehan Ul Haq

    2016-01-01

    Full Text Available Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR of the hip and internal fixation (IF of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined.

  6. Posterior dislocation of hip with ipsilateral intertrochanteric fracture: A report of two cases

    Science.gov (United States)

    Ul Haq, Rehan; Kumar, Jaswant; Dhammi, IK; Jain, Anil K

    2016-01-01

    Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR) of the hip and internal fixation (IF) of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined. PMID:27746503

  7. Current management of posterior wall fractures of the acetabulum.

    Science.gov (United States)

    Moed, Berton R; Kregor, Philip J; Reilly, Mark C; Stover, Michael D; Vrahas, Mark S

    2015-01-01

    The general goals for treating an acetabular fracture are to restore congruity and stability of the hip joint. These goals are no different from those for the subset of fractures of the posterior wall. Nevertheless, posterior wall fractures present unique problems compared with other types of acetabular fractures. Successful treatment of these fractures depends on a multitude of factors. The physician must understand their distinctive radiologic features, in conjunction with patient factors, to determine the appropriate treatment. By knowing the important points of posterior surgical approaches to the hip, particularly the posterior wall, specific techniques can be used for fracture reduction and fixation in these often challenging fractures. In addition, it is important to develop a complete grasp of potential complications and their treatment. The evaluation and treatment protocols initially developed by Letournel and Judet continue to be important; however, the surgeon also should be aware of new information published and presented in the past decade.

  8. CT of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Falchi, Marco E-mail: marcofalchi@yahoo.it; Rollandi, Gian Andrea

    2004-04-01

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  9. Failure of dual radius hydroxyapatite-coated acetabular cups

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    Zatti Giovanni

    2008-08-01

    Full Text Available Abstract Introduction Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue. Materials and Methods Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics® in 256 patients, with mean age of 63 years. Results At a mean follow-up of 10 years (range 8–12 years, 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%. The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50,15 to a postoperative value of 92,69. The mean polyethylene wear was 1,25 mm (min. 0,08, max. 3,9 mm, with a mean annual wear of 0,17 mm. The mean acetabular migration on the two axis was 1,6 mm and 1,8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases. The cumulative survivorship (revision as endpoint at the time was 88,9%. Conclusion Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the

  10. Failure of dual radius hydroxyapatite-coated acetabular cups.

    Science.gov (United States)

    D'Angelo, Fabio; Molina, Mauro; Riva, Giacomo; Zatti, Giovanni; Cherubino, Paolo

    2008-08-07

    Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue. Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics in 256 patients, with mean age of 63 years. At a mean follow-up of 10 years (range 8-12 years), 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%). The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50.15 to a postoperative value of 92.69. The mean polyethylene wear was 1.25 mm (min. 0.08, max 3.9 mm), with a mean annual wear of 0.17 mm. The mean acetabular migration on the two axis was 1.6 mm and 1.8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases). The cumulative survivorship (revision as endpoint) at the time was 88,9%. Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the patient refuses the possibility of a revision.

  11. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

    Institute of Scientific and Technical Information of China (English)

    LI Wen-jun; TIAN Wen; TIAN Guang-lei; CHEN Shan-lin; ZHANG Chang-qing; XUE Yun-hao; LI Zhong-zhe; ZHU Yin

    2009-01-01

    Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons.Inappropriate management of these injuries may result in chronic pain,stiffness,deformity,or post traumatic arthritis.Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization.The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.Methods From May 2005 to May 2007,a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation.Of the 26 cases,11 involved in metacarpophalangeal joint,and 15 interphalangeal joint in proximal interphalangeal.Kirschner wire,mini wire and absorbable suture were used for limited internal fixation.All patients were followed up and patients were accomplished with total active motion(TAM)of fingers.Results All patients were reviewed by an independent observer.The mean follow up was 13 months(range 9 to 24 months).Subjective,objective and radiographic results were evaluated.X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases,joint incongruity(less than 1 mm)and joint space narrowing in 3 cases respectively.Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases.An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery.Based on TAM the overall good-excellent rate of joint motion function was 80.8%.Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

  12. The influence of acetabular inclination angle on the penetration of polyethylene and migration of the acetabular component: a prospective, radiostereometric study on cemented acetabular components.

    Science.gov (United States)

    Kadar, T; Furnes, O; Aamodt, A; Indrekvam, K; Havelin, L I; Haugan, K; Espehaug, B; Hallan, G

    2012-03-01

    In this prospective study we studied the effect of the inclination angle of the acetabular component on polyethylene wear and component migration in cemented acetabular sockets using radiostereometric analysis. A total of 120 patients received either a cemented Reflection All-Poly ultra-high-molecular-weight polyethylene or a cemented Reflection All-Poly highly cross-linked polyethylene acetabular component, combined with either cobalt-chrome or Oxinium femoral heads. Femoral head penetration and migration of the acetabular component were assessed with repeated radiostereometric analysis for two years. The inclination angle was measured on a standard post-operative anteroposterior pelvic radiograph. Linear regression analysis was used to determine the relationship between the inclination angle and femoral head penetration and migration of the acetabular component. We found no relationship between the inclination angle and penetration of the femoral head at two years' follow-up (p = 0.9). Similarly, our data failed to reveal any statistically significant correlation between inclination angle and migration of these cemented acetabular components (p = 0.07 to p = 0.9).

  13. Percutaneous screw fixation in treatment of fractures of acetabular columns using computer-assisted imaging navigation system: experiment with cadaver model%计算机辅助影像导航经皮螺钉内固定治疗髋臼骨折的实验研究

    Institute of Scientific and Technical Information of China (English)

    王军强; 吴伟坚; 邓宁; 赵春鹏; 苏永刚; 吴新宝; 王满宜; 梁国穗

    2008-01-01

    acetabular fracture and to evaluate the safety and effieiency of the procedures.Methods Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models.Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules.Dynamic fluoroscopy Was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum,inner,outer,anterior,and posterior from multiple angles.The fluoroscopic images clearly showing the guide needles,anterior and posterior columns,and acetabulum were selected as registration images,and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table.Guided by the navigation system.totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons.The screw positions were estimated by visual method.The time needed to position the C-arm so as to obtain the standard registration image,time needed for fluoroscopy,and operation time,including establishment of navigation system,software interface operation,and screw insertion,were recorded.Results All the screws were inserted to the satisfying positions:placed within the desired bony corridor of the column and none of then were inserted into the joint.While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view.obturated inlet view,obturated oblique outlet view,or pelvic AP view.While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view,obturated oblique view,pelvic inlet view,or obturated oblique outlet view.The total surgical time required for screw insertion was 11.7 min for anterior column,and Was 9.2 min for posterior column.9.5 and 7.3 minutes were needed to position the C-arm X-ray machine so as to obtain the images of the anterior and posterior columns respectively.2.9 and

  14. Internal fixation for coronal shear fracture of the capitellum with polylactide resorbable fixation

    Science.gov (United States)

    Kraan, Gerald A; Krijnen, Matthijs R; Eerenberg, Jan Peter

    2013-01-01

    A 24-year-old woman with pain in the right elbow after a fall demonstrated a coronal shear fracture on radiographic studies. Perioperative a coronal shear fracture was seen and treated successfully with a polylactide Rigid fix resorbable pin. The operative correction resulted in normal function at 6 months follow-up. We state that a capitellum shear fracture can be fixated with a single resorbable pin, leading to successful fusion. PMID:23378544

  15. The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures.

    Science.gov (United States)

    Kanno, T; Sukegawa, S; Tatsumi, H; Nariai, Y; Ishibashi, H; Furuki, Y; Sekine, J

    2014-02-01

    We evaluated the safety, efficacy, and morbidity associated with the treatment of displaced mandibular condylar neck fractures using a retromandibular transparotid approach to reduce and rigidly fix using two 2.0-mm locking miniplates. Our surgical inclusion criteria were: patient selection of open reduction and fixation, displaced unilateral condylar fractures with derangement of occlusion, and bilateral condylar fractures with an anterior open bite. The study group consisted of 19 patients who underwent surgery for 19 mandibular condylar neck fractures; patients were analyzed prospectively, with more than 6 months of follow-up, and were evaluated in terms of functional results, scar formation, postoperative complications, and stability of fixation. The results showed that functional occlusion identical to the preoperative condition and correct anatomical reduction of the condylar segments in centric occlusion, followed by immediate functional recovery, was achieved in all patients. No patient suffered from any major or permanent complication postoperatively, although there were two cases (11%) of temporary facial nerve palsy, which resolved completely within 3 months. Surgical scars were barely visible. The retromandibular transparotid approach with open reduction and rigid internal fixation for displaced condylar neck fractures of the mandible is a feasible and safe, minimally invasive surgical technique that provides reliable clinical results.

  16. Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

    Directory of Open Access Journals (Sweden)

    Chris Dillingham

    2011-01-01

    Full Text Available Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year. Function and pain will improve, but not return to normal by the end of 12 months. Clinical Relevance. These results provide the surgeon with information that can be shared with patients on the anticipated timeline for normal recovery of function and strength.

  17. Effect of rehabilitation exercise in combined with nutrition intervention on the postoperative rehabilitation after internal fixation of lower humerus fracture

    Institute of Scientific and Technical Information of China (English)

    Ming-Chao Zhang

    2016-01-01

    Objective:To explore the effect of rehabilitation exercise in combined with nutrition exercise on the elbow joint function after internal fixation of lower humerus fracture.Methods: A total of 80 patients with lower humerus fracture who were admitted in our hospital from July, 2014 to July, 2015 were included in the study and randomized into the intervention group and the control group. All the patients were preformed with internal fixation and given anti-infection, pain relieving, and anticoagulation treatments after operation. On this basis, the patients in the intervention group were given rehabilitation exercise in combined with nutrition exercise. The serum protein level 1 and 10 d after operation, and the elbow joint function recovery 12 months after operation in the two groups were compared.Results: The comparison of serum Hb, ALB, PA, and Ca 1d after operation between the two groups was not statistically significant. The serum Hb, ALB, and PA levels 10 d after operation were significantly elevated when compared with 1 d after operation. The serum Hb and PA levels 10 d after operation in the intervention group were significantly higher than those in the control group. With the extending of rehabilitation time, the various ROM of elbow joint was significantly increased when compared with before treatment. The total active motion of elbow joint flexion and extension, and forearm pronation and supination 3 and 6 months after follow-up visit in the intervention group was significantly superior to that in the control group.Conclusions:After internal fixation of lower humerus fracture, systemic rehabilitation and nutrition intervention should be taken as early as possible. Rehabilitation can effectively prevent the tissue adhesion around the joint, and promote the fracture healing and the recovery of joint function. Nutrition intervention can significantly improve the nutrition status, and is beneficial to the fracture healing.

  18. Development of a brittle fracture acceptance criterion for the International Atomic Energy Agency (IAEA)

    Energy Technology Data Exchange (ETDEWEB)

    Sorenson, K.B.; Salzbrenner, R. (Sandia National Labs., Albuquerque NM (United States)); Nickell, R.E.

    1993-01-01

    An effort has been undertaken to develop a brittle fracture acceptance criterion for structural components of nuclear material transportation casks. The need for such a criterion was twofold. First, new generation cask designs have proposed the use of ferritic steels and other materials to replace the austenitic stainless steel commonly used for structural components in transport casks. Unlike austenitic stainless steel which fails in a high-energy absorbing, ductile tearing mode, it is possible for these candidate materials to fail via brittle fracture when subjected to certain combinations of elevated loading rates and low temperatures. Second, there is no established brittle fracture criterion accepted by the regulatory community that covers a broad range of structural materials. Although the existing IAEA Safety Series no.37 addressed brittle fracture, its the guidance was dated and pertained only to ferritic steels. Consultant's Services Meetings held under the auspices of the IAEA have resulted in a recommended brittle fracture criterion. The brittle fracture criterion is based on linear elastic fracture mechanics, and is the result of a consensus of experts from six participating IAEA-member countries. The brittle fracture criterion allows three approaches to determine the fracture toughness of the structural material. The three approaches present the opportunity to balance material testing requirements and the conservatism of the material's fracture toughness which must be used to demonstrate resistance to brittle fracture. This work has resulted in a revised Appendix IX to Safety Series no.37 which will be released as an IAEA Technical Document within the coming year. (author).

  19. Development of a brittle fracture acceptance criterion for the International Atomic Energy Agency (IAEA)

    Energy Technology Data Exchange (ETDEWEB)

    Sorenson, Ken B.; Salzbrenner, Richard [Sandia National Labs., Albuquerque, NM (United States); Nickell, Robert E. [Applied Science and Technology, Inc., Poway, CA (United States)

    1992-01-01

    An effort has been undertaken to develop a brittle fracture acceptance criterion for structural components of nuclear material transportation casks. The need for such a criterion was twofold. First, new generation cask designs have proposed the use of ferritic steels and other materials to replace the austenitic stainless steel commonly used for structural components in transport casks. Unlike austenitic stainless steel which fails in a high-energy absorbing, ductile tearing mode, it is possible for these candidate materials to fail via brittle fracture when subjected to certain combinations of elevated loading rates and low temperatures. Second, there is no established brittle fracture criterion accepted by the regulatory community that covers a broad range of structural materials. Although the existing IAEA Safety Series {number sign}37 addressed brittle fracture, its the guidance was dated and pertained only to ferritic steels. Consultant's Services Meetings held under the auspices of the IAEA have resulted in a recommended brittle fracture criterion. The brittle fracture criterion is based on linear elastic fracture mechanics, and is the result of a consensus of experts from six participating IAEA-member countries. The brittle fracture criterion allows three approaches to determine the fracture toughness of the structural material. The three approaches present the opportunity to balance material testing requirements and the conservatism of the material's fracture toughness which must be used to demonstrate resistance to brittle fracture. This work has resulted in a revised Appendix IX to Safety Series {number sign}37 which will be released as an IAEA Technical Document within the coming year.

  20. Total Hip Arthroplasty after Previous Acetabular Osteotomy: Comparison of Three Types of Acetabular Osteotomy.

    Science.gov (United States)

    Tamaki, Tatsuya; Oinuma, Kazuhiro; Miura, Yoko; Shiratsuchi, Hideaki

    2016-01-01

    To compare surgical results of total hip arthroplasty (THA) following acetabular osteotomy, operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following rotational periacetabular osteotomy (RAO; RAO group), 16 hips following shelf acetabuloplasty (Shelf group), and 2475 hips without previous osteotomy (Control group) were retrospectively reviewed. The operative time was significantly longer in the RAO group than in the Control group. Bulk bone augmentation was required more often in the Chiari and RAO groups than in the Control group. An early migration of the acetabular cup occurred in 2 hips in the RAO group. RAO made conversion to THA more complicated than did the Chiari osteotomy or the shelf acetabuloplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A computer study of biodegradable plates for internal fixation of mandibular angle fractures

    NARCIS (Netherlands)

    Tams, J; Van Loon, JP; Otten, B; Bos, RRM

    2001-01-01

    Purpose: This computer-based study was performed to determine the suitability of small biodegradable plate systems for mandibular angle fractures. Materials and Methods: In a 3-dimensional computer model of the mandible, fracture mobility and plate strain were calculated for bite forces applied on 1

  2. Fracture and migration into the coronary sinus of a totally implantable catheter introduced via the right internal jugular vein.

    Science.gov (United States)

    Pignataro, Bruno Soriano; Nishinari, Kenji; Wolosker, Nelson; Bomfim, Guilherme Andre Zoteli

    2014-12-01

    There has been an increase in the use of totally implantable devices. Catheter fractures are rare but known complications. This case report presents a rare migration site of the catheter fragment into the coronary sinus. The totally implantable catheter was introduced into the right internal jugular vein to deliver chemotherapy. Although it was an unusual site, the catheter fragment was removed without complications using loop-snare technique. 2014 BMJ Publishing Group Ltd.

  3. Fractures of the acetabulum in elderly patients: an update.

    Science.gov (United States)

    Guerado, E; Cano, J R; Cruz, E

    2012-12-01

    The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

  4. Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

    Directory of Open Access Journals (Sweden)

    Singh Ajay Pal

    2012-02-01

    Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

  5. The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery.

    Science.gov (United States)

    Duncan, James M; Nahas, Samuel; Akhtar, Kashif; Daurka, Jasvinder

    2015-01-01

    Surgical management of acetabular fractures is often highly complex, and a successful outcome depends upon an appreciation of the fracture pattern and the most appropriate approach to reduce and hold it. Currently, computed tomography (CT) images are used in conjunction with plain x-rays to identify the main fracture components and their spatial relationship to one another, and as such surgeons still have to make decisions based upon their ability to visualise the fracture from the images available. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. This report describes the use of a 3D printer to create a life-size model reconstruction of the pelvis of a 48 year old male patient who sustained a left sided associated both column acetabular fracture following a motorbike accident in the Sahara Desert. The model allowed visualisation of the multiple fracture fragments and their relative displacements. The tactile feedback allowed assessment of the different fracture fragments. The relative displacement of the quadrilateral plate and posterior column fragments could be assessed and the surgeon felt that these would be amenable to reduction from an ilioinguinal approach. An anatomic reduction was achieved and was held with the application of a pelvic brim plate with 2 screws lagging the posterior column/quadrilateral plate fragment. There are previous examples of 3D models being used in orthopaedic surgery through the use of rapid prototyping, however this method is usually expensive and time consuming. Advances in 3D printer technology offer surgeons a number of advantages when treating these complex fractures. With the ever-increasing economy, ease of use and speed of additive processing, the

  6. Osteochondritis dissecans after rotational acetabular osteotomy for dysplastic hip

    Energy Technology Data Exchange (ETDEWEB)

    Nozawa, Masahiko; Maezawa, Katsuhiko; Yuasa, Takahito; Morimoto, Kouichi; Asakura, Taro; Kurosawa, Hisashi [Juntendo University School of Medicine, Department of Orthopaedic Surgery, Tokyo (Japan)

    2005-12-01

    We encountered a rare case of osteochondritis dissecans of the femoral head after rotational acetabular osteotomy that recovered with conservative treatment 4 years after the detection of characteristic radiological findings. (orig.)

  7. Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

    NARCIS (Netherlands)

    van der Veen, Hugo; van Jonbergen, H.P.W.; Poolman, R.W.; Bulstra, S.K.; van Raay, J.J.A.M.

    2013-01-01

    Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher polyethyle

  8. Acetabular paralabral cyst: an uncommon cause of sciatica

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, P.M.; Sanders, T.G. [Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States); Matchette, M.W. [University of Texas Medical School, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 (United States); Parsons, T.W. [Department of Orthopedic Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States)

    2003-02-01

    The association between tears of the acetabular labrum and paralabral cysts has been well documented, and magnetic resonance imaging (MRI) has been shown to be the most accurate noninvasive method of depicting not only the normal anatomic structures of the hip, but also the common pathologic processes such as labral tears and paralabral cysts. We present the case of an acetabular paralabral cyst that resulted in clinically symptomatic compression of the sciatic nerve. (orig.)

  9. [Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

    Science.gov (United States)

    Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

    2016-12-20

    Objective: To make a systematic assessment of the complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Method: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed.The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion.The quality of included trials was evaluated.RevMan 5.0 was used for data analysis. Result: A total of 17 studies involving 1 402 patients were included.There were 687 patients with open reduction and internal fixation and 715 with external fixation.The results of Meta-analysis indicated that there were statistically significant differences with regard to the postoperatively total complications, infection, malunion, tendon rupture (I(2)=8%, RR=0.77(95%CI 0.65-0.91, Z=3.10, P0.05). Conclusion: Postoperative complications are present in both open reduction and internal fixation and external fixation.Compared with external fixation, open reduction and internal fixation is lower in total complications postoperatively, infection and malunion, but external fixation has lower tendon rupture incidence.

  10. TREATMENT OF CLOSED TIBIAL PILON FRACTURES WITH OPEN REDUCTION, INTERNAL FIXATION AND BONE GRAFTING. A STUDY OF 22 CASES COMPARING THE OBJE CTIVE AND SUBJECTIVE EVALUATION

    Directory of Open Access Journals (Sweden)

    Athmaram

    2015-02-01

    Full Text Available The cases of twenty two fractures of the ankle joint that involved the tibial plafond were reviewed. The fractures were classified in to five types according to the severity of the injury. Open reduction and internal fixation was performed using one third tubular plate for fibula and recon plate for the tibia. Bone grafting was don e to augment the fixation and maintain the reduction . For each fracture treated Objective and Subjective evaluation is done. The objective and subjective scores are compared. With this method we noticed that the Type III & IV fractures also had a good or e xcellent result .

  11. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    Directory of Open Access Journals (Sweden)

    D D Baksi

    2016-01-01

    Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

  12. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2013-01-01

    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  13. [Treatment of comminuted fractures of the lower end of the radius with internal osteosynthesis, traction and early mobilization].

    Science.gov (United States)

    Bégué, T; Judet, T; de Thomasson, E; Rouvreau, P; de Cheveigné, C; Garreau de Loubresse, C; Boury, G

    1995-01-01

    Goals for treatment of comminutive fractures of the distal radius include restoration of the articular profile of the proximal part of the joint, while axial loading forces must be avoided as much as possible to prevent secondary displacement. The choice of an internal fixation protected by an external wrist distractor-fixator, with early activo-passive mobilisation, seems to achieve the goal. Twelve patients with a comminuted fracture of the distal radius, including axial articular impigment displacement were reviewed for this study. All fractures were Frykman's type III, IV, VII or VIII. Distraction was done with a specific external apparatus, allowing an internal fixation, using an anterior plate and posterior Kirschner wires for the more complex cases. Distraction was released at the end of the surgical procedure, while the distractor was left in place. The wrist was mobilised early in the post-operative period, and the distractor was removed two months later. At a mean follow-up of 8.5 months, two patients were still painful. Mean motion of the wrist joint was 115 degrees for flexion-extension and 35 degrees for radio-ulnar deviation. Radiological results were good (10 cases), in both planes sagittal and frontal, and stable with time. The radio-ulnar index was correct in 11 cases. Only two cases of Sudeck's atrophy were noted. Authors use a specific external wrist distractor to obtain and maintain reduction in comminuted fractures of the distal end of the radius, using internal fixation in combination. Early motion of the wrist, protected by the wrist distractor seems to lower rates of Sudeck's atrophy.

  14. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    Science.gov (United States)

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  15. The fixateur interne in the reduction and stabilization of thoracolumbar spine fractures in patients with neurologic deficit.

    Science.gov (United States)

    Lindsey, R W; Dick, W

    1991-03-01

    A prospective analysis of 80 consecutive patients who underwent stabilization with the fixateur interne for thoracolumbar spine fractures with complete or incomplete paraplegia was undertaken to determine the results after bone healing. Follow-up examination at an average of 35 months (minimum, 24 months) included all 76 patients still alive. One patient died from a pulmonary embolism, and there were three other unrelated deaths. The mean wedge angle of the fractured vertebra was corrected from 17.4 degrees to 7.9 degrees and remained almost unchanged after 1 year (8.4 degrees) and 2 years, or 1 year after implant removal (8.2 degrees). Also, the wedge index showed nearly no bony loss of correction within the reduced fracture vertebra (0.61 before operation, 0.83 after operation; 0.81 at 1-year follow-up, 0.81 at 2-year follow-up, respectively). In the kyphosis angle measured by the Cobb method, however, there was a loss of 5 degrees after implant removal within the next year because of the disc space collapsed above the fractured vertebra. In this series, 70% of the cases had no formal fusion. All 29 cases of translational displacement of 4-36 mm were anatomically reduced. No neurologic or vascular complication occurred. Posterolateral fusion or transpedicular interbody fusion in the disrupted disc space is recommended.

  16. Biomechanical Comparison of Two Kinds of Internal Fixation in a Type C Zone Ⅱ Pelvic Fracture Model

    Institute of Scientific and Technical Information of China (English)

    Tao Wu; Wei Chen; Qi Zhang; Zhan-Le Zheng; Hong-Zhi Lyu; Yun-Wei Cui; Xiao-Dong Cheng

    2015-01-01

    Background:Unstable pelvic fractures are complex and serious injuries.Selection of a fixation method for these fractures remains a challenging problem for orthopedic surgeons.This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws and minimally invasive adjustable plate (MIAP) combined with one IS screw.Methods:This study was a biomechanical experiment.Six embalmed specimens of the adult pelvis were used.The soft tissue was removed from the specimens,and the spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained.The pubic symphysis,bilateral sacroiliac joints and ligaments,bilateral hip joints,bilateral sacrotuberous ligaments,and bilateral sacrospinous ligaments were intact.Tile C pelvic fractures were made on the specimens.The symphysis pubis was fixed with a plate,and the fracture on the posterior pelvic ring was fixed with two kinds of internal fixation in turn.The specimens were placed in a biomechanical machine at a standing neutral posture.A cyclic vertical load of up to 500 N was applied,and displacement was recorded.Shifts in the fracture gap were measured by a grating displacement sensor.Statistical analysis used:Paired-samples t-test.Results:Under the vertical load of 100,200,300,400,and 500 N,the average displacement of the specimens fixed with MIAP combined with one IS screw was 0.46,0.735,1.377,1.823,and 2.215 mm,respectively,which was significantly lower than that of specimens fixed with two IS screws under corresponding load (P < 0.05).Under the vertical load of 500 N,the shift in the fracture gap of specimens fixed with MIAP combined with one IS screw was 0.261 ± 0.095 mm,and that of specimens fixed with two IS screws was 0.809 ± 0.170 mm.The difference was significant (P < 0.05).Conclusion:The stability of Tile C pelvic fractures fixed with MIAP combined with one IS screw was better than that fixed with two IS screws.

  17. Femoral head fractures: hemiarthroplasty or total hip arthroplasty?

    Science.gov (United States)

    Ullmark, Gösta

    2014-10-02

    Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture.Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results.Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter.A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 13½-fold higher risks compared with a matt.The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference.A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly.

  18. Trabecular metal acetabular revision system (cup-cage construct to address the massive acetabular defects in revision arthroplasty

    Directory of Open Access Journals (Sweden)

    Rajesh Malhotra

    2012-01-01

    Full Text Available The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management options of type 3B Paprosky acetabular defects are limited with allograft and conventional cages. Trabecular metal technology has evolved to address these bone defects. Trabecular metal acetabular revision system (TMARS cup-cage construct is a new technique to address massive acetabular defects. We describe a case of failed hip reconstruction done for a Giant cell tumour of proximal femur managed by a two stage procedure, initial debridement and second stage reconstruction of acetabulum with TMARS cup-cage construct and femur with allograft prosthesis composite.

  19. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome.

    Science.gov (United States)

    Pan, M; Chai, L; Xue, F; Ding, L; Tang, G; Lv, B

    2017-07-01

    The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared. The relative displacement of the EFLIF was less than that of the plate (0.1363 mm to 0.1808 mm). The highest von Mises stress value on the plate was 33% higher than that on the EFLIF. A normal restoration of the Böhler angle was achieved in both groups. No significant difference was found in the clinical outcome on the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale, or on the Visual Analogue Scale between the two groups (p > 0.05). Wound complications were more common in those who were treated with ORIF (p = 0.028). Both EFLIF and ORIF systems were tested to 160 N without failure, showing the new construct to be mechanically safe to use. Both EFLIF and ORIF could be effective in treating Sanders type 2 calcaneal fractures. The EFLIF may be superior to ORIF in achieving biomechanical stability and less blood loss, shorter surgical time and hospital stay, and fewer wound complications.Cite this article: M. Pan, L. Chai, F. Xue, L. Ding, G. Tang, B. Lv. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017

  20. Second international conference on fundamentals of fracture. Program and abstract book. Summaries

    Energy Technology Data Exchange (ETDEWEB)

    1985-01-01

    The approximately 95 papers and abstracts are grouped under the following headings: atomic theory, continuum theory, experimental studies, environmental effects, fatigue, ceramics, high-temperature phenomena, and interfacial fracture. (DLC)

  1. TO COMPARE FUNCTIONAL OUTCOME, COMPLICATIONS & RESULTS OF OPEN REDUCTION & INTERNAL FIXATION WITH CLOSED REDUCTION & EXTERNAL FIXATION IN VOLAR DISPLACED DISTAL RADIAL FRACTURE

    Directory of Open Access Journals (Sweden)

    Ketan Gupta

    2015-02-01

    Full Text Available Distal radius fractures account for 17% of all fractures in adults. The fracture of the lower end of radius crush the mechanical foundation of man‟s most elegant tool, the hand. No other fracture has a greater potential to devastate hand function. Today, o pen reduction of the fracture with internal fixation and closed reduction of the fracture with external fixation, forms the mainstay of the treatment of an uncomplicated distal end radius fracture in a patient unless specifically contraindicated. AIMS AND OBJECTIVES: To compare functional outcome, complications & results of two commonly used surgical methods; Open reduction & internal fixation with volar placed buttress plate and Closed reduction & external fixation with „Jess fixator‟ and internal fixation with „k - wire‟ in volar displaced distal radial fractures. MATERIALS AND METHODS : Total 30 cases were included in the study. 15 patients were treated with Open reduction & internal fixation with volar placed buttress plate and 15 were treated with Closed r eduction & external fixation with „Jess fixator‟ and internal fixation with „k - wire‟ in volar displaced distal radial fractures. Patients were followed up at regular intervals and Anatomical and functional outcomes were evaluated in all the patients. RESUL TS: Patients treated with Open reduction & internal fixation, 8 showed excellent results, 5 good and 2 fair results. Patients treated with closed reduction and external fixation 4 showed excellent results, 5 good, 4 fair and 2 showed poor results. CONCLUSI ON: O.R.I.F is generally preferred modality gives better results in terms of functional recovery and decrease morbidity to patient

  2. Transmasseteric antero-parotid facelift approach for open reduction and internal fixation of condylar fractures

    OpenAIRE

    Choi, Moon-Gi

    2015-01-01

    Surgical approaches to the condylar fracture include intraoral, preauricular, submandibular, and retromandibular approaches. Each approach has its own advantages and disadvantages. When a patient needs esthetic results and an intraoral approach is not feasible, the transmasseteric antero-parotid facelift approach is considered. This approach permits direct exposure and allow the surgeon to fixate the fractured unit tangentially. Tangential fixation is critical to osteosynthesis. Disadvantages...

  3. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures.

    Science.gov (United States)

    Berend, Keith R; Lombardi, Adolph V; Mallory, Thomas H; Adams, Joanne B; Russell, Jackie H; Groseth, Kari L

    2005-10-01

    Constrained acetabular components can treat or prevent instability after total hip arthroplasty (THA). We examine long-term results of 755 consecutive constrained THA in 720 patients (1986-1993; 62 primary, 59 conversion, 565 revision, 60 reimplantation, and 9 total femur). Eighty-three patients (88 THAs) were lost before 10-year follow-up, leaving 639 patients (667 THAs) available for study. Dislocation occurred in 117 hips (17.5%), in 37 (28.9%) of 128 constrained for recurrent dislocation, and 46 (28.2%) of 163 with dislocation history. Other reoperations were for aseptic loosening (51, 7.6% acetabular; 28, 4.2% stem; 16, 2.4% combined), infection (40, 6.0%), periprosthetic fracture (19, 2.8%), stem breakage (2, 0.3%), cup malposition (1, 0.1%), dissociated insert (1, 0.1%), dissociated femoral head (1, 0.1%), and impingement of 1 broken (0.1%) and 4 (0.6%) dissociated constraining rings. Although constrained acetabular components prevented recurrent dislocation in 71.1%, they should be used cautiously, with a 42.1% long-term failure rate observed in this series. Dislocation was common despite constraint with previous history as a significant risk.

  4. Three-fin acetabular prosthesis for superior acetabular bone defects: a three-dimensional finite element analysis

    Institute of Scientific and Technical Information of China (English)

    LIU Yu-zeng; HAI Yong; ZHAO Hui

    2012-01-01

    Background Given that three-dimensional finite element models have been successfully used to analyze biomechanics in orthopedics-related research,this study aimed to establish a finite element model of the pelvic bone and three-fin acetabular component and evaluate biomechanical changes in this model after implantation of a three-fin acetabular prosthesis in a superior segmental bone defect of the acetabulum.Methods In this study,three-dimensional finite element models of the pelvic bone and three-fin acetabular component were first established.The prosthesis model was characterized by three different conformational fins to facilitate and optimize the prosthetic design.The spongy and cortical bones were evaluated using a different modulus of elasticity in this established model.Results The maximum and minimum von Mises stresses on the fins of the acetabular component were 15.2 and 0.74,respectively.The maximum and minimum micromotion between the three-fin acetabular component and the acetabulum bone interface were 27 and 13 μm,respectively.A high primary stability and implied better clinical outcome were revealed.Conclusion Finite element analysis may be an optimal strategy for biomechanics-related research of prosthetic design for segmental acetabular bone defects.

  5. Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

    Directory of Open Access Journals (Sweden)

    Singh Daria

    2006-01-01

    Full Text Available Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

  6. EVALUATION OF FUNCTIONAL OUTCOME AFTER OPEN REDUCTION AND INTERNAL FIXATION OF DISTAL FEMUR FRACTURES BY LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    L. Lokanadha Rao

    2016-09-01

    Full Text Available BACKGROUND In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. MATERIALS AND METHODS This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, King George Hospital, Visakhapatnam from September 2013 to September 2015. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis. 15 cases were in right femur (60% and 10 cases were in left femur (40%. RESULTS 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. CONCLUSION LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.

  7. CSNI Project for Fracture Analyses of Large-Scale International Reference Experiments (FALSIRE II)

    Energy Technology Data Exchange (ETDEWEB)

    Bass, B.R.; Pugh, C.E.; Keeney, J. [Oak Ridge National Lab., TN (United States); Schulz, H.; Sievers, J. [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Koeln (Gemany)

    1996-11-01

    A summary of Phase II of the Project for FALSIRE is presented. FALSIRE was created by the Fracture Assessment Group (FAG) of the OECD/NEA`s Committee on the Safety of Nuclear Installations (CNSI) Principal Working Group No. 3. FALSIRE I in 1988 assessed fracture methods through interpretive analyses of 6 large-scale fracture experiments in reactor pressure vessel (RPV) steels under pressurized- thermal-shock (PTS) loading. In FALSIRE II, experiments examined cleavage fracture in RPV steels for a wide range of materials, crack geometries, and constraint and loading conditions. The cracks were relatively shallow, in the transition temperature region. Included were cracks showing either unstable extension or two stages of extensions under transient thermal and mechanical loads. Crack initiation was also investigated in connection with clad surfaces and with biaxial load. Within FALSIRE II, comparative assessments were performed for 7 reference fracture experiments based on 45 analyses received from 22 organizations representing 12 countries. Temperature distributions in thermal shock loaded samples were approximated with high accuracy and small scatter bands. Structural response was predicted reasonably well; discrepancies could usually be traced to the assumed material models and approximated material properties. Almost all participants elected to use the finite element method.

  8. [Bone substitutes augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly: a meta-analysis].

    Science.gov (United States)

    Wu, Jian-bin; Yang, Lei; Zhou, Fei-ya; Feng, Yong-zeng

    2016-06-01

    To systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly. Subject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases. Eleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)]. Compared with single internal fixation, bone substitutes augmentation combined with internal

  9. Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results.

    Science.gov (United States)

    Kim, W Y; Greidanus, N V; Duncan, C P; Masri, B A; Garbuz, D S

    2008-01-01

    In cementless revision total hip arthroplasty (THA), achieving initial implant stability and maximising host bone contact is key to the success of reconstruction. Porous tantalum acetabular shells may represent an improvement from conventional porous coated uncemented cups in revision acetabular reconstruction associated with severe acetabular bone defects. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects done with a hemispheric, tantalum acetabular shell and multiple supplementary screws. At a mean follow-up of 40 (24-51) months, one acetabular shell had been revised in a patient with a Paprosky 3B defect. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent early clinical and radiographic results and warrants further evaluation in revision acetabular reconstruction associated with severe acetabular bone defects.

  10. LATE OPEN REDUCTION AND INTERNAL FIXATION FOR FRACTURES OF LATERAL CONDYLE OF HUMERUS IN CHILDREN: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Ajay

    2013-10-01

    Full Text Available ABSTRACT: BACKGROUND : Neglected fracture of the lateral condyle of distal humerus in children is very common. Patients with non union of the lateral condylar fracture have pain, instability or a progressive cubitus valgus deformity, condylar prominence. A neglected displaced lateral humeral condyle fracture remains a difficult problem to treat. The bone ends become indistinct and soft tissue becomes contracted; making anatomic reduction difficult. Moreover a n attempt to mobilize the fragment by stripping the soft tissues may lead to avascular necrosis. Several authors have recommended operative treatment for such patients, while others do not recommend operative intervention because stiff elbow and AVN are th e usual outcomes. The present study was undertaken to assess the results of open reduction and internal fixation in neglected lateral humeral condyle fracture in children. MATERIAL AND METHODS : This is a prospective study carried out between November 2008 and July 2011 in the department of orthopedics at Teerthanker Mahaveer Medical College and research centre, Moradabad. Eighteen patients (14M:4F with an average age of 7.3years (range 5.5 to 14 years who had lateral humeral condyle fracture and reporte d 3 or more weeks after sustaining injury, were included in the study. The fractures were classified according to the Jacobs system. All patients were operated using the lateral approach and fixation was done using K wire or screw with or without bone graf ting. The results were graded as excellent, good, fair or poor according to the modified criteria of Agarwal et al. RESULTS : There were 14 males and 4 females with a mean age of 7 years and 3 months (range 4 - 14 years. Among the nine (50% patients who pr esented between 5 to 8 weeks after injury, the results were excellent in 3, good in 4, fair in 1 and poor in 1 patient. Excellent to good results were seen in all the five (27% patients presenting between 3 - 5 weeks of injury. Among

  11. Influence of hooks and a lag screw on internal fixation plates for lateral malleolar fracture: a biomechanical and ergonomic study.

    Science.gov (United States)

    Sakai, Rina; Uchino, Masataka; Yoneo, Terumasa; Ohtaki, Yasuaki; Minehara, Hiroaki; Matsuura, Terumasa; Gomi, Tsutomu; Ujihira, Masanobu

    2017-02-23

    For internal fixation of AO classification Type B lateral malleolar fracture, insertion of lag screws into the fracture plane and fixation with a one-third tubular plate as a neutralization plate are the standard treatment procedures. The one-third tubular plate is processed to a hook shape and hung on the distal end of the fibula. In this study, to compare the function of the hook and lag screws of a one-third tubular plate and LCP for osteosynthesis of lateral malleolar fracture, mechanical indices of internal fixation were compared among the one-third tubular plates with lag screws with and without the hook and a locking compression plate. As mechanical tests, a compression test was performed in which compression in the bone axis direction produced by supporting the body weight was simulated, and a torsion test was performed in which external rotation of the bone axis caused by plantar flexion of the ankle joint was simulated. Muscle strength during walking and the force and torque acting on the ankle and knee joints were determined using inverse dynamic analysis. Finite element analysis was performed to analyze the function of hooks and lag screws. The joint reaction force determined by inverse dynamic analysis was adopted as the loading condition of finite element analysis. A stiffness equivalent to that of healthy bone could be achieved by all three internal fixations. It was clarified that the presence of the hook does not make a difference in stiffness. Displacement of the one-third tubular plate was small regardless of the presence or absence of the hook compared with those of locking compression plates. The presence of the hook did not make any difference in stiffness, suggesting that active preparation of the hook is unnecessary. We also clarified that lag screws inhibit displacement.

  12. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Overgaard, Søren; Lauritsen, Jens;

    2013-01-01

    treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. Methods 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1...... an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex. Results Cemented HA had...

  13. Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome.

    Science.gov (United States)

    Singh, Rabindra P; Carter, Lachlan M; Whitfield, Paul H

    2013-07-01

    We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ(2)=0.051, df=1, p=0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures.

  14. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

  15. Internal fixation vs conservative treatment for displaced distal radius fractures: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Yu, Guang Shu; Lin, Yan Bin; Le, Li Sheng; Zhan, Mei Feng; Jiang, Xiao Xiang

    2016-05-01

    The aim of the present study was to compare clinical outcomes of internal fixation and conservative approach in the treatment of displaced distal radius fractures. Reports of studies were retrieved from the PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid, CNKI, and Wanfang Data databases, as well as other sources. Methodological quality of the trials was critically assessed, and relevant data were extracted. Review Manager (RevMan) meta-analysis software (version 5.0; Cochrane Collaboration, London, UK) was used for data analysis. A total of 10 randomized controlled trials, which included 653 patients, were eligible for inclusion in the present meta-analysis, 7 of which were in English, and 3 of which were in Chinese. The trials had medium risk of bias. Results of meta-analysis showed that patients undergoing conservative treatment for distal radius fractures had better restoration of pronation (MD=1.80, 95% confidence interval [CI]=0.18-3.42, p=0.03; heterogeneity p=0.17, I2=43%), but shorter restoration of radial length (MD=2.62, 95% CI=1.47-3.76, pinternal fixation and conservative treatment for displaced distal radius fractures. Best course of of treatment must be determined based on concrete conditions.

  16. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing.

    Science.gov (United States)

    Oh, Hyoung-Keun; Choo, Suk-Kyu; Kim, Ji-Wan; Lee, Mark

    2015-12-01

    We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Fracture-related infection: A consensus on definition from an international expert group

    NARCIS (Netherlands)

    W.-J. Metsemakers (Willem-Jan); Morgenstern, M. (M.); McNally, M.A. (M. A.); Moriarty, T.F. (T. F.); McFadyen, I. (I.); Scarborough, M. (M.); N.A. Athanasou (Nicholas); P.E. Ochsner (P.); Kuehl, R. (R.); Raschke, M. (M.); Borens, O. (O.); Xie, Z. (Z.); Velkes, S. (S.); Hungerer, S. (S.); Kates, S.L. (S. L.); Zalavras, C. (C.); Giannoudis, P.V. (P. V.); Richards, R.G. (R. G.); M.H.J. Verhofstad (Michiel)

    2017-01-01

    textabstractFracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or

  18. [Analysis of reason and strategy for the failure of posterior pedicle screw short-segment internal fixation on thoracolumbar fractures].

    Science.gov (United States)

    Xing, Jin-Ming; Peng, Wen-Ming; Shi, Chu-Yun; Xu, Lei; Pan, Qi-Huao

    2013-03-01

    To analyze the reason and strategy for failure of posterior pedicle screw short-segment internal fixation on thoracolumbar fractures. From March 2008 to December 2010,the clinical data of 18 patients with thoracolumbar fracture failed in posterior pedicle screw short-segment internal fixation were retrospectively analyzed. There were 11 males and 7 females with an average age of 37.2 years (ranged, 19 to 63). The time from the first operation to complication occurrence was from 6 to 44 months with an average of 14.3 months. Of them,fusion failure was in 7 cases (combined with screw breakage in 4 cases), the progressive neuro-dysfunction was in 5 cases,the progressive lumbodorsal pain was in 6 cases. All 18 patients with kyphosis were treated with anterior internal fixation remaining posterior fixation (9 cases) and anterior internal fixation after posterior fixation removal (9 cases). All the patients were followed up from 18 to 50 months with an average of 30.5 months. No intetnal fixation loosening and breakage were found, moreover, X-ray and lamellar CT showed bone healing well. Preoperative, postoperative at 3 months and at final follow-up, ODI score was respectively 31.6+/-5.1, 8.6+/-5.7, 8.3+/-3.2; VAS score was respectively 7.2+/-2.3, 2.3+/-0.7, 2.1+/-1.1; kyphosis angle was respectively (-21.2/-+7.8 degreeso, (-5.3+/-6.8 degrees ), (-5.8+/-7.8 )degrees. Compared with preoperative data ,above-listed items had obviously ameliorated(Pinternal fixation may result in the complications such as bone nonunion ,internal fixation breakage and progressive kyphosis. Anterior reconstruction may be a good strategy for the failure of posterior operation.

  19. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Blacksin, M.F.; Zurlo, J.V. [Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark, NJ (United States); Levy, A.S. [Department of Orthopedic Surgery, University of Medicine and Dentistry of New Jersey, University Hospital, Newark, NJ 07103-2426 (United States)

    1998-08-01

    Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee. (orig.) With 4 figs., 2 tabs., 13 refs.

  20. A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

    Science.gov (United States)

    OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

    2017-04-01

    The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

  1. An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures.

    Science.gov (United States)

    Peng, Weihai; Zheng, Wei; Shi, Kai; Wang, Wangshu; Shao, Ying; Zhang, Duo

    2015-11-09

    Internal fixation of bone fractures using biodegradable poly(L-lactic-acid) (PLLA)-based materials has attracted the attention of many researchers. In the present study, 36 male beagle dogs were randomly assigned to two groups: PLLA/PLLA-gHA (PLLA-grafted hydroxyapatite) group and PLLA group. PLLA/PLLA-gHA and PLLA plates were embedded in the muscular bags of the erector spinae and also implanted to fix mandibular bone fractures in respective groups. At 1, 2, 3, 6, 9, and 12 months postoperatively, the PLLA/PLLA-gHA and PLLA plates were evaluated by adsorption and degradation tests, and the mandibles were examined through radiographic analysis, biomechanical testing, and histological analysis. The PLLA/PLLA-gHA plates were non-transparent and showed a creamy white color, and the PLLA plates were transparent and faint yellow in color. At all time points following surgery, adsorption and degradation of the PLLA/PLLA-gHA plates were significantly less than those of the PLLA plates, and the lateral and longitudinal bending strengths of the surgically treated mandibles of the beagle dogs in the PLLA/PLLA-gHA group were significantly greater than those of the PLLA group and reached almost the value of intact mandibles at 12 months postoperatively. Additionally, relatively rapid bone healing was observed in the PLLA/PLLA-gHA group with the formation of new lamellar bone tissues at 12 months after the surgery. The PLLA/PLLA-gHA nano-composite can be employed as a biodegradable material for internal fixation of mandibular bone fractures.

  2. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  3. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis.

    Science.gov (United States)

    Wang, Weiguo; Wei, Junjie; Xu, Zhanwang; Zhuo, Wenkun; Zhang, Yuan; Rong, Hui; Cao, Xuecheng; Wang, Pingshan

    2014-05-22

    A meta-analysis was performed to assess the association between healing rate, avascular necrosis (AVN) of femoral head and two reductions-open reduction internal fixation (ORIF) and closed reduction internal fixation (CRIF) for femoral neck fracture. A literature-based search was conducted to identify all relevant studies published before September 10, 2013. The odd ratio (OR) and 95% confidence interval (CI) were used for estimating the effects of the two reduction methods. Data were independently extracted by two investigators who reached a consensus on all of the items. The heterogeneity between studies was examined by χ2-based Q statistic. Egger's regression analysis was used to evaluate publication bias. Statistical analysis was performed by Stata 10.0 software. We examined 14 publications. The results of the present meta-analysis showed that AVN of femoral head were significant associated with the two reductions (CRIF vs. ORIF, OR=1.746, 95% CI 1.159-2.628, p=0.008), while the healing rate were not (CRIF vs. ORIF, OR=0.853, 95% CI 0.573-1.270, p=0.433). The present meta-analysis indicated the risk of AVN of femoral head was significant higher after CRIF fixation compared with ORIF, but no association between the healing rate and the two reductions for femoral neck fracture.

  4. MR imaging findings of acetabular dysplasia in adults

    Energy Technology Data Exchange (ETDEWEB)

    James, Steven; Connell, David [The Royal National Orthopaedic Hospital, Radiology Department, London, Middlesex (United Kingdom); Miocevic, Miranda; Malara, Frank; Pike, Jonathan [Victoria House Hospital, Radiology Department, Melbourne (Australia); Young, David [Melbourne Orthopaedic Group, Orthopaedic Surgery, Melbourne (Australia)

    2006-06-15

    To evaluate the diagnostic accuracy of MR imaging in the identification of labral and articular cartilage lesions in patients with acetabular dysplasia. Pre-operative MR imaging was performed on 27 hips in 25 consecutive patients (16 males, 9 females, age range 19-52 years, mean age 31.2 years) with radiographic evidence of acetabular dysplasia (centre-edge angle of Wiberg <20 degrees). The average duration of symptoms was 16.2 months. Two musculoskeletal radiologists assessed MR images in consensus for the presence of abnormality involving the acetabular labrum and adjacent acetabular articular cartilage. A high resolution, non-arthrographic technique was used to assess the labrum and labral chondral transitional zone. Surgical correlation was obtained in all cases by a single surgeon experienced in hip arthroscopy and ten patients with normal hip MRI were included to provide a control group. The acetabular labra in the dysplastic hips demonstrated abnormal signal intensity, and had an elongated appearance when compared with the control group (mean length 10.9 mm vs 6.4 mm). Morphological appearances in the labra included surface irregularity, fissures and cleft formation. MR imaging correctly identified the severity of chondral abnormality in 24 of 27 hips (89%) when compared with arthroscopic findings. MR imaging demonstrates an elongated labrum, focal intra-substance signal change and irregularity and fissuring of the margins in patients with acetabular dysplasia. Abnormality is also identified at the labral chondral transitional zone, where fissuring, focal clefts, chondral deficiency and subchondral cyst formation may be apparent. A high-resolution, non-arthrographic technique can provide an accurate preoperative assessment and evaluate the presence of premature osteoarthritis. (orig.)

  5. Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures.

    Science.gov (United States)

    Wang, Jie; Ma, Jian-Xiong; Jia, Hao-Bo; Chen, Yang; Yang, Yang; Ma, Xin-Long

    2016-05-01

    Subtrochanteric fractures are common and result in significant morbidity and mortality. Various kinds of implants have been used to fix it. The aim of this study was to compare the biomechanical performance of PFN, DHS, DCS, and the PFLP in the treatment of subtrochanteric comminuted fractures.A total of 32 antiseptic human femurs from 16 donors were randomly allocated to 4 groups for fixation with PFN, DHS, DCS, and PFLP. A 2-cm cylindrical bone fragment was removed 1 cm below the lesser trochanter to simulate OTA/AO 32-C3.2 post instrumentation fracture. All specimens in single-leg stance situation were preloaded 5 times at 100 N in the axial direction to eliminate the time effect of relaxation and settling, followed by cyclic testing at a rate of 1 Hz with stepwise increasing load. Keeping the valley load at a constant level of 100 N during the entire cyclic test, the peak load, starting at 200 N, was increased by 100 N at 300-cycle steps until a maximum of 1500 cycles or until failure of the bone-implant construct occurred. Each specimen was kept unloaded under 100 N compression for 30 minutes between the 300-cycle steps.Femoral head displacement after 1500 cycles was 1.09 mm ± 0.13 for PFN, 1.78 mm ± 0.25 for DHS, 2.63 mm ± 0.46 for DCS, and 2.26 mm ± 0.16 for PFLP, with significant difference between any 2 implants (P subtrochanteric fractures OTA/AO 32-C3.2 revealed in the current test setup highest fixation strength with PFN, followed by DHS, PFLP, and DCS.

  6. Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint.

    Science.gov (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A

    2015-12-01

    With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.

  7. Effect of different restorative procedures on the fracture resistance of teeth submitted to internal bleaching

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    Andiara Ribeiro Roberto

    2012-02-01

    Full Text Available The aim of this study was to evaluate the influence of different restorative procedures on the fracture resistance of endodontically treated teeth submitted to intracoronal bleaching. Fifty upper central incisors were distributed into 5 groups: GI - healthy teeth; GII - endodontically treated teeth sealed with Coltosol; GIII - endodontically treated teeth bleached and sealed with Coltosol; GIV - endodontically treated teeth bleached and restored with composite resin; and GV - endodontically treated teeth bleached and restored with a fiberglass post and composite resin. In the bleached specimens, a cervical seal was made prior to bleaching with 38% hydrogen peroxide. The gel was applied on the buccal surface and in the pulp chamber, and was then light-activated for 45 s. This procedure was repeated three times per session for four sessions, and each group was submitted to the restorative procedures described above. The specimens were submitted to fracture resistance testing in a universal testing machine. There were statistically significant differences among the groups (p 0.05. The restorative procedures using composite resin were found to successfully restore the fracture resistance of endodontically treated and bleached teeth.

  8. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    Science.gov (United States)

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

  9. Para-acetabular periarthritis calcarea: Its radiographic manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Kawashima, Akira; Murayama, Sadayuki; Ohuchida, Toshiyuki; Russel, W.J.

    1988-10-01

    On retrospective reviews of radiographs, periarthritis calcarea was distinguished from os acetabula by interval radiographic progression and regression. Among 59 men and 51 women, there were 137 instances of para-acetabular calcifications and ossifications, which were morphologically classified as 58 discrete, 58 amorphous, and 21 segmented types. At least 43 of 90 densities were newly developed. Mean age at first detection was 47.7 years. Three of the discrete densities were unchanged and represented os acetabula. Thus, recognition of para-acetabular periarthritis calcarea is not only of academic importance; it can facilitate proper treatment as well. (orig./GDG).

  10. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  11. FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    Madhusudhana

    2015-10-01

    Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

  12. Percutaneous acetabuloplasty for metastatic acetabular lesions

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    Logroscino Giandomenico

    2008-05-01

    Full Text Available Abstract Background Osteolytic metastases around the acetabulum are frequent in tumour patients, and may cause intense and drug-resistant pain of the hip. These lesions also cause structural weakening of the pelvis, limping, and poor quality of life. Percutaneous acetabuloplasty is a mini-invasive procedure for the management of metastatic lesions due to carcinoma of the acetabulum performed in patients who cannot tolerate major surgery, or in patients towards whom radiotherapy had already proved ineffective. Methods We report a retrospective study in 25 such patients (30 acetabuli who were evaluated before and after percutaneous acetabuloplasty, with regard to pain, mobility of the hip joint, use of analgesics, by means of evaluation forms: Visual Analog Scale, Harris Hip Score, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC, Eastern Cooperative Oncology Group (ECOG. The results obtained were analysed using the χ2 Test and Fisher's exact test. Significance was sent at P Results Marked clinical improvement was observed in all patients during the first six post-operative months, with gradual a worsening thereafter from deterioration of their general condition. Complete pain relief was achieved in 15 of our 25 (59% of patients, and pain reduction was achieved in the remaining 10 (41% patients. The mean duration of pain relief was 7.3 months. Pain recurred in three patients (12% between 2 weeks to 3 months. No major complications occurred. There was transient local pain in most cases, and 2 cases of venous injection of cement without clinical consequences. Conclusion Percutaneous acetabuloplasty is effective in improving the quality of life of patients with osteolytic bone tumours, even though the improvement is observed during the first 6 months only. It can be an effective aid to chemo- and radiotherapy in the management of acetabular metastases.

  13. Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients☆

    Science.gov (United States)

    Guimarães, Rodrigo Pereira; de Góes Ribeiro, Arthur; Ulson, Oliver; de Ávila, Ricardo Bertozzi; Ono, Nelson Keiske; Polesello, Giancarlo Cavalli

    2016-01-01

    Objective To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. Methods A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. Results The patients’ mean age was 40 years (range 22–77 years) and the mean length of follow-up was 18.5 months (range 3–69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). Conclusion Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection. PMID:27069879

  14. Involvement of Residents Does Not Increase Postoperative Complications After Open Reduction Internal Fixation of Ankle Fractures: An Analysis of 3251 Cases.

    Science.gov (United States)

    Louie, Philip K; Schairer, William W; Haughom, Bryan D; Bell, Joshua A; Campbell, Kevin J; Levine, Brett R

    Ankle fractures are common injuries frequently treated by foot and ankle surgeons. Therefore, it has become a core competency for orthopedic residency training. Surgical educators must balance the task of training residents with optimizing patient outcomes and minimizing morbidity and mortality. The present study aimed to determine the effect of resident involvement on the 30-day postoperative complication rates after open reduction and internal fixation of ankle fractures. A second objective of the present study was to determine the independent risk factors for complications after this procedure. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program database who had undergone open reduction internal fixation for ankle fractures from 2005 to 2012. Propensity score matching was used to help account for a potential selection bias. We performed univariate and multivariate analyses to identify the independent risk factors associated with short-term postoperative complications. A total of 3251 open reduction internal fixation procedures for ankle fractures were identified, of which 959 (29.4%) had resident involvement. Univariate (2.82% versus 4.54%; p = .024) and multivariate (odds ratio 0.71; p = .75) analyses demonstrated that resident involvement did not increase short-term complication rates. The independent risk factors for complications after open reduction internal fixation of ankle fractures included insulin-dependent diabetes, increasing age, higher American Society of Anesthesiologists score, and longer operative times. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Analysis of Orbital Volume Measurements Following Reduction and Internal Fixation Using Absorbable Mesh Plates and Screws for Patients With Orbital Floor Blowout Fractures.

    Science.gov (United States)

    Hwang, Won Joo; Lee, Do Heon; Choi, Won; Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong

    2017-08-22

    Hinge-shaped fractures are common type of orbital floor blowout fractures, for which reduction and internal fixation is ideal. Nonetheless, orbital floor reconstruction using alloplastic materials without reducing the number of bone fragments is the most frequently used procedure. Therefore, this study analyzed and compared the outcomes between open reduction and internal fixation using absorbable mesh plates and screws, and orbital floor reconstruction, by measuring the orbital volume before and after surgery. Among patients with orbital floor blowout fractures, this study was conducted on 28 patients who underwent open reduction and internal fixation, and 27 patients who underwent orbital floor reconstruction from December 2008 to September 2015. The mechanism of injury, ophthalmic symptoms before and after surgery, and the degree of enophthalmos were examined; subsequently, the volumes of the affected and unaffected sides were measured before and after surgery based on computed tomography images. This study compared the degree of recovery in the correction rate of the orbital volume, ophthalmic symptoms, and enophthalmos between the 2 groups. The patients who underwent open reduction and internal fixation, and the patients who underwent orbital floor reconstruction showed average correction rates of 100.36% and 105.24%, respectively. Open reduction and internal fixation showed statistically, significantly superior treatment outcomes compared with orbital floor reconstruction. The ophthalmic symptoms and incidence of enophthalmos completely resolved in both groups. For orbital floor blowout fractures, open reduction and internal fixation using absorbable mesh plates and screws was a feasible alternative to orbital floor reconstruction.

  16. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures.

    Directory of Open Access Journals (Sweden)

    Zhiyong Li

    Full Text Available OBJECTIVE: This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS: From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females with a mean age of 44.8 years (range, 20-64 years. There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females with a mean age of 46.3 years (range, 23-64 years. There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS: In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months. All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100. In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months. The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68 and 16.2% (11/68, respectively, significantly higher than those in study group (both P<0.05. The mean Harris score in control group was 83.8 (41-100, significantly lower than that in study group (P<0.05. CONCLUSION: Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

  17. Treatment of Femoral Neck Fractures: Unipolar Versus Bipolar Hemiarthroplasty

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    Somashekar

    2013-07-01

    Full Text Available BACKGROUND AND OBJECTIVE: Intracapsular femoral neck fractures are common in the elderly population. To avoid the poor outcome of internal fixation and for early mobilization, hemiarthroplasty is performed. However, there is inadequate evidence to support the choice between unipolar or bipolar hemiarthroplasty. The aim of this study was to compare the outcome of unipolar with the bipolar prosthesis in geriatric patients. METHODS: Forty-one patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics, between September 2009 and October 2012. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year. RESULTS: The two groups of patients with mean age of 67.3 in bipolar group and 75.6 in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in bipolar and unipolar groups was 86.18±12.18 and 79.79±15.55, respectively (p=0.183; range of motion was 210.63±28.39 and 181.58±37(p=0.015 with bipolar and unipolar groups, respectively. Functional activities were better in the bipolar group. Complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion were encountered in unipolar prostheses. CONCLUSION: The use of bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.

  18. Safety and efficacy of vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a prospective multicenter international randomized controlled study

    Science.gov (United States)

    Leali, Paolo Tranquilli; Solla, Federico; Maestretti, Gianluca; Balsano, Massimo; Doria, Carlo

    2016-01-01

    Summary Background Vertebral compression fractures (VCFs) treated non-operatively can diminish function and quality of life, and lead to chronic health effects. The short-term safety and effectiveness of vertebroplasty for symptomatic VCFs are well-documented, but long-term follow-up is needed. Purpose The aim of this paper was to analyse a multicenter international experience of 200 compression fractures treated with percutaneous vertebroplasty (VP) and compare the results of this procedure with the result of 200 patients treated conservatively. To estimate cost-effectiveness of VP compared to conservative care in terms of: pain reduction, quality of life, complications, secondary fractures and mortality. Materials and methods 400 patients have been enrolled in a prospective randomized controlled study with painful VCFs with bone edema on MR imaging, local back pain for 6 weeks or less, osteoporosis and aged 55 years or older; after obtaining informed consent patients are included and randomized for VP or conservative care. Before treatment and at follow-up with regular intervals during 1-year period were administered to patients standard questionnaires addressing: clinical symptoms, pain medication, Visual Analogue Scale (VAS) score for pain, Oswestry Disability Index (ODI) score to evaluate functional activity. Results 200 patients treated with PV compared with 200 patients treated conservatively had significantly better VAS and used less analgesics 1 day after treatment. Twenty-four hours after VP, there was a reduction in pain scores and an improvement in physical functions, whereas remain unchanged in the patients treated conservatively. Conclusions Pain relief and improvement of mobility and function after PV is immediate and significantly better in the short term compared with non-surgical care treatment. PMID:28228788

  19. High Prevalence of Chronic Pain With Neuropathic Characteristics After Open Reduction and Internal Fixation of Ankle Fractures.

    Science.gov (United States)

    Rbia, Nadia; van der Vlies, Cornelis H; Cleffken, Berry I; Selles, Ruud W; Hovius, Steven E R; Nijhuis, Tim H J

    2017-09-01

    Unstable ankle fractures require treatment with open reduction and internal fixation (ORIF). Long-term functional outcome is satisfying in most patients; however, a number of patients have persistent complaints. Superficial nerve complications following ankle surgery may be the cause of chronic pain and disability. In this observational retrospective survey, a cohort of 527 women and men, who underwent ORIF in the period from January 2007 to January 2014, were invited to an online questionnaire. Pain symptoms were assessed using the McGill Pain Questionnaire (MPQ) and the Douleur Neuropathic en 4 Questions (DN4) Questionnaire. Descriptive statistics were used to present patient characteristics; a logistic regression model was used to analyze prognostic factors of neuropathic pain. A total of 271 patients completed the questionnaire. Mean follow-up period was 5.8 years (±1.9). Persistent neuropathic pain symptoms were present in 61 of all patients, and 51 of these patients reported an impaired quality of life caused by their symptoms. In univariate analysis, the following parameters were associated with neuropathic pain: age, hypertension, a thyroid disorder, lower back pain, fracture dislocations, and late complications such as nonunion, posttraumatic arthritis, or osteochondral injury. In multivariate analysis, an age between 40 and 60 years was found to be a significant predictor of neuropathic pain. Hypertension, dislocation, and late complications were significant predictors of persistent pain without neuropathic characteristics. The present study demonstrated a prevalence of persistent neuropathic pain symptoms after ORIF for ankle fractures in 23% of the respondents, which caused an impaired health-related quality of life. We identified 4 significant predictors of chronic and neuropathic pain after ORIF. This knowledge may aid the treating surgeon to identify patients who are at increased risk of persistent postoperative neuropathic pain and may affect the

  20. Pitfalls associated with open reduction and internal fixation of fractured ribs.

    Science.gov (United States)

    Sarani, Babak; Schulte, Leah; Diaz, Jose J

    2015-12-01

    Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and the probability of death increases further with age. Treatment is centered on pain control and early mobilization to provide adequate pulmonary hygiene. Multimodality interventions, such as incentive spirometry, postural changes, and coughing, are pivotal in minimizing the risk of pneumonia and death. Recently, many studies have found mortality benefit to operation fixation (ORIF) of ribs in select patients. However, this procedure remains underutilized partly due to lack of familiarity with its technique and pitfalls by trauma surgeons, in particular. Whereas there are publications on operative technique, there are no studies describing pitfalls associated with this procedure. The purpose of this paper is to describe pitfalls on the technical aspects of ORIF of the ribs based on the medical literature where possible and based on our experience in instances where peer reviewed evidence is lacking. The paper is not meant to serve as a protocol for managing rib fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures.

    LENUS (Irish Health Repository)

    McGreal, G

    2012-02-03

    We use a braided polyester suture in place of cerclage wire in tension band fixations. The objective of this study was to test the biomechanical properties of this technique. Sixteen cadaveric patellae were fractured and repaired by modified tension band fixation. Eight were fixed using eighteen gauge stainless steel wire as a tension band and eight using braided polyester. All specimens were subjected to tensile testing. Polyester was 75.0% as strong as wire. For dynamic testing, the patellae of seven cadaveric knees were fractured and then fixed with polyester tension bands. These were mounted in a device capable of extending the knees from 90 degrees to neutral against an applied force. None of the fixations failed. Three of the specimens fixed using 18 gauge stainless steel wire were compared with three fixed using polyester over 2000 cycles of knee flexion and extension. Polyester performed as well as wire. We conclude that polyester is an acceptable alternative to wire in tension band fixation.

  2. G7 BiSpherical Acetabular Shell PMCF Study

    Science.gov (United States)

    2017-08-29

    Rheumatoid Arthritis; Osteoarthritis; Noninflammatory Degenerative Joint Disease; Avascular Necrosis; Correction of Functional Deformity; Non-Union Fracture; Femoral Neck Fractures; Trochanteric Fractures

  3. Comparison Study of the Use of Absorbable and Nonabsorbable Materials as Internal Splints after Closed Reduction for Nasal Bone Fracture

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    Chang Ryul Yi

    2014-07-01

    Full Text Available Background The authors sought to compare the use of the nonabsorbable polyvinyl alcohol sponge (PVA, Merocel and absorbable synthetic polyurethane foam (SPF, Nasopore Forte plus as intranasal splints after closed reduction of fractured nasal bones during the hospitalization period. Methods The medical records of 111 patients who underwent closed reduction for nasal bone fracture at Sanggye Paik Hospital, Inje University College of Medicine, from 2012 to 2013 were reviewed retrospectively. PVA (group A or SPF (group B was packed as an internal splint after closed reduction. The efficacy of the materials was compared and statistically analyzed. Results PVA was used in 82 patients, and SPF was used in 29 patients. The patients in group B complained significantly more of nasal pain on the first day after operation than the patients in group A. Headaches on the operation day were significantly more painful in group B than in group A. Bleeding on the fourth postoperative day was significantly reduced in group B as compared to group A. The patients in group B exhibited significantly more intensive nasal obstruction on the operation day and the following day than the patients in group A. However, on the third and fourth postoperative days, the nasal obstruction in group B was less than that in group A. The pain and bleeding related to the packing material was significantly reduced in group B as compared to group A. Conclusions The use of SPF as an absorbable packing material is a reasonable substitute for the traditional nonabsorbable material.

  4. A CLINICAL STUDY OF MANAGEMENT OF FRACTURE BOTH BONES FOREARM WITH INTERNAL FIXATION BY TWO DIFFERENT METHODS

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    Venkateswara Rao

    2015-09-01

    Full Text Available BACKGROUND AND OBJECTIVES: 60 cases of fracture both bone forearm in adults were operated and fixed using two different instruments in Siddhartha Medical College/Government General Hospital, Vijayawada between May 2013 to April 2015. METHODS: Most of the cases were young adult male with age ranging between 20 - 75yrs. The functional outcome of two different modalities of surgical management of diaphyseal fracture of both bone forearm in adults are interpreted. 30 patients were operated with DCP, and 30 patients were operated with intramedullary nailing. RESULTS : By Anderson Scoring System out of 30 cases of DCP 66.67% were excellent, 33.33% were satisfactory. Out of 30 cases of Intramedullary nailing with Talwalker square nails 50% were excellent, 23.33% were satisfactory, 16.67% were unsatisfactory, 10% had failure results. CONCLUSION : Open reduction and internal fixation can be considered as the treatment of choice if there were no contraindications for this because it is important to maintain length, opposition, axial alignment and rotational alignment if a good range of movement of forearm is to be restored. This is achieved in the present study.

  5. [Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures].

    Science.gov (United States)

    Feng, Yong-Zeng; Hong, Jian-Jun; Peng, Lei; Shui, Xiao-Long; Tang, Jun; Chen, Lin-Wei; Guo, Xiao-Shan

    2011-02-01

    To compare the outcome of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures. The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group P + E). There were 18 male and 10 female patients with a mean age of (45 ± 6) years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group N + E). There were 12 male and 10 female patients with a mean age of (43 ± 9) years. The index of peri-operation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared. There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N + E was significantly longer than in Group P + E [(21.1 ± 3.0) weeks vs. (15.4 ± 2.9) weeks]. Meanwhile, the function of ankle score (44.3 ± 1.7 vs. 41.8 ± 2.5) and the line of foot score (8.6 ± 2.3 vs. 6.8 ± 3.6) in Group P + E were respectively significantly higher than that in Group N + E. However, there were no statistical difference on ankle pain, buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P + E, significantly less than the 8 cases of Group N + E. Minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the

  6. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

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    Fakoor

    2015-08-01

    Full Text Available Background Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives In this study we compared two surgical approaches, open reduction and internal fixation (ORIF and closed reduction with external fixation (CR + EF, for treatment of intra-articular distal radius fractures. Patients and Methods Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification were treated with two surgical methods (ORIF and CR + EF; 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ. We compared radiological parameters of distal radius, range of motion (ROM of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results In our study, radiological findings for the ORIF group were radial inclination (RI: 19.35, radial length (RL: 10.35, radial tilt (RT: 8.92, and ulnar variance (UV: 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E: 137, Radial/Ulnar deviation (R/U: 52, and Supination/Pronation (S/P: 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  7. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures.

    Science.gov (United States)

    Zhao, Xing-Wen; Ma, Jian-Xiong; Ma, Xin-Long; Jiang, Xuan; Wang, Yin; Li, Fei; Lu, Bin

    2017-03-01

    Both external fixation (ExFx) and open reduction and internal fixation(ORIF) were used to treat complex tibial plateau fractures, but it was not sure which one was better. So we did this meta-analysis to evaluate the outcomes of ExFx and ORIF in managing complex tibial plateau fractures. Articles published before August 5, 2016 were selected from PubMed, Cochrane library, and some other electronic database. Relevant journals were also searched manually with no language limited. Two independent reviewers searched and assessed the literature. A fixed effect model was initially used for meta-analyses with RevMan 5.3. When compared with ORIF, cases undergoing ExFx were more likely to return to the preinjury state at the early stage, but no difference in the later period of follow-up. However, ExFx group had higher infection rate (OR 1.98, 95% CI 1.08-3.63, P = 0.03), higher venous thromboembolism rate (OR 1.56, 95% CI 0.49-4.96, P = 0.45), higher re-operation rate (OR 0.87, 95% CI 0.47-1.62, P = 0.66) and lower compartment syndrome rate (OR 0.61, 95% CI 0.12-3.22, P = 0.56), lower TKA rate (OR 0.51, 95% CI 0.20-1.34, P = 0.17). There were no statistically significant differences in the rate of deep infection, venous thromboembolism, compartment syndrome and VTE between the two groups. Although external fixation may offer some advantages, both were acceptable strategies in managing complex tibial plateau fractures. According to our analysis results, we strongly recommend that selection of definitive fixators should base on the fracture patterns, soft-tissue condition as well as the injury stages in clinical practice. More important, further multicentered, randomized controlled studies should be implemented to get a more reliable and clear result. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  8. MRI morphometric hip comparison analysis of anterior acetabular labral tears

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    Aly, Abdel Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Saskatoon City Hospital, Saskatoon, SK (Canada); Rajasekaran, Sathish [HealthPointe, Pain, Spine and Sport Medicine, Alberta (Canada); Obaid, Haron [Royal University Hospital, University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2013-09-15

    Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip. Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed. Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7 , 95 % confidence interval [CI]: 56.2-69.2 ) compared with the AALTs group (46.9 , 95 % CI: 40.1-53.7 ). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9 , 95 % CI: 39.3 -44.5 ) compared to AALTs group (29.4 , 95 % CI: 24.2 -34.6 ). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group. Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI. (orig.)

  9. Effect of the state of internal boundaries on granite fracture nature under quasi-static compression

    Science.gov (United States)

    Damaskinskaya, E. E.; Panteleev, I. A.; Kadomtsev, A. G.; Naimark, O. B.

    2017-05-01

    Based on an analysis of the spatial distribution of hypocenters of acoustic emission signal sources and an analysis of the energy distributions of acoustic emission signals, the effect of the liquid phase and a weak electric field on the spatiotemporal nature of granite sample fracture is studied. Experiments on uniaxial compression of granite samples of natural moisture showed that the damage accumulation process is twostage: disperse accumulation of damages is followed by localized accumulation of damages in the formed macrofracture nucleus region. In energy distributions of acoustic emission signals, this transition is accompanied by a change in the distribution shape from exponential to power-law. Granite water saturation qualitatively changes the damage accumulation nature: the process is delocalized until macrofracture with the exponential energy distribution of acoustic emission signals. An exposure to a weak electric field results in a selective change in the damage accumulation nature in the sample volume.

  10. A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture: a case report

    Directory of Open Access Journals (Sweden)

    Mounasamy Varatharaj

    2012-11-01

    Full Text Available 【Abstract】 Breakage of surgical instruments and implants during operative procedures is not uncommon in any surgical discipline. The need for removal and the out-come of leaving the broken instruments and implants in the surgical area have not been described in detail. Few studies have suggested removal if they are lying loosely in the tis-sues or joint, close to neurovascular structures. Challenges and the amount of time spent in the retrieval of broken in-struments and implants are well known among surgeons, so most choose to leave them in situ. We reported a novel method of retrieval of a broken drill bit in the femoral medul-lary canal during internal fixation of a type C distal femoral fracture. Key words: Fracture fixation, internal; Femoral fractures; Surgical instruments

  11. Cementless acetabular fixation in patients 50 years and younger at 10 to 18 years of follow-up.

    Science.gov (United States)

    Teusink, Matthew J; Callaghan, John J; Warth, Lucian C; Goetz, Devon D; Pedersen, Douglas R; Johnston, Richard C

    2012-08-01

    The purpose of the study was to evaluate the 10- to 18-year follow-up of cementless acetabular fixation in patients 50 years and younger. We retrospectively reviewed a consecutive group of 118 patients (144 hips) in whom primary total hip arthroplasty had been performed by 2 surgeons using a cementless acetabular component. Two (1.4%) cementless acetabular components were revised because of aseptic loosening. Twenty-four hips (16.7%) were revised for any mechanical failure of the acetabular component mostly related to acetabular liner wear and osteolysis. The average linear wear rate was 0.19 mm per year, which was higher than our previous reports with cemented acetabular fixation. The fiber mesh ingrowth surface of the cementless acetabular component in this study was superior to cemented acetabular components in terms of fixation. However, the high rates of wear and osteolysis have led to poor overall acetabular component construct survivorship.

  12. Effects of low-dose microwave on healing of fractures with titanium alloy internal fixation: an experimental study in a rabbit model.

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    Dongmei Ye

    Full Text Available BACKGROUND: Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. METHODS: Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. FINDINGS: The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. CONCLUSION: Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method.

  13. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis.

    Science.gov (United States)

    Xu, Jiaming; Zhang, Changqing

    2014-04-11

    This meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population. Databases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software. A total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = -1.28; 95% CI: -1.81, -0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: -0.34, 1.20; P = 0.27). For the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.

  14. Traumatic conditions of the coxofemoral joint: luxation, femoral head-neck fracture, acetabular fracture.

    Science.gov (United States)

    Marchionatti, Emma; Fecteau, Gilles; Desrochers, André

    2014-03-01

    Diagnosis and treatment of traumatic conditions of the hip joint in cattle remain a challenge for the veterinarian. This article is intended to give an overview of the most common orthopedic problems of the bovine coxofemoral joint, diagnostic procedures, and treatment options.

  15. Aumento acetabular pela técnica de Stahelli modificada Acetabular increase with modified Stahelli technique

    Directory of Open Access Journals (Sweden)

    Sílvio Pereira Coelho

    2000-09-01

    Full Text Available Os autores apresentam neste trabalho um estudo retrospectivo realizado em 18 pacientes submetidos a tratamento cirúrgico de insuficiência acetabular pela osteotomia da pelve seguindo a técnica descrita por Lynn T. Staheli. Enfatizam a modificação da técnica deste autor, com a introdução do enxerto ósseo, retirado da tábua externa do ilíaco, numa fenda aprofundada até cerca da cortical interna do ilíaco. Os pacientes foram acompanhados através de consultas ambulatoriais previamente a cirurgia e pós-operatoriamente com seguimento que variou de 2 meses a 4 anos no serviço de ortopedia infantil do Hospital Independência - Complexo Hospitalar ULBRA/Porto Alegre-RS. O objetivo do trabalho foi avaliar o quadril acometido pré e pós-operatoriamente, demonstrando a evolução e vantagens da variação da técnica de Staheli desenvolvida neste serviço. Observou-se que a cirurgia, se realizada sob técnica adequada e em mãos experientes, torna-se uma fonte válida de tratamento para aquelas patologias que levam a uma insuficiente cobertura da cabeça femoral.The authors present in this paper a retrospective study of eighteen patients treated surgically for insufficiency of the acetabular coverage with the shelf procedure according to Lynn T. Staheli. This study was done at the Service of Pediatric Orthopedics of Hospital Independência - Complexo Hospitalar ULBRA/Porto Alegre-RS. They call attention to the modification of the surgical technique in that the bone graft taken from outer cortex of the iliac bone, is deepened in the slot in the superior rim of the acetabulum. The follow-up ranged from two months to four years. The aim of this paper was to evaluate the affected hip pre and postoperatively showing the results and the advantages of the modified shelf technique. They observed that if the surgery is performed according to the correct technique and by an experienced surgeon, it is a very good alternative to the treatment of those

  16. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Energy Technology Data Exchange (ETDEWEB)

    Werner, Clement M.L. [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland); University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Copeland, Carol E.; Stromberg, Jeff; Turen, Clifford H. [University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Ruckstuhl, Thomas; Bouaicha, Samy [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland)

    2011-11-15

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (<20 ) or the AI (>12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  17. External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies

    Institute of Scientific and Technical Information of China (English)

    Yi-Chen Meng; Xu-Hui Zhou

    2016-01-01

    Purpose:Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair.External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures.However,conclusions of comparative studies regarding which method is superior are controversial.Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.Methods:A computerized research of MEDLINE,EMBASE,Springer,and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted.Weighted mean difference (WMD),risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for estimating the effects of the two methods.Statistical analyses were done using Review Manager Version 5.2.Results:Ten cohort studies and one randomized clinical trial were included in our ultimate analysis.And the analysis found no significant difference between the two methods in deep infection (p =0.13),reduction (p =0.11),clinical evaluation (p =0.82),post-traumatic arthrosis (p =0.87),and union time (p =0.35).Besides,ExFix group was found to have a higher rate of superficial infection (p =0.001),malunion (p =0.01) and nonunion (p =0.02),but have a lower risk of unplanned hardware removal (p =0.0002).Conclusions:We suggest that ORIF has a relatively lower incidence rate of superficial infection,malunion and nonunion,but a higher rate of unplanned hardware removal.No difference was found in deep infection,reduction,clinical evaluation,post-traumatic arthrosis and union time.

  18. External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies.

    Science.gov (United States)

    Meng, Yi-Chen; Zhou, Xu-Hui

    2016-10-01

    Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002). We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.

  19. CLINICAL AND FUNCTIONAL OUTCOME OF DISTAL RADIUS FRACTURES MANAGED BY LIGAMENTOTAXIS AND/OR PERCUTANEOUS PINNING VERSUS OPEN REDUCTION & INTERNAL FIXATION BY BUTTRESS PLATES

    Directory of Open Access Journals (Sweden)

    Biju

    2015-05-01

    Full Text Available INTRODUCTI ON: We studied the clinical and functional outcome of distal radius fractures managed by ligamentotaxis and/or percutaneous pinning versus open reduction & internal fixation by buttress plates. METHODS : This prospective study was conducted during Aug 2012 to October 2014. All skeletally matured patients were having both Intra articular and extra articular Closed Distal Radius fractures were studied. Treatment was done either external fixator supplemented with k wires or internal fixation with plate and screws. The radiographic evaluation included radial length, palmar tilt, any evidence of jointincongruity and radio ulnar joint instability and arthritis. The assessments that were made includes Subjective assessment – pain, numbness, weakness of hand, stiffness, OBJECTIVE : R ange of motion measured by hand held goniometer, Measurement of grip strength done by commercially available hand dynamometer. Unaffected hand served as control. RESULTS : Male patients (85.46% outnumbered female patients (14.54% in incidence. The incidence of distal ra dius fractures was common between the ages of 20 to 40 years. Left sided fractures were more common (52.73%. Type III was most common type of fracture (Frykman’s Classification, accounting for 29% of all fractures.25 cases were treated by external fixati on and 30 cases were treated by open reduction and buttress plating. The results were evaluated by using STEWART ET AL anatomical and functional scoring system. The average range of movement at the knee joint was Dorsiflexion 70*, Palmar Flexion 65*, Ulnar Deviation 25*, Radial Deviation 15*, Supination 70*, Pronation 65*. Most common early complication was pin tract infection. Based on the stewar et al scoring, 4(7.27% had excellent, 43(78.18% had good, 7(12.72% had fair, 1(1.81% had poor results. CONC LUSION : We observed that both fixations were equally same, there is no superiority with over the other. The incidence of complications in

  20. Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) protocol: a pragmatic multi-centre randomised controlled trial of cast treatment versus surgical fixation for the treatment of bi-cortical, minimally displaced fractures of the scaphoid waist in adults.

    Science.gov (United States)

    Dias, Joseph; Brealey, Stephen; Choudhary, Surabhi; Cook, Liz; Costa, Matthew; Fairhurst, Caroline; Hewitt, Catherine; Hodgson, Stephen; Jefferson, Laura; Jeyapalan, Kanagaratnam; Keding, Ada; Leighton, Paul; Rangan, Amar; Richardson, Gerry; Rothery, Claire; Taub, Nicholas; Thompson, John; Torgerson, David

    2016-06-04

    this. The SWIFFT Trial is a rigorously designed and adequately powered study which aims to contribute to the evidence-base to inform clinical decisions for the treatment of this common fracture in adults. The trial is registered with the International Standard Randomised Controlled Trial Register ( ISRCTN67901257 ). Date registration assigned was 13/02/2013.

  1. External fixation combined with limited internal fixation for Pilon fractures%外固定支架结合有限内固定治疗Pilon骨折

    Institute of Scientific and Technical Information of China (English)

    周淮; 徐晓军

    2011-01-01

    Objective To investigate the clinical effect of Pilon fractures treated with external fixation and limited internal fixation.Methods 24 cases of Pilon fractures of tibia were treated with external fixation combined limited internal fixation.Results 24 cases were followed up for 10 ~ 20 months.No bone nonumon or skin necrosis complication was found.According to Mazur ankle joint scoring system, the results were excellent in 14, good in 7 , and fair in 3.Conclusions External fixation combined with limited internal fixation can immohilize the sections of fracture and achieve excellent ankle joint function,so it is an effective surgical treatment of Pilon fractures.%目的 探讨外固定支架结合有限内固定治疗Pilon骨折的疗效.方法 采用外固定支架结合有限内固定治疗24例Pilon骨折.结果 24例均获得随访,时间10~20个月.无骨不连、皮肤坏死发生.踝关节功能Mazur评分:优14例,良7例,可3例.结论 外固定支架结合有限内固定可以获得术后骨折稳定,取得良好踝关节功能,是治疗Pilon骨折有效的手术方案.

  2. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

    Energy Technology Data Exchange (ETDEWEB)

    Nitschke, Ashley [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology, Aurora, CO (United States); Lambert, Jeffery R. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); Glueck, Deborah H. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); University of Colorado School of Medicine, University of Colorado Denver, Department of Radiology, Aurora, CO (United States); Jesse, Mary Kristen; Strickland, Colin [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Mei-Dan, Omer [University of Colorado School of Medicine, University of Colorado Denver, Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, Aurora, CO (United States); Petersen, Brian [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Inland Imaging, Division of Musculoskeletal Radiology, Spokane, WA (United States)

    2015-11-15

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain. (orig.)

  3. Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease

    Directory of Open Access Journals (Sweden)

    WI Faisham

    2009-05-01

    Full Text Available Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86.

  4. PATHOLOGICAL AND MORPHOLOGICAL RESEARCH OF EXPERIMENTAL ACETABULAR DYSPLASIA

    Institute of Scientific and Technical Information of China (English)

    张自明; 马瑞雪; 吉士俊; 牛之彬

    2004-01-01

    Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and flat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films.Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.

  5. Para-acetabular periarthritis calcarea: its radiographic manifestations.

    Science.gov (United States)

    Kawashima, A; Murayama, S; Ohuchida, T; Russell, W J

    1988-01-01

    On retrospective reviews of radiographs, periarthritis calcarea was distinguished from os acetabula by interval radiographic progression and regression. Among 59 men and 51 women, there were 137 instances of para-acetabular calcifications and ossifications, which were morphologically classified as 58 discrete, 58 amorphous, and 21 segmented types. Correlations with other radiographic abnormalities, symptoms, signs, and laboratory abnormalities were sought, but not established. Out of 93 serially imaged opacities, 90 changed, including 37 of the 40 instances (92.5%) of the discrete type and 53 instances (100%) of the amorphous and segmented types--due to periarthritis calcarea. At least 43 of 90 densities were newly developed. Mean age at first detection was 47.7 years. Three of the discrete densities were unchanged and represented os acetabula. Thus, recognition of para-acetabular periarthritis calcarea is not only of academic importance; it can facilitate proper treatment as well.

  6. Pelvic muscle and acetabular contact forces during gait.

    Science.gov (United States)

    Pedersen, D R; Brand, R A; Davy, D T

    1997-09-01

    Locations, magnitudes, and directions of pelvic muscle and acetabular contact forces are important to model the effects of abnormal conditions (e.g., deformity, surgery) of the hip accurately. Such data have not been reported previously. We computed the three-dimensional locations of all pelvic muscle and acetabular contact forces during level gait. The approach first required computation of the intersegmental joint resultant forces and moments using limb displacement history, foot-floor forces, and estimated limb inertial properties from one subject. The intersegmental resultant moments were then distributed to the muscles using a 47-element muscle model and a non-linear optimization scheme. Muscle forces were vectorally subtracted from the intersegmental resultants to compute the acetabular contact forces. While the peak joint force magnitudes are similar to those reported previously for the femur, the directions of pelvic contact forces and muscle forces varied considerably over the gait cycle. These variations in contact force directions and three-dimensional forces could be as important as the contact force magnitudes in performing experimental or theoretical studies of loads and stresses in the periacetabular region.

  7. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  8. A case report of the management and the outcome of a complete epiphyseal separation and dislocation with left anterior column fracture of the acetabulum

    Directory of Open Access Journals (Sweden)

    Jesús Palencia

    2016-01-01

    Conclusion: Epiphyseal fracture with dislocation of the femoral head is rare among children and adolescents, especially when associated with an acetabular fracture. AVN in such cases can develop, and it represents a challenge to orthopedic surgeons due to the poor prognosis and the future functional limitations of the joint.

  9. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate.

    Science.gov (United States)

    Grosso, Matthew J; Danoff, Jonathan R; Murtaugh, Taylor S; Trofa, David P; Sawires, Andrew N; Macaulay, William B

    2017-01-01

    Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up. The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups. We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. A CLINICAL STUDY ON FUNCTIONAL OUTCOME AFTER COMBINED ARTHROSCOPIC AND FLUOROSCOPIC ASSISTED REDUCTION AND INTERNAL FIXATION OF CLOSED TIBIAL PLATEAU FRACTURES IN ADULTS

    Directory of Open Access Journals (Sweden)

    Bhavani Prasad

    2015-06-01

    Full Text Available BACKGROUND AND INTRODUCTION: Management of tibial plateau fractures had witnessed tremendous improvement in surgical techniques over the past decades. Conservative treatment of these fractures results in consistently poor results. The present literature supports that absolute anatomi cal reduction and stable fixation of peri articular fractures followed by early post - operative rehabilitation is crucial for good results. And if this is achieved by minimal damage to soft tissue the results are much better. In this study it is achieved by arthroscopy and fluoroscopy. MATERIALS AND METHODS: We have conducted a prospective study between September 2009 to august 2013 including 9 patients with tibial plateau fractures treated with combined arthroscopic and fluoroscopic reduction and internal f ixation with or without bone grafting. And then the radiographic and functional evaluation done. RESULTS: According to Hohl’s clinical and radiographic scoring systems 4 patients were assessed excellent, 3 good, 2 fair. According to Rasmussen’s clinical sc oring system 4 patients excellent, 3 good and 2 fair results. CONCLUSION: The use of arthroscopy and fluoroscopy in the management of tibial plateau fractures results in good outcome. It also helped to simultaneously treat the meniscal injuries. But its use is mainly limited to Shatzkar type1, 2, 3, 4

  11. Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.

    Science.gov (United States)

    Ricciardi, Benjamin F; Fields, Kara G; Wentzel, Catherine; Kelly, Bryan T; Sink, Ernest L

    2017-09-01

    Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. Cohort study; Level of evidence, 3. A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14

  12. Analysis of Internal Fixation for Tri-ankle Fracture in 36 Cases%内固定治疗三踝骨折36例分析

    Institute of Scientific and Technical Information of China (English)

    张小东; 钟桂午; 王晓红; 杜小龙; 王贻幸

    2011-01-01

    Objective: To evaluate the efficacy and prognosis of internal fixation treatment for the tri-malleolar fracture with posterolateral approach combined with medial approach. Methods:36 cases of trimalleo-lar fracture were treated with internal fixation by posterolateral approach combined with medial approach. Results:All the patients were followed up for 6 -21 months, the average time is 12. 5 months; the fracture healed in 12 - 16 weeks postoperative. According to Baird - Jackson criteria,there were excellent in 20 cases, good in 12 cases and fair in 4 case. Excellent and good rate clinical result was 88. 9%. Conclusions:The internal fixation treatment of trimalleolar fracture with posterolateral approach combined with medial approach is easy to perform and the fixation is reliable, which is suitable for the surgical treatment of the trimalleolar fracture.%目的:探讨后外侧入路联合内侧入路内固定治疗三踝骨折的疗效及预后.方法:对36例三踝骨折采用后外侧入路联合内侧入路切开复位内固定.结果:术后均得到10~32个月,平均12.5个月的随访.骨折愈合时间12~16周.疗效评定依据Baird-jackson踝关节评分标准:本组优20例,良12例,可4例,优良率88.9%.结论:采用后外侧入路联合内侧入路进行内固定治疗三踝骨折,其操作简便,固定可靠,适用于三踝骨折的手术治疗.

  13. Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein--a case report.

    Science.gov (United States)

    Ko, Seung Yeon; Park, Sun Cheol; Hwang, Jeong Kye; Kim, Sang Dong

    2016-04-11

    The totally implantable venous access ports (TIVAPs) are indicated for patients undergoing chemotherapy, total parenteral nutrition and long-term antibiotic treatment. But, among their complications, the fracture and migration of the catheter of a TIVAP via internal jugular vein represents a very rare but potentially severe condition. A 50-year-old woman indentified with a spontaneous fracture and migration of catheter of a TIVAP via right internal jugular vein after adjuvant chemotherapy for ovary cancer. She had been not evaluated and not managed with the heparin lock flush solution during three months after adjuvant chemotherapy. And then, she complained right neck bulging during saline infusion via a TIVAP and a chest radiography showed the fractured and migrated catheter of a TIVAP in right atrium. So, we emergently removed the catheter fragment by a goose neck snare via right femoral vein. After then, there was no problem. If the fractured catheter of a TIVAP is detected, it is desirable to remove a fragment by an endovascular approach if it is possible.

  14. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty.

    Science.gov (United States)

    Potty, Anish G; Corona, Jacqueline; Manning, Blaine T; Le, Amanda; Saleh, Khaled J

    2014-01-01

    Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.

  15. DECOVALEX - an International Cooperative Research Project on Coupled Thermo-hydro-mechanical Processes in Fractured Rocks

    Science.gov (United States)

    Tsang, C. F.

    2003-12-01

    The international cooperative project DECOVALEX (acronym for DEvelopment of COupled THM models and their VALidation against EXperiments) was established in 1992 by national agencies involved in nuclear waste disposal. The aim of this project is to develop and test models capable of simulating coupled thermo-hydro-mechanical (THM) processes. Over the last ten years, about 16 research teams from 10 countries have participated in this joint effort. The project objectives include: a. support development of computer simulators for THM modeling; b. investigate and implement suitable algorithms for THM modeling; c. compare model calculations with results from field and laboratory experiments; d. design new experiments to support code development; e. study the application of THM modeling to performance and safety assessment. A large number of benchmark tests (BMT) and test cases (TC) have been studied within the project. BMTs are hypothetical problems used for investigating the behavior of individual coupled THM processes, using alternative conceptual and numerical models by different teams. TCs are laboratory and field experiments that were analyzed to advance our understanding of THM processes and whose data were used to test computer models. A number of large-scale, multiyear experiments have been studied within the project, including: a. multiple borehole tests for shaft excavation design at Sellafield, UK; b. THM experiment on the bentonite-rock system at Kamaishi Mine, Japan; c. full scale bentonite-rock test (FEBEX) at Grimsel Underground Research Laboratory, Switzerland; d. Drift Scale Heater Test (DST) in the Exploratory Studies Facility at Yucca Mountain, USA. The talk will present an overview of the ten-year project by highlighting a few of the main results and lessons learned.

  16. Femoral Deformity May Be More Predictive of Hip Range of Motion Than Severity of Acetabular Disease in Patients With Acetabular Dysplasia: An Analysis of the ANCHOR Cohort.

    Science.gov (United States)

    Fabricant, Peter D; Sankar, Wudbhav N; Seeley, Mark A; Beaulé, Paul E; Clohisy, John C; Kim, Young-Jo; Millis, Michael B; Peters, Christopher L; Podeszwa, David A; Schoenecker, Perry L; Sierra, Rafael J; Sink, Ernest L; Sucato, Daniel J; Zaltz, Ira

    2016-07-01

    It is generally believed that acetabular dysplasia (AD) is associated with increased hip range of motion (ROM). The purpose of this study was to investigate the associations between dysplasia severity and hip ROM in a large multicenter cohort. A prospective registry of patients undergoing periacetabular osteotomy for symptomatic AD by 1 of 13 surgeons was used to analyze 1,051 patients (mean age, 26 ± 10 years). Multivariable linear regression modeling was used to investigate for associations between dysplasia severity (severe, 15°), α angle, and hip ROM. When controlling for age, sex, body mass index, and α angle, only internal (α = 1.94; P = 0.005) and external (α = -2.63; P dysplasia severity. Alpha angle was greater for those with severe AD compared with subjects with mild disease (60° ± 16° versus 57° ± 15°; P = 0.038). Alpha angle was also significantly correlated with rotational ROM parameters (internal and external rotation in flexion and extension) (Pearson r, range: -0.077 to -0.216; P dysplasia severity, whereas external rotation in extension was inversely associated. Furthermore, α angle was greater with increasing dysplasia severity and predictive of rotational ROM parameters. Taken together, these data suggest that femoral-sided deformity, including α angle and possibly femoral version, may be responsible for differences in ROM based on dysplasia severity. Level III, Prognostic.

  17. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia.

    Science.gov (United States)

    Sekimoto, T; Ishii, M; Emi, M; Kurogi, S; Funamoto, T; Yonezawa, Y; Tajima, T; Sakamoto, T; Hamada, H; Chosa, E

    2017-07-01

    We have previously investigated an association between the genome copy number variation (CNV) and acetabular dysplasia (AD). Hip osteoarthritis is associated with a genetic polymorphism in the aspartic acid repeat in the N-terminal region of the asporin (ASPN) gene; therefore, the present study aimed to investigate whether the CNV of ASPN is involved in the pathogenesis of AD. Acetabular coverage of all subjects was evaluated using radiological findings (Sharp angle, centre-edge (CE) angle, acetabular roof obliquity (ARO) angle, and minimum joint space width). Genomic DNA was extracted from peripheral blood leukocytes. Agilent's region-targeted high-density oligonucleotide tiling microarray was used to analyse 64 female AD patients and 32 female control subjects. All statistical analyses were performed using EZR software (Fisher's exact probability test, Pearson's correlation test, and Student's t-test). CNV analysis of the ASPN gene revealed a copy number loss in significantly more AD patients (9/64) than control subjects (0/32; p = 0.0212). This loss occurred within a 60 kb region on 9q22.31, which harbours the gene for ASPN. The mean radiological parameters of these AD patients were significantly worse than those of the other subjects (Sharp angle, p = 0.0056; CE angle, p = 0.0076; ARO angle, p = 0.0065), and all nine patients required operative therapy such as total hip arthroplasty or pelvic osteotomy. Moreover, six of these nine patients had a history of operative or conservative therapy for developmental dysplasia of the hip. Copy number loss within the region harbouring the ASPN gene on 9q22.31 is associated with severe AD. A copy number loss in the ASPN gene region may play a role in the aetiology of severe AD.Cite this article: T. Sekimoto, M. Ishii, M. Emi, S. Kurogi, T. Funamoto, Y. Yonezawa, T. Tajima, T. Sakamoto, H. Hamada, E. Chosa. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular

  18. Internal fixation of severely displaced mandibular condylar neck fracture with the aid of ramus osteotomy. A revised technique

    DEFF Research Database (Denmark)

    Hillerup, S

    1997-01-01

    A technique is described whereby the mandibular condyle can be located, replaced and fixed in case of a severely displaced fracture with exarticulation of the condylar head.......A technique is described whereby the mandibular condyle can be located, replaced and fixed in case of a severely displaced fracture with exarticulation of the condylar head....

  19. Mortality in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

    2008-01-01

    BACKGROUND: Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival...... rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric...... and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods. METHODS: In this multicenter register study, data of 4,291 patients treated from 1991 to 1993 (n = 1,723) or 1998 to 2000 (n = 2,568) for pelvic fractures in one of the 23 participating...

  20. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...

  1. 2nd International Workshop on Physics-Based Modelling of Material Properties and Experimental Observations with special focus on Fracture and Damage Mechanics: Book of Abstracts

    OpenAIRE

    Nilsson, Karl-Fredrik; YALCINKAYA Tuncay; Oren, Ersin Emre; Tekoğlu, Cihan

    2013-01-01

    This report covers the book of abstracts of the 2nd International Workshop on Physics Based Modelling of Material Properties and Experimental Observations, with special focus on Fracture and Damage Mechanics. The workshop is organized in the context of European Commission’s Enlargement and Integration Action, by the Joint Research Centre in collaboration with the TOBB University of Economics and Technology (TOBB ETU) on 15th-17th May 2013 in Antalya, Turkey. The abstracts of the keynote le...

  2. FRACTURE RESISTANCE AND FAILURE PATTERN OF TEETH SUBMITTED TO INTERNAL BLEACHING WITH 37% CARBAMIDE PEROXIDE, WITH APPLICATION OF DIFFERENT RESTORATIVE PROCEDURES

    OpenAIRE

    Gerson Bonfante; Osvaldo Bazzan Kaizer; Luiz Fernando Pegoraro; Accácio Lins do Valle

    2006-01-01

    OBJECTIVE: This study investigated the compressive fracture strength and failure pattern in premolars submitted to endodontic treatment and internal bleaching with 37% carbamide peroxide for 21 days, with application of different restorative procedures. MATERIAL AND METHODS: Six groups were employed (n = 10): 1) non-bleached teeth and pulp chamber sealed with IRM; 2) bleached teeth and pulp chamber sealed with IRM; 3) bleached teeth and pulp chamber filled with light cured composite resin; 4)...

  3. Biomechanical comparison of different stabilization constructs for unstable posterior wall fractures of acetabulum. A cadaveric study.

    Directory of Open Access Journals (Sweden)

    Yuntong Zhang

    Full Text Available PURPOSE: Operative treatment of unstable posterior wall fractures of acetabulum has been widely recommended. This laboratory study was undertaken to evaluate static fixation strength of three common fixation constructs: interfragmentary screws alone, in combination with conventional reconstruction plate, or locking reconstruction plate. METHODS: Six formalin-preserved cadaveric pelvises were used for this investigation. A posterior wall fracture was created along an arc of 40-90 degree about the acetabular rim. Three groups of different fixation constructs (two interfragmentary screws alone; two interfragmentary screws and a conventional reconstruction plate; two interfragmentary screws and a locking reconstruction were compared. Pelvises were axial loaded with six cycles of 1500 N. Dislocation of superior and inferior fracture site was analysed with a multidirectional ultrasonic measuring system. RESULTS: No statistically significant difference was found at each of the superior and inferior fracture sites between the three types of fixation. In each group, the vector dislocation at superior fracture site was significantly larger than inferior one. CONCLUSIONS: All those three described fixation constructs can provide sufficient stability for posterior acetabular fractures and allow early mobilization under experimental conditions. Higher posterior acetabular fracture line, transecting the weight-bearing surface, may indicate a substantial increase in instability, and need more stable pattern of fixation.

  4. Sacroiliac joint dysfunction as a reason for the development of acetabular retroversion: a new theory.

    Science.gov (United States)

    Cibulka, Michael T

    2014-05-01

    Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.

  5. Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

    Science.gov (United States)

    Hu, Chuanzhen; Zhang, Weibin; Qin, Hui; Shen, Yuhui; Xue, Zichao; Ding, Haoliang; An, Zhiquan

    2015-02-01

    To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

  6. Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Shao-Bo; Zhang, Yi-Bao; Wang, Sheng-Hong; Zhang, Hua; Liu, Peng; Zhang, Wei; Ma, Jing-Lin; Wang, Jing

    2017-04-01

    To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture. We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group. LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  7. Acetabular anatomy and the relationship with pelvic vascular structures. Implications in hip surgery.

    Science.gov (United States)

    Feugier, P; Fessy, M H; Béjui, J; Bouchet, A

    1997-01-01

    Most direct vascular trauma occurring during hip surgery results from injury to pelvic vascular structures which are not visible during the procedures of reaming, drilling holes or the fixation of screws. In this study, 5 pelves of fresh cadavers were injected with a radiopaque mixture and were visualised with a scanner according to 5 predetermined sections. Bone depth of the acetabulum was measured in each section. A calculation was made describing the minimal distance separating the inner cortex from the principal pelvic vessels. After an anatomic dissection of each pelvis, the relationship between the vessels and screws of the fixation cup, implanted identically on the quadranted acetabulum, was observed. The screws placed in the anterior and inferior quadrants and the center of the acetabulum endangered the external iliac v. and a. and the obturator pedicle. The depth of the periacetabular bone was greater in the superior and posterior quadrants. The inferior gluteal, pudendal and superior gluteal aa. were more than ten mm from the posterior wall. Conversely, the external iliac and obturator pedicles came in contact with the osseous surface on which they lay. A projection of the vessels on the acetabulum was made, and the reproducible character of the acetabular-quadrant system was verified. The superior quadrant offers all the characteristics of a vascular safe zone. A knowledge of these anatomic relationships explain vascular trauma in pelvic fractures and helps to prevent vascular injury in hip surgery.

  8. Rigid internal fixation of zygoma fractures: A comparison of two-point and three-point fixation

    Directory of Open Access Journals (Sweden)

    Parashar Atul

    2007-01-01

    Full Text Available Background: Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Therefore the treatment must achieve adequate and stable reduction at fracture sites so as to restore the complex multidimensional relationship of the zygoma to the surrounding craniofacial skeleton. Many experimental biophysical studies have compared stability of zygoma after one, two and three-point fixation with mini plates. We conducted a prospective clinical study comparing functional and aesthetic results of two-point and three-point fixation with mini plates in patients with fractures of zygoma. Materials and Methods: Twenty-two patients with isolated zygomatic fractures over a period of one year were randomly assigned into two-point and three-point fixation groups. Results of fixation were analyzed after completion of three months. This included clinical, radiological and photographic evaluation. Results: The three-point fixation group maintained better stability at fracture sites resulting in decreased incidence of dystopia and enophthalmos. This group also had better malar projection and malar height as measured radiologically, when compared with the two-point fixation group. Conclusion: We recommend three-point rigid fixation of fractured zygoma after accurate reduction so as to maintain adequate stabilization against masticatory forces during fracture healing phase.

  9. Uncemented Total Hip Replacement After Two Years of Neglected Hip Dislocation With Fracture of Posterior Column and Wall of the Acetabulum

    Directory of Open Access Journals (Sweden)

    DC

    2016-07-01

    Full Text Available Introduction Posterior hip dislocation of the hip with acetabular fracture is a challenging problem to treat. Such dislocations are associated with avascular necrosis of the femoral head if neglected. Managing such conditions with total hip replacement (THR is very difficult because of associated altered anatomy. Case Presentation We hereby report a two-year neglected hip dislocation with associated acetabular fracture successfully treated with uncemented THR. The patient was successfully treated with uncemented THR and experienced significant improvement in his functional status, with a Harris hip score of 82 at the two-year follow up. Radiologically, there were no radiolucent areas or osteolysis, with good consolidation of the bone graft. Conclusions A neglected hip dislocation with acetabular fracture can be managed satisfactorily with uncemented THR. Bone reconstruction using chunk grafts and use of cementless components ensures long-term survival and also preserves adequate bone stock for revision, especially in young patients.

  10. A Comparative Assessment of Postoperative Analgesic Efficacy of Lornoxicam versus Tramadol after Open Reduction and Internal Fixation of Mandibular Fractures.

    Science.gov (United States)

    Jain, Ankesh Dilip; Vsm, Ravisankar; Ksn, Siva Bharani; Km, Sudheesh; Tewathia, Nisha

    2017-09-01

    Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is to critically compare the postoperative analgesic efficacy of small doses of intravenous TRAMADOL (opioid analgesic) versus LORNOXICAM (NSAID) in patients with mandibular trauma undergoing open reduction and internal fixation (ORIF) and to assess the presence of any adverse effects due to NSAID or opioid use. Forty adult ASA grade I-II patients with mandibular trauma, scheduled for ORIF under general anesthesia in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, were selected for the study. The patients were randomly assigned into a tramadol group (Group T) and a lornoxicam group (Group L) and were administered intravenous tramadol 50 mg and intravenous lornoxicam 8 mg, respectively, at specific postoperative intervals. Pain intensity was quantitatively assessed at the 2nd, 4th, 6th, 12th, and 24th postoperative hours using a visual analog scale of 10 cm. Adverse effects of the analgesics were also recorded and compared. Both the drugs resulted in a significant decrease in pain intensity from 2nd to 24th postoperative hours, but better pain control was observed in Group L at 24th postoperative hour. Only two patients experienced nausea and vomiting in Group T and one patient experienced gastric acidity in Group L. The comparative results clearly demonstrate that pain control by intravenous lornoxicam is significantly better than by intravenous tramadol at 24th postoperative hour after ORIF of mandibular trauma. Side effects produced by both the drugs were minor and had no apparent effect on the study results.

  11. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  12. Biomechanical investigation of ambulatory training in patients with acetabular dysplasia.

    Science.gov (United States)

    Kanai, Akira; Kiyama, Takahiro; Genda, Eiichi; Suzuki, Yasuo

    2008-07-01

    The purpose of this study was to investigate the effectiveness and safety of ambulatory training in patients with acetabular dysplasia. To achieve this, we studied the hip joint moment in subjects walking with laterally and horizontally elevated arms and changing speeds as a form of training to strengthen hip joint abductor muscles. We studied eight women with pre- or early stage hip disease (center-edge angle of Wieberg 18.5 degrees to -3.0 degrees ) and six healthy women. In exercise task 1 the subjects walked at a rate of 90 steps/min, with abduction of 90 degrees in the shoulder joint ipsilateral or contralateral to the affected hip joint, and either no load or a 1 kg weight in either hand. In exercise task 2, walking speed was changed in three stages from 60 steps/min (s-gait), 90 steps/min (n-gait), and 120 steps/min (f-gait), with both hands swinging freely. Using results from a three-dimensional motion analysis system, the hip joint moments were calculated. In both the healthy and the acetabular dysplasia groups, the abduction moment of the hip joint decreased significantly with ipsilateral elevation and increased significantly with contralateral elevation. There was no significant change in hip flexion moment in either group. The hip extension moment decreased significantly with contralateral elevation, but no significant changes were seen in ipsilateral elevation. In the walking rate variation, the extension hip moment in fast gait was higher than in slow gait. It was concluded that ambulatory training with contralateral horizontal arm elevation may be an effective way of increasing hip joint abductor muscle strength. Ipsilateral arm elevation decreases gluteus medius muscle tension and is an effective way of ambulatory training for people with compensated trendelenburg gait. Variable speed walking is an effective exercise method that can strengthen extensor muscles. Therefore, these ambulatory training methods are useful for acetabular dysplasia patients.

  13. Postmortem retrieved canine THR: femoral and acetabular component interaction.

    Science.gov (United States)

    Skurla, Carolyn P; James, Susan P

    2004-01-01

    Dogs are the preferred animal model for testing of human total hip replacements (THRs). A postmortem retrieval program for clinical, cemented, canine THR was established to analyze the long-term performance of THRs in dogs and to compare that performance to postmortem retrievals of human THRs. The purpose of the present study was to analyze the interaction between the femoral and acetabular components. Thirty-eight postmortem retrievals from 29 dogs were donated and analyzed. The acetabular components (ACs) were measured for volumetric wear and graded for articulating surface damage. Femoral and acetabular components were mechanically tested for implant stability. Digital image analysis was performed on contact radiographs of transverse femoral slices. Of 14 cases with a firmly implanted femoral component (FC). 6 articulated against loose ACs. Of 24 cases with a loose FC, 16 articulated against loose ACs. Only 4 specimens had both components firmly implanted, and 14 specimens had both components loose. There was a significant positive correlation between AC volumetric wear and FC loosening; however, there was no evidence of osteolysi