Ganglioneuroma with scoliosis of the thoracic spine. Iliofemoral approach is one of the most important approaches for acetabular fractures. Pelvic and acetabular fractures fractures of the pelvis and acetabulum are among the most serious injuries treated by orthopaedic surgeons. Acetabular exposure complete exposure of the acetabulum is required, regardless of the type of approach. The acetabulumrefers to the part of the pelvis that meets the upper end of the thigh bone the femoral headto form the hip joint.
The surgical treatment of a displaced acetabular fracture. Materials and methods this is a retrospective clinical study 30 patients in the orthopedic department, hospital sultanah bahiyah. Improved intraoperative fluoroscopy for pelvic and acetabular. Accurate classification of acetabular fractures is important for determining the proper surgical treatment 1, 2. Fractures of the pelvis and acetabulum thieme connect. Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. A novel approach for treatment of acetabular fractures ncbi.
Sliding trochanteric osteotomy will improve visualization at the acetabular dome and the. Hip replacement surgery can be performed as a total replacement or a hemi half replacement. Over the past decade, surgical approaches to the acetabulum and the surgical tactic for repair of common fracture patterns have been advanced. The kocherlangenbeck approach was used in the surgical treatment of 14 63. Apr 10, 2017 surgical approach to acetabulum fractures depend on the type of fracture and fracture displacement along with surgical preference of the surgeon. This is much less common than most hip fractures, where the top of the thigh bone is damaged, not the socket. A safe technique of anterior column lag screw fixation in. An interactive surgical planning tool for acetabular. Arthroscopic reduction and internal fixation of femoral head and acetabular fractures.
Preop and postop xrays were done in all patients under going acetabular surgery with follow up for 24 months. Orthopaedic surgery fractures of the pelvis and acetabulum ao. Many times patients will have additional injuries that require immediate treatment. A total hip replacement total hip arthroplasty or tha. Hear the authors discuss fractures of the pelvis and acetabulum. Radiograph of the pelvis demonstrating a fracture of the pubic bone. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. Emille letournel was a master and also a pioneer in orthopaedic surgery. When the cup implant is fully seated, remove the acetabular cup impactor handle.
Intraoperative judet views are performed to assess fracture reduction and screw position. Excellent outcomes after repair of these injuries can be achieved. Surgical approach to acetabulum fractures depend on the type of fracture and fracture displacement along with surgical preference of the surgeon. This book discusses the current indications, evaluation and surgical procedures for treating acetabular fractures in older patients, covering both nonsurgical and. Evaluation of a computer integrated surgical technique for. Acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. If the hip is flexed and a force is transmitted through the femur posteriorly, as commonly occurs in a motor vehicle accident, the posterior wall will fracture. The majority of acetabular fractures are caused by some type of highenergy event, such as a car collision. This study is aimed to concentrate on the outcome of surgical treatment for displaced acetabular fracture in the local setting.
The reported incidence is approximately 3 per 100,000 per year. The goal of this video is to show the exact surgical technique of open reduction and internal fixation of a comminuted posterior wall acetabular fracture using the spring plate in a stepwise manner. Twentyseven acetabular fractures were operated through an iliofemoral. Acetabular fracture an often complex fracture which can be divided into two broad clinical groups based on the patients age and energy of impact, with high energy fractures being more common in younger patients and often linked to vehicular accidents and low energy fractures occurring in older patients. In a healthy hip, these two bones fit together like a ball and cup, in which the ball rotates freely in the cup. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. In some cases, as in the elderly, or in those cases in which. The doctor may delay the surgery for a few days to make sure the overall condition of the patient is stable. The first larger case series was published by okelberry in 1955 in which he performed internal fixation of seven acetabular fractures via an anterior iliofemoral approach 7. Acetabular fracture overview, symptoms, and treatments. Acetabular fracture fixation via stoppa limited intrapelvic approach. Total hip arthroplasty after operative treatment of an acetabular fracture. Acetabular fractures will be welcomed by orthopaedic and trauma surgeons, as well as by residents and fellows, in these fields. Like any other acetabular fracture, if the femoral head is dislocated out of the socket, early reduction into socket is a priority.
Safe surgical technique for associated acetabular fractures article pdf available in patient safety in surgery 71. A feasibility study was therefore undertaken to evaluate a new technique of percutaneous acetabular fracture fixation utilizing a stored ct image of the pelvis in a computer integrated surgical system, consisting of an array of three ccd cameras and a computer workstation. The classification scheme developed by judet et al. Mar 16, 2019 acetabular fractures are fractures that extend into the hip joint and pose a challenge for orthopaedic trauma surgeons. In 1964, robert judet, jean judet, and emile letournel published a landmark article describing a classification system and surgical approaches to treat acetabular fractures. With the hip flexed to 90, positions of the femur and associated fractures are as follows. In general, surgical approach to the acetabulum depends on the location of the fracture, the type of fracture, and complexity of the fracture. It has been a pleasure to comply with requests to publish this book in english. Pdf safe surgical technique for associated acetabular fractures. Spring plate as an adjunct in posterior acetabular wall. Introduction generally caused by high energy trauma such high energy injuries usually have a high incidence of major associated injuries the fracture or fracture dislocation produced depends on the magnitude and the direction of the injuring force as well as on the strength of the bone.
Pelvic and acetabular fractures aurangabad joint care india. In fractures of this type, the femoral head is often driven through the acetabulum because of the impact of the fall or accident. Through a carefully selected collection of 59 cases covering a comprehensive range of foot and ankle surgeries, this book fulfills the need for a practical, handson manual for surgeons. Surgical dislocation technique for the treatment of. Figures 2, 3, 4 and 5a,b,c show a preoperative xrays, msct and postoperative xrays of the patients with transversal transtectal acetabular fractures and the iliac bone fracture. An alternative form of surgical management is the pao surgical technique often used for pincertype impingement to reduce acetabular retroversion, and is one of the few surgical approaches to have an association as a sexspecific treatment secondary to the increased prevalence of pincertype morphology in the female population. Association of bone and joint surgeons, vancouver, bc.
Often the result of a traumatic incident such as a motor vehicle accident or a bad fall, these fractures require rapid and precise treatment and, in some cases, one or more surgical procedures. Acetabular fraacture management with surgical approaches. Prof nabil ebraheim, university of toledo, ohio, usa. Outcome of surgical treatment for displaced acetabular fractures. Unlike a hip fracture, which can be treated relatively easily, to repair an acetabular fracture, the orthopedic surgeon, must, in essence, fix the broken bones from the inside out. The use of gelatin hemostatic matrix to reduce postoperative bleeding after total knee arthroplasty. Acetabular fractures wheeless textbook of orthopaedics. In a smaller number of cases, a lowenergy incident, such as a fall from standing, may cause an acetabular fracture in an older person who has weaker bones. Intraoperatively, fluoroscopy is positioned to obtain an obturator obliqueinlet view while placing a supraacetabular screw.
Iliofemoral approach to acetabulum trauma international. The first known descriptions of surgical fixation of acetabular fractures were case reports in 1943. Acetabular definition of acetabular by medical dictionary. Acetabular fractures, safe surgical technique, acetabular fixation, patient safety introduction the anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture. Safe surgical technique for associated acetabular fractures. It is very rare for both sides of the hip joint to be damaged in an injury. Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. With the acetabular cup implant in the appropriate position and alignment, use a mallet to impact the acetabular cup impactor handle. Urist described surgical fixation of an acetabular fracture via an anterior iliofemoral approach in 1949 6. Bellabarba c, berger ra, bentley cd, quigley lr, jacobs jj, rosenberg ag, et al. Anteroposterior pelvic radiograph a and ct scan b of irreducible hip dislocation with posterior wall acetabular fracture. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular. Acetabular fractures in older adults are increasing in frequency and present unique challenges to the surgeons charged with their treatment.
I began writing the first edition of this book, fractures of the pelvis and. Acetabular fractures can be frustrating because there are many types of acetabular fractures, each of which requires different surgical positioning eg, prone, lateral, supine, modified. Surgical hip dislocation allows for a 360 view of the acetabulum and may facilitate a reduction in selected acetabular fractures. Outcomes after surgical treatment of acetabular fractures. Acetabular fractures are usually caused by either highenergy trauma, most commonly from an automobile accident, or from what is called an insufficiency fracture.
The exact surgical plan will be discussed with you before you are asked to consent agree to surgery. Nov 28, 2018 acetabulum fracture morphology depends on the degrees of flexion or extension and adduction or abduction. Acetabular fracture definition of acetabular fracture by. A surgical approach will be selected with the expectation that. Surgical management of fracture of acetabulum 76 p j m h s vol. Because acetabular fractures damage the cartilage surface of the bone, an important goal of surgery is to restore a smooth, gliding hip surface. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. Description of operative technique and treatment results. Acetabular fractures in older patients assessment and. It allows access to anterior column as well as anterior wall fractures. Pdf safe surgical technique for associated acetabular. An acetabular fracture occurs when the socket of the hip joint is broken. Feb 15, 20 the anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns.
Surgery for acetabulum fractures if you require surgery, this can be done in several ways. Fortunately, there are some basic fracture patterns that offer clues to the surgical approach and the positioning needed for each patient. These include patient resuscitation, a detailed diagnosis of the injury pattern, choosing and executing the proper open or percutaneous exposures, accurately reducing the injury sites, and providing safe and stable fixation without complications. However, the surgical approaches required, the ability to receive an anatomic reduction, and the application of rigid internal fixation techniques is more complex. However, in this injury, nonoperative treatment rarely gives satisfactory results. During the operation, your doctor will reconstruct the normal anatomy of the hip jointaligning the bone fragments to restore the surface of the acetabulum, and fitting the femoral head into the hip. Acetabular fractures, safe surgical technique, acetabular fixation, patient safety introduction the anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular. This study reported a 63% to 37% male to female ratio 1.
Fortunately, there are some basic fracture patterns that offer clues to the surgical. Acetabulum fracture an overview sciencedirect topics. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. Older women tend to experience this type of fracture more often. Column concept two columns converging to form a cavity 4.
Improved intraoperative fluoroscopy for pelvic and. Orthopaedic surgery enclosed within the deep and complex structures of the hip joint and the surroundings, acetabular fractures confront the. Between march 2011 and march 2012, fifteen patients with acetabular fracture underwent surgery using the psa technique. Pdf associated acetabular fractures are challenging injuries to manage. This section focuses on the arthroscopic surgical techniques enabling arthroscopic reduction and internal fixation of the acute and the malunited femoral head fracture as well as the acetabular rim and anterior column fracture. The fourth edition of this wellknown and highly regarded book by marvin tile et. The complex surgical approaches and the technical difficulty in achieving. Use the approach with which you are most familiar and achieve the best surgical results. The second edition was published in 1993 but it is still a greatfully source. Nov 24, 2016 acetabular fraacture management with surgical approaches 1. Management of acetabular fractures in the elderly patient. After examination of the plain films as well as the ct scan the surgeon should be knowledgeable of the precise anatomy of the fracture he or she is dealing with. Nov 21, 2005 a feasibility study was therefore undertaken to evaluate a new technique of percutaneous acetabular fracture fixation utilizing a stored ct image of the pelvis in a computer integrated surgical system, consisting of an array of three ccd cameras and a computer workstation. The main goal of the surgical treatment is to restore a smooth hip surface.
It is ideal for general trauma and orthopedic surgeons, as well as foot and. Sep 04, 20 the aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. Conventional anterior column lag screw fixation in acetabular fracture is a difficult technique that has potential risks of vascular injury, hip joint penetration and excessive radiation exposure. This book is distributed under the terms of the creative commons. The choice of approach rests with the surgeon, but going from front, or anterior approach is must.
The degree of hip rotation generally does not contribute significantly to the fracture pattern. This excellent book must be read and earn by all orthopaedic surgeon who treat and understand acetabular fractures. In general, most acetabular fractures are operated on. Because of the complex acetabular anatomy, various classification schemes have been suggested 35, but the judetletournel classification system remains the most widely accepted 2, 4, 6. Prolonged traction 4 to 12 weeks if fracture indicates surgery, but the. Acetabular fractures, safe surgical technique, acetabular fixation, patient safety introduction the anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns. 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. Acetabular fractures are a challenging topic for radiologists and orthopedists. Outcome of surgical treatment for displaced acetabular. Access to video presentations demonstrating surgical approaches and reduction techniques performed by worldrenowned experts is included. The successful surgical management of pelvic ring disruptions and acetabular fractures relies on many important factors. Offering authoritative, comprehensive coverage of hip surgery, the 2nd edition of surgery of the hip is the definitive guide to hip replacement, other open and arthroscopic surgical procedures, and surgical and nonsurgical management of the hip across the lifespan. An insufficiency fracture is most common in older patients and is caused by the bone being weakened by osteoporosis.
Acetabular fractures primarily occur in young people who are. The anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns. First, resect the acetabular labrum and place a blunt retractor. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including. Operative management of displaced acetabular fractures yields better results than nonoperative management. This highly valuable book, manual of fracture managementfoot and ankle examines the techniques and procedures for the management of fractures and dislocations of the foot and ankle. This highly valuable book, manual of fracture managementfoot and ankle examines the techniques and procedures for the management of fractures and dislocations of the. Acetabular fraacture management with surgical approaches 1. Orthopaedic surgery enclosed within the deep and complex structures of the hip joint and the surroundings, acetabular fractures confront the orthopaedic surgeon with great challenges. We propose a safe technique of anterior column lag screw fixation inoutin technique and present the outcome.
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