Objective To discuss the short-term effectiveness of total hip arthroplasty (THA) for post-traumatic osteoarthritis secondary to acetabular fracture. Methods Between January 2004 and March 2012, the clinical data was analyzed retrospectively from 12 cases (13 hips) of post-traumatic osteoarthritis secondary to acetabular fracture undergoing THA. Of 12 patients, 6 were male and 6 were female, with an average age of 55.6 years (range, 40-68 years). The locations were the left hip in 5 cases, the right hip in 6 cases, and bilateral hips in 1 case. The interval between acetabular fracture and THA was 65.7 months on average (range, 12-240 months). The preoperative hip Harris score was 48.8 ± 9.5. Results The incisions healed by first intention. No deep vein thrombosis and infection occurred postoperatively. Ten cases were followed up 1-7 years (mean, 4.8 years). The hip Harris score was 86.5 ± 8.6 at last follow-up, showing significant difference when compared with preoperative score (t=10.520, P=0.006). X-ray films showed no acetabular prosthesis instability. Stem subsidence (2 mm) occurred in 1 case, peri-prosthetic osteolysis in 2 cases, and heterotopic ossification in 2 cases (Brooker type I and type II in 1 case, respectively). Conclusion THA has satisfactory short-term effectiveness for post-traumatic osteoarthritis secondary to acetabular fracture. The good effectiveness is based on strict case selection, pathological evaluation, and the proper acetabular reconstruction.
Objective To investigate the indication, operative approach, postoperative management, and complication of acetabular fracture. Methods Sixty-eight patients (51 males,17 females; age 15-65 years) with acetabular fracture were reviewed retrospectively. Among the patients, 55 were injured in the traffic accidents and 13 were injured in the falls (acute injury in 60, old injury in 8). According to the Letournel classification, 16 had a fracture of the posterior wall, 13 had a fracture of the posterior wall and posterior column, 12 had a fracture of the anterior wall and anterior column, 8 had a fracture of the anterior and posterior column, and 19 had a transverse acetabular fracture. All the patients underwent an operative treatment. Results There was no injury to the nerves and blood vessels during the operation. According to the 1-12-year follow-up for 51 patients, 26 (51.0%) patients had an excellent function, 17（33.3%）had a good function，6（11.8%）had a fair function, and 2（3.9%）had a poor function. The excellent and good rate was 84.3%. After operation, heterotopic ossification was observed in 4 patients, and necrosis of the femoral head in 2 patients. Conclusion Operative management should be performed as soon as possible in the patients with a displaced acetabular fracture. Recovery of the stability of the acetabulum and smoothness of the acetabular articular cartilage is important to the recovery of the function.
ObjectiveTo study the experimental biomechanics of acetabular posterior wall fractures so as to provide theoretical basis for its clinical treatment. MethodsSix formalin-preserved cadaveric pelvises were divided into groups A and B (n=3). The fracture models of superior-posterior wall and inferior-posterior wall of the acetabulum were created on both hips in group A;fractures were fixed with two interfragmentary screws and a locking reconstruction plate. The fracture models of superior-posterior wall of acetabulum were created on both hips in group B;fractures were fixed with two interfragmentary screws and a locking reconstruction plate at one side, and with acetabular tridimensional memory fixation system (ATMFS) at the other side. The biomechanical testing machine was used to load to 1 500 N at 10 mm/min speed for 30 seconds. The displacement of superior and inferior fracture sites was analyzed with the digital image correlation technology. ResultsNo fracture or internal fixation breakage occurred during loading and measuring;the displacement valuess of the upper and lower fracture lines were below 2 mm (the clinically tolerable maximum value) in 2 groups. In group A, the displacement values of the upper and lower fracture lines at superior-posterior wall fracture site were significantly higher than those at inferior-posterior wall fracture site (P<0.01), and the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P<0.01) in two fracture types. In group B, the displacement values of the upper and lower fracture lines at the side fixed with screws and a locking reconstruction plate were similar to the values at the side fixed with ATMFS, all being close to 2 mm;the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P<0.05) in two fixation types. ConclusionThe actual biomechanical effect of the superior-posterior wall of acetabulum is much greater than that of the inferior-posterior wall of acetabulum and they should be discriminated, which might be the reasons of reduction loss, femoral head subluxation, and traumatic arthritis during follow-up.
Objective To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology. Methods Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation. Results All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision. ConclusionThe fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.
This study aims to analyze the biomechanical stability of Magic screw in the treatment of acetabular posterior column fractures by finite element analysis. A three-dimensional finite element model of the pelvis was established based on the computed tomography (CT) and magnetic resonance imaging (MRI) data of a volunteer and its effectiveness was verified. Then, the posterior column fracture model of the acetabulum was generated. The biomechanical stability of the four internal fixation models was compared. The 500 N force was applied to the upper surface of the sacrum to simulate human gravity. The maximum implant stresses of retrograde screw fixation, single-plate fixation, double-plate fixation and Magic screw fixation model in standing and sitting position were as follows: 114.10, 113.40 MPa; 58.93, 55.72 MPa; 58.76, 47.47 MPa; and 24.36, 27.50 MPa, respectively. The maximum stresses at the fracture end were as follows: 72.71, 70.51 MPa; 48.18, 22.80 MPa; 52.38, 27.14 MPa; and 34.05, 30.78 MPa, respectively. The fracture end displacement of the retrograde tension screw fixation model was the largest in both states, and the Magic screw had the smallest displacement variation in the standing state, but it was significantly higher than the two plate fixations in the sitting state. Magic screw can satisfy the biomechanical stability of posterior column fracture. Compared with traditional fixations, Magic screw has the advantages of more uniform stress distribution and less stress, and should be recommended.
ObjectiveTo investigate the effectiveness of modified Stoppa approach with medial wall spring plate (MWSP) for involving quadrilateral of acetabulum fracture. MethodsBetween March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years (range, 19-56 years). The causes included traffic accidents injury (21 cases), crash injury of heavy object (10 cases), and falling injury from height (7 cases). The interval of injury and admission was 3 hours to 2 days (mean, 11 hours). There were 12 cases of anterior column fracture (type D), 5 cases of transverse fractures (type E), 8 cases of T shaped fractures (type H), 6 cases of anterior column fracture with posterior transverse fractures (type I), and 7 cases of double column fractures (type J) according to Letournel-Judet classification. Based on fracture types, MWSP was used to fix fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled' Aubigne and Postel score system. ResultsThe operation time was 85-210 minutes (mean, 130 minutes).The intra-operative blood loss was 450-900 mL (mean, 650 mL). There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomical reduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All patients were followed up for 7 to 18 months with an average of 10 months. Fractures healed well within 13-16 weeks with an average of 14 weeks. At 1 year after operation, the results were excellent in 9 cases, good in 21 cases, general in 5 cases, and poor in 3 cases, and the excellent and good rate was 78.95% according to the Merled'Aubigne and Postel hip score standards. ConclusionInvolving quadrilateral of acetabulum fracture can be fixed with MWSP by modified Stoppa approach or combined with other approaches to obtain good exposure, less invasion, satisfactory reduction, stable fixation, and low complications.
ObjectiveTo explore the effectiveness of a new H-shaped anatomical titanium plate in treatment of posterior wall/posterior column acetabular fractures.MethodsBetween March 2012 and April 2019, 46 patients with acetabular fractures involving posterior wall/posterior column were treated with the new H-shaped anatomical titanium plates. There were 28 males and 18 females. The age ranged from 20 to 70 years, with an average of 45.5 years. Among the patients, 34 cases were injured by traffic accidents and 12 cases by falling from height. The time from injury to operation ranged from 2 to 14 days, with an average of 7 days. According to Letournel-Judet classification, there were 12 cases of posterior wall fractures, 1 case of posterior column fracture, 3 cases of transverse fractures, 9 cases of transverse fractures involving posterior walls, 8 cases of posterior column and posterior wall fractures, 2 cases of anterior column and posterior semi-transverse fractures, 3 cases of T-shaped fractures, and 8 cases of double column fractures. Matta reduction standard was used to evaluate fracture reduction and Merle d’Aubign-Postel score was used to evaluate hip joint function.ResultsAll operations were successfully completed. The time of posterior operation was 60-120 minutes, with an average of 80 minutes. The amount of intraoperative blood loss ranged from 200 to 600 mL, with an average of 300 mL. All the incisions healed by first intention and no infection, deep vein thrombosis, or sciatic nerve injury occurred. All 46 patients were followed up 6-72 months, with an average of 37 months. According to Matta reduction standard, 40 cases obtained anatomic reduction, 4 cases satisfactory reduction, 2 cases unsatisfactory reduction, and the satisfaction rate was 95.7% (44/46). All fractures healed, and the healing time was 3-6 months, with an average of 4.3 months. No internal fixation failure occurred during the follow-up. At last follow-up, the Merle d’Aubign-Postel score ranged from 6 to 18 (mean, 15.5), including 38 cases of excellent, 4 cases of good, 2 cases of fair, and 2 cases of poor, with an excellent and good rate of 91.3% (42/46). Heterotopic ossification occurred in 4 cases, traumatic arthritis in 4 cases, and osteonecrosis of femoral head in 2 cases after operation.ConclusionFor acetabular fractures involving posterior wall/posterior column, the new H-shaped anatomical titanium plate can provide stable fixation, satisfactory reduction, and good recovery of hip function.
ObjectiveTo explore the effectiveness of the calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach.MethodsBetween January 2015 and December 2017, 18 patients with acetabular fracture involving quadrilateral surface were treated with the calcaneal plate bridge reconstruction plate via the modified Stoppa approach. There were 12 males and 6 females. The age ranged from 28 to 63 years (mean, 39 years). The cause of injury was traffic accident in 13 cases and falling from height in 5 cases. According to the Letournel-Judet classification, there were 10 cases of anterior and posterior column fractures, 6 cases of T-shaped fractures, and 2 cases of anterior column and posterior semi-transevere fractures. The interval from injury to operation was 6 to 24 days (mean, 8.6 days). The reduction quality was assessed by postoperative X-ray film and CT according to the criteria proposed by Matta. The hip joint function was assessed by the modified Merled’Aubigné-Postel score.ResultsThe operation time was 120-240 minutes (mean, 165 minutes) and the intraoperative blood loss was 600-1 400 mL (mean, 850 mL). All patients were followed up 18-30 months (mean, 24.5 months). There were 2 cases of the fat liquefaction of abdominal incisions, 3 cases of intraoperative injury of lateral femoral cutaneous nerve, 1 case of lower limb thrombosis, and 1 case of abdominal pain and hematuria due to intraoperative accidental bladder injury. According to the criteria proposed by Matta, the reduction quality rated as anatomic reduction in 12 cases, satisfactory reduction in 5 cases, and unsatisfied reduction in 1 case, and the satisfaction rate was 94.4%. All fractures healed with the healing time of 3-5 months (mean, 3.4 months). During follow-up, no internal fixator loosening, breakage, or fracture displacement occurred. At last follow-up, according to modified Merled’Aubigné-Postel score, hip joint functions rated as excellent in 11 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 83.3%.ConclusionApplication of calcaneal plate bridge reconstruction plate via the modified Stoppa approach for the acetabular fracture involving the quadrilateral surface can obtain satisfactory effectiveness.