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 compare the effectiveness between modified ilioinguinal approach combined with Kocher-Langenbeck (K-L) approach and Stoppa approach combined with K-L approach for the treatment of complicated acetabular fractures.MethodsBetween May 2011 and May 2016, Sixty-two patients with complicated acetabular fractures were treated with operation via combined anterior and posterior approaches. Thirty-four cases (group A) were treated with modified ilioinguinal approach combined with K-L approach, and 28 cases (group B) were treated with Stoppa approach combined with K-L approach. There was no significant difference in gender, age, injury causes, the type of fracture, time from injury to operation, and associated injury between 2 groups (P>0.05). The operation time, intraoperative blood loss, and hospitalization time were recorded. X-ray film was performed to evaluate the fracture reduction according to the Matta reduction criteria and observe the fracture healing, osteoarthritis, and heterotopic ossification. Clinical results were evaluated according to the grading system of modified d’Aubigne and Postel.ResultsThere was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05). Postoperative incision fat liquefaction occurred in 2 cases in group A and group B respectively, and deep vein thrombosis of lower extremity occurred in 1 case in group A. No iatrogenic injury was found in 2 groups. Fifty-six patients were followed up after operation. Thirty patients in group A were followed up 12-48 months (mean, 31.8 months). Twenty-six patients in group B were followed up 12-46 months (mean, 30.2 months). At 12 months after operation, according to the grading system of modified d’Aubigne and Postel, the hip function was rated as excellent in 9 cases, good in 16 cases, fair in 3 cases, and poor in 2 cases, with the excellent and good rate of 83.3% in group A; the hip function was rated as excellent in 7 cases, good in 14 cases, fair in 2 cases, and poor in 3 cases, with the excellent and good rate of 80.8% in group B. There was no significant difference in the hip function between 2 groups (Z=0.353, P=0.724). The X-ray films showed that there were 23 cases of anatomical reduction, 6 cases of satisfactory reduction, and 1 case of unsatisfactory reduction in group A, and 20 cases, 5 cases, and 1 case in group B, respectively. There was no significant difference in the results of fracture reduction between 2 groups (Z=0.011, P=0.991). Fracture healing was observed in both groups. There was no significant difference in fracture healing time between 2 groups (t=0.775, P=0.106). During follow-up, 5 cases of osteoarthritis changes, 2 cases of heterotopic ossification, and 2 cases of avascular necrosis of femoral head occurred in group A, and 4 cases, 2 cases, and 1 case in group B, respectively. The difference between 2 groups was not significant (P>0.05).ConclusionAccording to the location and type of fracture, making a choice between the modified anterior approach and Stoppa approach, and then combined with K-L approach for treatment of complicated acetabular fracture, can obtain satisfactory effectiveness.
Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
ObjectiveTo evaluate the surgical techniques, perioperative complications, clinical outcomes of the modified Stoppa approach in the treatment of acetabular anterior and posterior column fractures. MethodsBetween March 2008 and October 2014, 42 cases of acetabular anterior and posterior column fractures were treated by modified Stoppa approach or modified Stoppa approach combined with iliac fossa approach, and the clinical data were retrospectively analyzed. There were 20 females and 22 males with an average age of 43.2 years (range, 19-68 years). Fractures were caused by traffic accident in 21 cases, by falling from height in 16 cases, and by heavy pound in 5 cases. The time from injury to operation was 3-15 days (mean, 6 days). According to fracture classification of Letournel-Judet, there were 20 cases of both column fractures, 15 cases of anterior and posterior hemi-transverse fractures and 7 cases of T-shaped fractures. The intraoperative blood loss, the amount of blood transfusion, the operation time, the volumn of drainage, and complication were recorded. Matta radiological standard was used to evaluate the reduction quality of fracture, and Merled'Aubigné-Postel system to evaluate hip function. ResultsThe average intraoperative blood loss was 900 mL; the average amount of blood transfusion was 400 mL; the average volume of drainage was 110 mL; and the average operation time was 165 minutes. Intraoperative complications included 4 cases of tractive injury of obturator nerve and 2 cases of the external iliac vein injury, and postoperative complications included 2 cases of lateral femoral cutaneous nerve palsies and 1 case of deep vein embolism of lower extremity, which were improved after treatment. The patients were followed up 36 months on average (range, 12-48 months). There was no infection or heterotopic ossification. According to Matta radiological evaluation system, the reduction quality of fractures was rated as excellent in 21 cases, good in 16 cases, and poor in 5 cases, with an excellent and good rate of 88.1%. The healing time of fracture was 3.5-8.0 months (mean, 5.1 months). According to Merled'Aubigné-Postel system for hip function, 20 cases were graded as excellent, 15 cases as good, 4 cases as fair, and 3 cases as poor, with an excellent and good rate of 83.3% at last follow-up. ConclusionModified Stoppa approach or with iliac fossa approach can get full exposure of quadrilateral area, good reduction, and firm internal fixation in the treatment of acetabular fractures associated with T-shaped fractures, both column fractures, anterior and posterior hemi-transverse fractures.
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.
Objective To investigate the effectiveness of HoloSight Orthopaedic Trauma Surgery Robot-assisted infra-acetabular screw placement for treatment of acetabular fractures. Methods The clinical data of 23 patients with acetabular fractures treated with open reduction and internal fixation and infra-acetabular screw placement in two medical centers between June 2022 and October 2023 were retrospectively analyzed. According to the the method of infra-acetabular screw placement, the patients were divided into navigation group (10 cases, using HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement) and freehand group (13 cases, using traditional X-ray fluoroscopy to guide screw placement). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, and Judet-Letournel classification between the two groups (P>0.05). The time of infra-acetabular screw placement, the fluoroscopy frequency, the guide pin adjustment times, the quality of screw placement, the quality of fracture reduction, and the function of hip joint were compared between the two groups. ResultsAll patients completed the operation successfully. The time of screw placement, the fluoroscopy frequency, and guide pin adjustment times in the navigation group were significantly less than those in the freehand group (P<0.05). The quality of screw placement in the navigation group was significantly better than that in the freehand group (P<0.05). Patients in both groups were followed up 6-11 months, with an average of 7.7 months. There were 9 and 9 cases in the navigation group and the freehand group who achieved excellent and good fracture reduction quality at 1 week after operation, and 12 and 12 cases with excellent and good hip joint function at last follow-up, respectively, and there was no significant difference between the two groups (P>0.05). The fractures in both groups healed well, and there was no significant difference in healing time (P>0.05). During the follow-up, there was no complication related to screw placement, such as failure of internal fixation, vascular and nerve injury, incisional hernia. ConclusionIn the treatment of acetabular fractures, compared with the traditional freehand screw placement, the HoloSight Orthopaedic Trauma Surgery Robot-assisted screw placement can reduce the time of screw placement, improve the accuracy of screw placement, and reduce the amount of radiation, which is an efficient, accurate, and safe surgical method.
Objective To evaluate the security and effectiveness of minimal invasive fixation with three dimensional (3D) fluoro-images based on navigation system in the management of acetabular fractures. Methods Between August 2008 and January 2010, 12 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction. There were 7 males and 5 females, aged 28-57 years (mean, 38.1 years). Fractures were caused by traffic accident in 9 cases, and fall ing from height in 3 cases. According to AO classification, there were 1 case of A2.2 type, 3 cases of A2.3 type, 2 cases of A3.2 type, 2 cases of A3.3 type, 1 case of B2.2 type, 1 case of B3.2 type, 1 case of C2.1 type, and 1 case of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean, 1.2 days). Results Totally 28 screws were implanted. The average time to implant 1 screw was 24.8 minutes. Twenty-seven screws were placed correctly with a successful rate of 96.4%, only 1 screw was reinserted for deviation. All the screws were checked by the 3D fluoro-images, which showed they were not in the joint space after fixation. The results were the same as that by CT scanning. Incisions healed by first intention, and no implant failure occurred. All 12 patients were followed up 7 to 24 months with an average of 16.8 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. Conclusion The minimal invasive fixation with 3D fluoro-images based on navigation system makes the surgery for the nondisplaced acetabular fracture more precise and time-saving, minimizes the surgery injury, and improves the cl inical results with less compl ications.
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.