BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as poss...BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although "special shaped precontoured plates" have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIM To evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates(CCRPs) for posterior wall acetabulum fracture treatment.METHODS Twelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models(experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures(of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate(PABP). Samples were placed through thetest device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTS The average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs(P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL(posterosuperior fracture line vertical to the ground surface) and CL(posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs(P = 0.036 and P = 0.045, respectively).According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL(posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs(P= 0.261).CONCLUSION PABP provides more stable fixation in acetabulum posterior wall fractures than5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.展开更多
Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater tro...Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.展开更多
文摘BACKGROUND The purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although "special shaped precontoured plates" have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIM To evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates(CCRPs) for posterior wall acetabulum fracture treatment.METHODS Twelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models(experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures(of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate(PABP). Samples were placed through thetest device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTS The average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs(P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL(posterosuperior fracture line vertical to the ground surface) and CL(posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs(P = 0.036 and P = 0.045, respectively).According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL(posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs(P= 0.261).CONCLUSION PABP provides more stable fixation in acetabulum posterior wall fractures than5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.
文摘Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.
