The anterior column contains the anterior half of the iliac wing that is contiguous. The full spectrum of the evaluation, diagnostic work up, and treatment options of these fractures will be covered. Pdf clinical and radiological assessment of acetabular fracture. Central fracturedislocation of the acetabulum radiology. The ball, at the top of your femur thighbone is called the femoral head. Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. 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.
Treatment algorithm of acetabular periprosthetic fractures. A surgical approach will be selected with the expectation that. The fractures have to be correctly identified radiologically and clear definition of fracture patterns should be made before planning. The primary landmark of the hip and acetabulum is the anterior superior iliac spine asis. 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 socket. Fractures of the pelvis and acetabulum by marvin tile and a great selection of related books, art and collectibles available now at. The acetabulum is often referred to as the socket part of the hip joint. One of the most common acetabulum fractures with a. Manu bhushan mengi anatomy an incomplete hemispherical socket with an inverted horseshoeshaped articular surface surrounding the nonarticular cotyloid fossa. The second edition was published in 1993 but it is still a greatfully source. Ct is helpful in understanding the va rious fracture patterns. Pdf controversies in treatment of acetabular fracture. In reptiles and birds, the acetabula are deep sockets.
With 50 contributors, new techniques are covered with a focus on minimally invasive procedures. Fractures of the acetabulum occur as a result of the force exerted through the head of the femur to the acetabulum. A new diagnostic approach for periprosthetic acetabular fractures. Your fractured acetabulum a guide for patients about the injury and post operative recovery trauma and orthopaedics department. Acetabular fracture fractures of the acetabulum occur when the head of the femur is driven into the pelvis. Periprosthetic fractures of the acetabulum request pdf. Biological fixation of posterior wall fractures of acetabulum. T type acetabular fracture treated through surgical hip. Stoppa approach to the acetabulum for fractures vumedi. Introductionfractures of the acetabulum generally occur in younger individuals as a result of highenergy motorvehicle accidents. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur. During the intervening years, there has been little to add to our views as to the best management of acetabular fractures, but an additional chapter has been.
For example, the bone can break straight across the socket or shatter into many pieces. 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. Late salvage of failed open reduction and internal fixation of posterior wall fractures of the acetabulum. The algorithm was scientifically validated, it improves the correct diagnosis rate of 30% while divising by 3 the time required. Fractures of the acetabulum portion of the hip can be quite serious due to its location and formation. Specific mar algorithm, smart metal artifact reduction software general. Combined transverse and posterior wall fractures, transverse multifragmentary fractures, and ttype fractures are the most common indications for this technique.
An integrated multidisciplinary approach to comprehensive treatment is provided by a renowned faculty of experts. The ball moves in the socket, allowing your leg to rotate and move forward, backward and sideways. Threedimensional 3d reconstruction of ct data can be helpful in understanding the complex fracture patterns. A repeat ct after traction is sometimes used to assess response to treatment. Above all, i thought it was time to report the longterm results of the 940 acetabular fractures, 90070 of which were treated surgically a unique series. Fractures of the acetabulum are very complex and severe injuries that occur after high energy trauma such as fall from a. Radiographic analysis and classification of displaced acetabular fractures by letournels classification allows the surgeon to choose better the appropriate surgical approach. Few reports concerning the occurrence and treatment of periprosthetic fractures of the acetabulum during and after total hip arthroplasty are available. Judet and letournel classification for acetabular fractures. Acetabular fractures diagnosis john libbey eurotext. Present here is the audiovideo of the live surgery where in posterior wall of the acetabulum has been stabilised biologically by innovating minimal invasive technique by. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. Acetabular fractures are quite challenging injuries for the orthopedic surgeon because of their low incidence and their deep and complex anatomy.
Preventing posttraumatic osteoarthritis is a challenging problem following acetabular fracture. Because acetabular fractures damage the cartilage surface of the bone, an important goal of surgery is to restore a smooth, gliding hip surface. The classification system of judet and letournel has led to improved management of such inju. It is the cup part of the pelvis that wraps around the ball or head portion of the femur to create the hip joint. Acetabular fractures in the elderly can occur in the setting of high or lowenergy trauma. Surgical management of fracture of acetabulum dilip kumar doltani, jugdesh kumar, ghulam mahboob abstract objective. Acetabulum fractures archives trauma international. Transverseposterior wall fractures, t shaped fractures. The management of these fractures can be challenging. The judet and letournel classification is the most widely used classification system for acetabular fractures. The socket, called the acetabulum, is a part of your pelvis.
Periprosthetic acetabular fractures after total hip arthroplasty tha are mostly. Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. The objective of this study was to evaluate surgeonindependent parameters that might influence radiographic outcome and early complication rates of highenergy acetabular fractures treated by open reduction and internal fixation via the kocher. Reconstruction of an acetabular fracture, in the presence of hip arthroplasty can be. Proper recognition, description and classification of acetabular fractures allow. Mechanisms of injury for acetabulum fractures impact of the femoral head with the acetabular articular surface gtalong the axis of the femoral neck anywhere along the long axis of the femoral shaft. The algorithm proposed by helfet provides a very good clinical treatment.
The book uses hundreds of illustrations, plates, and legends to demonstrate important concepts and surgical procedures. It classifies acetabular fractures into ten major fracture patterns, which consist of five simple patterns and five complex patterns 1,2. Surgical dislocation allows direct reduction of the intraarticular fragment. The perforate acetabulum is a cupshaped opening on each side of the pelvic girdle formed where the ischium, ilium, and pubis all meet, and into which the head of the femur inserts. However, for orthopaedic surgeons with less experience with these fractures, correct classification can be more difficult. They divided acetabular fractures into five simple fracture patterns and five. The femoral head acts like a hammer and is the last link in the chain of forces transmitted from the greater trochanter, knee, or foot to the acetabulum. See also fractures broken bones the hip is a ballandsocket joint. The fourth edition of this wellknown and highly regarded book by marvin tile et al. The use of an algorithm for classifying acetabular fractures. He has described everything which related acetabular fractures, xrays, results of the operative treatment, aproaches etc.
Articular socket is composed of and supported by two columns of bone, described by letournel and judet as an inverted y. Surgical dislocation has recently gained popularity in certain types of acetabular fracture because of its 360 degrees access to the acetabulum. The third edition of this definitive work is broadened to include the next generation of trauma specialists. Anterior column is composed of the bone of the iliac crest, the iliac spines, the. Acetabular fractures should be managed after the goal of achieving. Surrounding the adult acetabulum are several boney landmarks that can be used internally and externally as a guide for the position of the native anatomy. Acetabular fractures may result from highenergy trauma or lowenergy trauma in the elderly. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. The acetabulum divides into an anterior and posterior column. Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. New features include current percutaneous techniques and an.
Clinical and radiological assessment of acetabular fracture. Treatment strategies for fractures of the pelvis and acetabulum have improved dramatically over the years. The use of an algorithm for classifying acetabular. Early mobilize the patient with displaced acetabular fractures with operative management. Fractures of the acetabulum sonoran orthopaedic trauma. Organisms in the dinosauria clade are defined by a perforate acetabulum, which can be thought of as a hipsocket.
The letournel and judet classification system is commonly used for classifying acetabular fractures. In the evaluation of the five most common acetabular fractures, assessment. 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. When the socket is fractured, it is called an acetabular fracture. Structurally compromising osteoporosis is heralded by fractures induced by minor trauma, such as a fall from standing height. Most fractures of the acetabulum are due to severe traumatic injuries, such as a car. The degree of underlying osteoporosis determines the resultant fracture characteristics.
Algorithm for treatment of periprosthetic acetabular fractures proposed by helfet. Acetabulum fractures require systematic approach for understanding the fracture pattern and also for planning the treatment plan. The acetabular fracture are usually associated with visceral and neurovascular. Acetabulum fracture an overview sciencedirect topics. Fractures of the pelvis and acetabulum principles and methods of managementfourth edition the fourth edition of this wellknown and highly regarded book by tile et al is now a twovolume comprehensive set of books based on the ao principles of operative management of frac tures, as applied to the pelvis and acetabulum. Such fractures are far less common than fractures to the ball part of the joint.
Management of acetabulum fractures trauma international. Results of 167 consecutive cases of acetabular fractures. Columns and walls the acetabulum is formed by anterior and posterior columns of bone, which join in the supraacetabular region 2, 6, 8. Subchondral fracture of the femoral head after acetabular. Iliopectineal line fracture detection for computeraided acetabular. This prospective study was carried out from april 1998 to december, 2000 in. Periprosthetic fractures of the acetabulum after total hip arthroplasty are uncommon, but are increasing in number and severity. A fracture classification algorithm based on radiography is used, with correlation made to ct. Judet and letournel classification for acetabular fractures dr francis deng and dr benoudina samir et al. Periprosthetic acetabular fractures can occur intraoperatively, in particular during insertion of noncemented cups or. Residents used the letournel and judet classification.
The socket part is lined with smooth cartilage and is called the acetabulum, which is part of the pelvis. Fractures of pelvis and acetabulum principles of management. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur the acetabulum is a cavity situated on the outer surface of the hip bone, also called the coxal bone or innominate bone. In this text, youll find valuable information for successfully managing these conditions from an experienced master surgeon who shares his extensive knowledge of the field. Principles and methods of management print isbn 97832006317 online isbn 978320067. These fractures may occur intraoperatively, during the. Next and from the hip center, a line is drawn to the acetabular fracture edge. This course is focused on the management of patients with fractures to the pelvis and acetabulum. For those patients with pelvic insufficiency fractures involving the acetabulum, a standard ct with a bony algorithm may be useful, especially if operative management is under consideration. Displaced central fracture dislocation of the hip are serious injuries.
925 646 1116 181 939 761 1014 1538 1132 72 662 513 915 1540 895 1140 593 1525 646 116 879 979 132 250 1293 942 1638 38 1563 854 968 1461 1079 237 343 1406 1043 1366 92 726 144 1458 334