2014

Correlation of stability and complications measurements in traumatic hip dislocation cases associated with posterior wall acetabular fracture

Aim: To evaluate the relationship between stability criteria and complications in traumatic hip dislocations associatedwith posterior acetabular wall fracture.Material and Methods: The study retrospectively investigated 18 patients treated for posterior acetabulum fracture dislocation in the orthopedics and traumatology clinicfrom 2014-2017. All patients had wall defect, acetabular fracture index and coronal posterior acetabular arc angle (PAAA)assessed. Fracture types were determined according to Letournel’s definitions.Results: Preoperative radiological tests found the mean width of intact hip wall was 33.8 mm (range 31-39 mm), mean wall length in fracture hips was 13.7 mm (range 5-21 mm), and mean wall defect was measured as 59.1% (range 37.5-86%). When intact hips were assessed mean coronal PAAA was 54.2 degrees (range 41-65). For fractured hips, coronal PAAA was 18.2 degrees mean (range 6-29). Acetabular fracture index (AFI) was determined as mean 40.8 (range 14-62.5). Regarding complications in the postoperative period, one patient had avascular necrosis of the femoral head and 9 patients had osteoarthritis.Conclusion: Though Defect percentage, AFI and coronal PAAA values are important proven markers for stability, in our study there was no correlation identified with complications.

PDF

___

Ahmed M, Abuodeh Y, Alhammoud A, et al. Epidemiology of acetabular fractures in Qatar. Int 0rthop 2018;42:2211-7.
Laird, A. and J. Keating, Acetabular fractures: a 16-year prospective epidemiological study. The Journal of bone and joint surgery. Br 2005;87:969-73.
Moed BR, SEW Carr, SE, Watson MS, et al. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clinical Orthopaedics Relat Res 2000;377:57-67.
Larson, CB, Carroll, B. Fracture dislocations of the hip. Clinical Orthopaedics and Related Research 1973;92:147-54.
Calkins, M.S., et al., Computed tomography evaluation of stability in posterior fracture dislocation of the hip. Clin orthop Relat Res 1988;227:152-63.
Keith JE Jr, Brashear HR Jr, Guilford WB. Stability of posterior fracture-dislocations of the hip. Quantitative assessment using computed tomography. J Bone joint Surgery Am 1988;70:711-4.
Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum. J Orthopaedic Trauma 2009;23:7-15.
Harnroongroj T, Purinon S, Theerawoot T, et al. Posterior acetabular arc angle of the femoral head assesses instability of posterior fracture-dislocation of the hip. Int Orthop 2013;37:1141-5.
Harnroongroj H, Kongkhet R, Narumol S, et al. Posterior acetabular arc angle of unstable posterior hip fracture-dislocation. Int Orthop 2013;37:2443-9.
P Suryanarayan, AR Kesavan, Surgical approaches to the acetabulum. Indian J Orthop 2002;36:17-9.
Moed, B.R. and D.E. Karges, Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients. Jof Orthop Trauma 1994;8:34-9.
Jimenez, M.L. and M.S. Vrahas, Surgical approaches to the acetabulum. Orthopedic Clinics 1997; 28:419-34.
Letournel, E, Acetabulum fractures: classification and management. Orthopedic Trauma Directions 2007;5:27-33.
Giannoudis PV, Grotz MR, Papakostidis C, et al, Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint surg Br 2005;87:2-9.
Giannoudis PV, Nikolaou VS, Kheir E, et al, Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture. J Bone Joint surg Br 2009;91:1354-9.
Briffa, N, Pearce R, Hill AM, et al., Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint surg Br 2011;93:229-36.
Giannoudis PV, Tzioupis C, Moed BR. Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint surg B 2007;89:503-9.
Rommens PM, MV Giménez, MH Hessmann. Is the posterior wall avulsion the simplest acetabular fracture? Eur J Trauma 2000;26:144-54.
Beaulé PE, Dorey FJ,. Matta JM, Letournel classification for acetabular fractures: assessment of interobserver and intraobserver reliability. J Bone Joint Surg Am 2003;85:1704-9.
Murphy D, Kaliszer M, Rice J, et al., Outcome after acetabular fracture: prognostic factors and their inter-relationships. Injury 2003;34:512-7.
Sevimli R, Bilal Ö. Proximal Femoral Nail Applications for the treatment of femur neck fractures. Van Medical J 2013;20:207-11.