Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Oct 2024
ReviewAcetabular fractures in geriatric patients: epidemiology, pathomechanism, classification and treatment options.
The incidence of geriatric acetabular fractures has shown a sharp increase in the last decades. The majority of patients are male, which is different to other osteoporotic fractures. The typical pathomechanism generally differs from acetabular fractures in young patients regarding both the direction and the amount of force transmission to the acetabulum via the femoral head. ⋯ Primary arthroplasty of geriatric acetabular fractures is a treatment option, which does not require anatomic reduction, allows for immediate postoperative full weightbearing and obviates several complications, which are associated with internal fixation. The major issue is the fixation of the acetabular cup in the fractured bone. Primary cups, reinforcement rings or a combination of arthroplasty and internal fixation may be applied depending on the acetabular fracture type.
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Anterior approaches to the acetabulum can be distinguished into extrapelvic, intrapelvic and combined extrapelvic and intrapelvic approaches. Historically, the extrapelvic ilioinguinal approach was introduced in the French, English and German literature during the late 60s and became gradually the Gold-standard in treating anterior acetabular fractures. ⋯ More recently, more supero-medial approaches, allowing access to the large and true pelvis have been developed, e.g. the Pararectus approach. The historical development, the value and approach-related results of the ilioinguinal approach are analyzed and discussed.
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Arch Orthop Trauma Surg · Oct 2024
ReviewThe infraacetabular screw - anatomy, radiology, biomechanics and clinics.
Acetabular fracture surgery follows the primary aim of anatomic reduction and rigid stable fixation of the fracture. Infraacetabular screws (IAS) allow for an increased stability of the acetabular fixation by closing the periacetabular fixation frame without requiring an additional posterior approach. The osseous screw corridor for infraacetabular screws use the transition zone between the acetabular ring and the obturator ring. ⋯ The inlet view, the combined obturator oblique outlet view and a 1/3 iliac oblique outlet view may be used for the intraoperative radiological assessment for both the entry point and the screw trajectory of IAS. Several biomechanical studies have shown that IAS increase the stiffness of the internal fixation. Scientific proof for an improved clinical outcome is still missing.
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Acetabular fractures are prognostic relevant fractures in terms of function and daily activities. Open reduction and internal fixation (ORIF) is still the gold-standard in treating these injuries. Over recent years, several reports are dealing with outcome evaluations but have the main disadvantage of combining several fracture types., Thus, it remains unclear to discuss a fracture-based prognosis. ⋯ Early hip joint failure (THR, Femoral head necrosis, severe heterotopic ossification) within the 1st year is frequently seen in associated posterior column and posterior wall fractures, but with a relative good prognosis, if the joint survived the first year after ORIF. The highest survival rates of the hip joint is observed with ABC-fractures. Also, these fractures seem to be "forgiving fractures".
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Arch Orthop Trauma Surg · Oct 2024
Comparative StudyComparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.
Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. ⋯ Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries. Level of Evidence: V.