Bilateral acetabular fractures in elderly patients due to seizures are very rare and management is a challenge. The standard treatment for acetabular fracture, open reduction with internal fixation, is not recommended for the elderly because of poor bone quality and the need for bed rest. In the acute phase, total hip arthroplasty may be the best treatment option because it allows early mobilization and avoids bed rest complications. We report the case of a 76-year-old man with a bilateral comminuted acetabular fractures and a left fracture dislocation of the shoulder, treated by immediate shoulder arthroplasty and a one-stage bilateral total hip arthroplasty procedure at 3 weeks, with a good result at 1-year follow-up.
BackgroundMRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases.MethodsDynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI.ResultsThe study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05).ConclusionThe Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.
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