Acetabular posterior wall morphology. A CT-based method to distinguish two acetabular posterior wall types

Graulich, Tilman; Graeff, Pascal; Nicolaides, Stine; Haertlé, Marco; Omar, Mohamed; Krettek, Christian; Liodakis, Emmanouil

doi:10.1016/j.jor.2020.01.027

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…We believe that a larger bony posterior wall has a high impact and protective function to prevent posterior BHA dislocations. Recently, we also described the reference values for the posterior wall coverage with a mean PASA of 100° and PWA of 72° in a healthy patient collective [16]. Our data with reduced PASA and PWA in patients with dislocated BHAs (PASA: 96 ± 6 vs. 109 ± 10; p < 0.01) and (PWA: 67 ± 6 vs. 77 ± 10; p = 0.02) show that a more open acetabular posterior wall is associated with a higher risk for BHA dislocation.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of no dementia and PASA and PWA > 95.5° and 71.5°, respectively, or an intraoperative closed acetabulum, we would consider a BHA arthroplasty. Alternatively, in place of measuring the posterior wall angles, the decision can be made by 3D reconstructions as recently described [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dislocation after BHA seems to be independent from the surgical approach [ 15 ]. A recent study has reported that posterior wall acetabular morphology may influence hip stability [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Graulich

Graeff

Jaiman

et al. 2020

Eur J Orthop Surg Traumatol

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Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Graulich

Graeff

Jaiman

et al. 2020

Eur J Orthop Surg Traumatol

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“…Among the 100 pelvic specimens in this study, the maximum diameter of Magic screws was 6.97 ± 0.98 mm for men and 6.39 ± 0.85 mm for women. Due to the trend in anatomical morphology of the acetabular posterior column thinning from the acetabular top to the bottom [9], when screws with a diameter greater than 5.5 mm or 5.2 mm were used to x the acetabular posterior column for men and women respectively, with the increase in screw diameter and length, the distal end of the screw would be tangential to the posterior wall of the acetabulum or the bony cortex of the area of the quadrilateral, or even pierce them. The important anatomical structure on the surface of the posterior wall of the acetabulum was the sciatic nerve, which traveled outward and downward at the upper-middle third of the line connecting the posterior superior iliac spine and the ischial tuberosity, and passed through the inferior foramen of the piriformis, descending across the posterior wall of the acetabulum, and traveled between the greater trochanter of the femur and the ischial tuberosity [10].…”

Section: Discussionmentioning

confidence: 99%

CT Imaging Anatomical Study of Percutaneous Magic Screw Fixation for Acetabular Posterior Column Fracture

Lü

Gong

Chen

et al. 2022

Preprint

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Background: Research into minimally-invasive fixation of acetabular posterior column fracture has mostly focused on anatomic measurement through the ischial tuberosity in a retrograde manner, and few anatomic studies have been carried out on anterograde percutaneous Magic screws. The purpose of this paper was to discuss the entry point, entry direction and fixation range of Magic screws for fixation of acetabular posterior column fracture.Method: Materialise’s Interactive Medical Image Control System (Mimics) 19.0 software was used to carry out three-dimensional (3-D) reconstruction based on the Computed tomography (CT) data of the pelvises of 100 cases. A virtual Magic screw was placed in the acetabular posterior column, and the screw entry point, entry direction, length, diameter, safety range and fixation range were determined. Osteotomy modeling was performed on the acetabular posterior column with virtual Magic screw fixation, and the changing law of the width of the screw channel was observed. The narrowest distance and position between the screw edge and the acetabulum were measured.Results: The bone entry point of the Magic screw on the posterior side to the anterior inferior iliac spine and cephalad side to the acetabular top for the males were 33.32 ± 5.52 mm and 13.42 ± 3.68 mm, respectively; and those for females were 33.94 ± 5.43 mm and 9.11 ± 3.82 mm, respectively. The screw for males had a back rake angle of 57.37 ± 6.53° and a leaning inside angle of 52.12 ± 5.61°, with an angle of 15.16 ± 3.45° to the iliac wing. For females, those angles were 55.61 ± 7.94°, 51.53 ± 5.59° and 9.76 ± 3.69°, respectively. The maximum screw diameter was 6.97 ± 0.98 mm for males and 6.39 ± 0.85 mm for females. The screw length was 76.73 ± 9.20 mm for males and 63.64 ± 8.37 mm for females. The safety ranges of back rake angle and leaning inside angle of the 5.5 mm diameter screws for the males were 7.18 ± 3.32° and 9.42 ± 3.96°, respectively, and those of 5.2 mm diameter screws for females were 8.39 ± 2.83° and 10.37 ± 3.92°, respectively. For 60% of the male specimens, the screw fixation range was above the acetabular top, with a length of 60.45 ± 5.92 cm; and for 40% of the male specimens, the screw fixation range was below the acetabular top, with a length of 50.68 ± 6.49 cm. For females, 24% of the specimens were above the acetabular top, with a length of 52.19 ± 7.76 cm; and 76% of the specimens were below the acetabular top, with a length of 38.40 ± 4.35.Conclusion: Percutaneous Magic screws provide a minimally-invasive fixation method for acetabular posterior column fracture with high surgical difficulty, and can be used to fix fractures located in the middle and upper segment of the posterior column.

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“…Recently, we showed that posterior wall morphology differs by age, gender, and the degree of osteoarthritis [ 8 ]. The various posterior wall types can be distinguished by measurement of posterior wall angles [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

Graulich

Gräff

Pacha

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Smaller posterior acetabular walls have been shown to independently influence the risk for bipolar hip dislocation. We asked whether differences would also be observed in patients with traumatic posterior hip dislocation with and without posterior wall fractures. Methods Between 2012 and 2020 we observed 67 traumatic posterior hip dislocations. Of these, 43 traumatic posterior hip dislocations in 41 patients met the inclusion criteria. Eighteen dislocations were excluded with an acetabular fracture other than posterior wall fracture and six dislocations had insufficient computed tomography (CT) data. The mean age was 41 ± 11 years, 32 males and nine females. We observed 26 traumatic hip dislocations with posterior wall fractures and 17 without. All patients underwent polytrauma CT scans and postoperative/postinterventional pelvic CT scans. On axial CT-scans, posterior wall determining angles were measured. Results Patients with posterior wall fractures were not significantly older than patients without posterior wall fractures (42 ± 12 vs. 38 ± 10 years; p = 0.17). Patients without posterior wall fractures had significantly smaller posterior acetabular sector angles (84° ± 10°) than did patients with posterior wall fractures (105° ± 12°) (p < 0.01; OR 1.178). Likewise, the posterior wall angle was significantly smaller in patients without posterior wall fracture (62° ± 9°) than in those with posterior wall fractures (71° ± 8°) (p < 0.01; OR 1.141). Conclusion Both posterior acetabular sector angle and posterior wall angle are independent factors determining the posterior wall fracture morphology in patients with traumatic posterior hip dislocation. Age and the observed trauma mechanism did not differentiate between traumatic posterior hip dislocations with and without posterior wall fractures.

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Acetabular posterior wall morphology. A CT-based method to distinguish two acetabular posterior wall types

Cited by 6 publications

References 12 publications

Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

CT Imaging Anatomical Study of Percutaneous Magic Screw Fixation for Acetabular Posterior Column Fracture

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

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