Anatomic basis of a superior approach to the acetabulum with osteotomy of the ala of the ilium

Abstract

This study demonstrates the importance of a superior approach to acetabulum with intrapelvic osteotomy of the iliac ala in certain fractures of the acetabulum. This study is based on the dissection of 15 formolized and 5 frozen subjects, the surgical treatment of 17 acetabular fractures, and the performances of 2 Chiari-type osteotomies and 2 Salter-type osteotomies. We investigated the gluteus medius muscle and its pedicle in relation to the iliac ala. Landmarks for the osteotomy lines and the gluteal pedicles are defined in terms of the requirements of different surgical approaches. The superior approach for acetabular fractures was made using a skin incision of Smith-Petersen type. The underlying principle is the performance of an intrapelvic osteotomy of the iliac ala, the anterosuperior part of the ala being tilted outward and backward and pedicled on the gluteal muscles. This provides intra- and extrapelvic exposure of the acetabular walls. The advantages and drawbacks of this route of approach in surgery of the pelvic girdle are discussed in terms of the types of fracture treated and tumoral locations. The anatomic findings are illustrated from traumatology and tumoralpathology. This approach seems particularly suitable for acetabular fractures interrupting the pelvic ring.

Association of Hindfoot Ligament Tears and Osteochondral Lesions

“…The LTCL has been previously defined by Trouilloud et al 50 as having three orientations: Type A, B, and C. This study observed these same three classifications; however, the distribution of the orientations was much different than that described by Troilloud et al 50 In their series of 20 foot and ankle specimens, they found that Type A occurred in 35%, Type B in 23%, and Type C in 42% of specimens. Our study found Type A in 75%, Type B in 21%, and Type C in 4% of specimens.…”

“…Two of the ligaments were found to have varying positional attachments; LTCL and DCCL. The LTCL was documented according to the classification scheme presented by Trouillard et al 50 When the LTCL was continuous with the CFL, it was classified as Type A and occurred in 42 of 56 (75%) observed. When the LTCL was anterior and separated from the CFL, it was classified as Type B and occurred in 12 (21%) specimens.…”

“…Our study found Type A in 75%, Type B in 21%, and Type C in 4% of specimens. Trouilloud et al 50 described the LTCL in type C specimens as being a ligament in the sinus tarsi, parallel to the interosseous ligament. The ligaments of the sinus tarsi were not documented in our study due to the process required to do so; however, during the dissection process, the investigators could regularly identify the presence or absence of these ligaments.…”

Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

“…RTSA was first described as a solution to treat older patients with rotator cuff tear arthropathy for which nonsurgical therapies had failed 32 . The U.S. Food and Drug Administration approved the RTSA implant for use in December 2003 for elderly patients with a rotator cuff arthropathy indication.…”

“…The concept of reverse total shoulder arthroplasty (RTSA) was first explained by Grammont et al 32 >25 years ago. During the past 2 decades, the RTSA has been used to treat a range of complex shoulder diseases, including total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) implant failures, complex proximal humeral fractures, asymmetric glenoid wear, posterior humeral head subluxation in patients with intact rotator cuffs, and irreparable rotator cuff tears in the absence of arthritis 36 .…”