Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results

Perumal, Ramesh; Valleri, Durga Prasad; Gessesse, Milkias Tsehaye; Jayaramaraju, Dheenadhayalan; Rajasekaran, Shanmuganathan

doi:10.1007/s00590-019-02584-3

Cited by 10 publications

(23 citation statements)

References 28 publications

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“…Studies have reported that patients with PWFs and marginal impaction showed poor clinical outcomes because of the failure to identify the improperly reduced impacted fragments [ 11 ]. With the advances in surgical techniques and the awareness of fracture patterns from preoperative CT scans, the clinical outcomes of PWFs with marginal impaction have improved [ 10 , 21 ]. Preoperative CT scan provides more precise information about the status of margin impaction in an acetabular fracture and helps surgeons to ensure accurate fracture reduction, thereby preventing possible complications.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Lin

Liu

et al. 2022

JCM

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Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.

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Section: Discussionmentioning

confidence: 99%

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Lin

Liu

et al. 2022

JCM

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“…Os objetivos do manejo cirúrgico das fraturas acetabulares são principalmente obter redução anatômica e restaurar a congruência articular para efeitos adequados e redução da chance de complicações, uma vez que a má redução da fratura cria incongruência articular, levando a instabilidade articular e artrite precoce. 2,[5][6][7] Embora as fraturas posteriores da parede possam ser complicadas pela presença de cominução ou impactação…”

Section: Discussionunclassified

Padrão incomum de impacto marginal osteocondral em fraturas acetabulares: Um relatório de dois casos

Ibrahim

Badran

Khalifa

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Introdução As fraturas acetabulares podem ser acompanhadas por lesões de impacto articular, afetando os desfechos se não vistas ou tratadas de modo incompleto. A impactação marginal detectada em estudos de imagem pré- ou intraoperatórios deve ser reduzida anatomicamente usando a cabeça femoral como modelo e aumentando o defeito com enxerto ósseo, se necessário. A superfície articular do segmento impactado parece voltada para a frente durante a cirurgia, que é a descrição clássica de tais lesões. Apresentação do caso No relatório atual, descrevemos um padrão incomum de aparecimento de lesões de impacto marginal em dois pacientes, onde a superfície articular do fragmento impactado está voltado para a cavidade articular, sendo o inverso da descrição clássica, aludindo ao mecanismo provável de sua ocorrência, à técnica de redução e às consequências de ignorar tal lesão. Conclusão Lesões de impacto marginal devem ser diagnosticadas e tratadas corretamente para preservar a congruência articular; no entanto, o cirurgião deve estar ciente da possibilidade de um padrão incomum de impacto marginal no qual o fragmento poderia ser revertido; manter esta possibilidade em mente facilitaria seu diagnóstico e manejo.

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“…However, we did not observe an increase in PTOA in patients with marginal impaction in our cohort. This could be due to the requirement of anatomically disimpacting osteochondral fragments and the improvement of the bone grafting technique [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures

Lai

Tseng

et al. 2022

BMC Musculoskelet Disord

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Background To date, no study has compared the surgical outcomes between posterior wall acetabular fractures with and without associated femoral head fractures. Therefore, we evaluated whether an associated femoral head fracture increases the incidence of fracture sequelae, including post-traumatic osteoarthritis (PTOA) and osteonecrosis of the femoral head (ONFH), following osteosynthesis for posterior wall acetabular fractures. Methods This retrospective clinical study enrolled 183 patients who underwent osteosynthesis for posterior wall acetabular fractures between 2009 and 2019 at a level-1 trauma center. The incidence of PTOA, ONFH, and conversion to total hip arthroplasty (THA) was reviewed. Results The incidence of PTOA, ONFH, and conversion to THA following osteosynthesis were 20.2%, 15.9%, and 17.5%, respectively. The average time for conversion to THA was 18.76 ± 20.15 months (range, 1–82). The results for the comparison of patients with associated femoral head fractures and isolated posterior wall acetabular fractures were insignificant (PTOA: 27.3% vs. 15.7%, p = 0.13; ONFH: 18.2% vs. 14.3%, p = 0.58; conversion to THA: 20.4% vs. 15.7%, p = 0.52). Upon evaluating other variables, only marginal impaction negatively affected ONFH incidence (odds ratio: 2.90). Conclusions Our methods failed to demonstrate a significant difference in the rate of PTOA, ONFH, or conversion to THA in posterior wall acetabular fractures with and without an associated femoral head fracture. Beyond femoral head fractures, the marginal impaction of the acetabulum could have led to early sequelae. Level of evidence Level III

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Marginal impaction in complex posterior wall acetabular fractures: role of allograft and mid-term results

Cited by 10 publications

References 28 publications

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Padrão incomum de impacto marginal osteocondral em fraturas acetabulares: Um relatório de dois casos

Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures

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