Simultaneous Ipsilateral “Floating Hip” with Hip Dislocation and Femoral Neck and Shaft Fractures Associated with “Floating Knee” Injuries with Patella Fracture and Traumatic Sciatic Nerve Injury

Simultaneous ipsilateral “floating-hip” and “floating-knee” injuries are very rare and severe, and they occur in high-velocity road traffic accidents. A 55-year-old man presented with posterior wall fracture – dislocation of the acetabulum, complete fracture – dislocation of the femoral head, ipsilateral femoral shaft fracture, open patellar fracture, Gustilo type II, tibial fracture, and traumatic sciatic nerve injury/peroneal division. Given the fact that hip dislocation is an orthopedic emergency, we first did closed external tibial fixation, femoral head reduction, osteosynthesis of the acetabular fracture, and partial patellectomy. After 2 days, the patient underwent a second surgery; fixation of the neck and femoral shaft fractures was done, with a self-dynamic internal fixator. After 14 months from the injuries, radiographs show complete healing of all fractures, the patient walks independently without crutches, and the peroneal nerve is partially recovered. Despite the seriousness of the presented injuries, we did not have any complications, and 14 months after the injury, the femoral head is still viable, with no signs of femoral head osteonecrosis.

Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty

Introduction: Acetabular fractures (AFxs) are rare injuries considering their incidence. The gold standard of treatment is open reduction and internal fixation (ORIF). Surgical treatment represents a challenge for orthopedic surgeons. Our purpose is to assess the short- to medium-term functional outcomes and complications of surgically treated AFx. We analysed the factors influencing clinical outcomes, the incidence of complications and the predictors of conversion in total hip arthroplasty (THA).Materials and Methods: We retrospectively analysed 102 patients with AFx treated between December 2017 and September 2020. The inclusion criteria were AFx treated with ORIF and more than 12 months of follow-up (FU). We evaluated the quality of reduction with X-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). Postoperative superficial and deep infections, neurological sequelae and deep vein thrombosis were documented. X-rays were performed to confirm the adequacy of fixation and complications. At the final FU, the radiographs were graded according to Matta’s Radiological Outcome Grading, and the clinical outcomes were graded using the Oxford Hip Score (OHS).Results: Of 102 patients, 62 patients were enrolled. The statistical analysis revealed that OHS was influenced by quality of reduction (P=0.033), injury severity score (ISS) (P=0.005) and age (> 75 years) (P=0.029). A significant correlation between the patient’s BMI and the OHS was recorded. The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by the posterior approach (P=0.031) and by an ISS > 15 (P= 0.0003). The analysis showed a correlation between AVN and posterior hip dislocation (P=0.004). OA had a correlation with postoperative quality of reduction (P=0.014). Eight patients required THA. Comparing patients with and without THA, a significant correlation between THA and posterior dislocation (P=0.022), isolated posterior wall fracture (P=0.039) and ISS > 15 (P=0.029) was recorded.Conclusion: Despite the improvement of surgical techniques and perioperative care, a high rate of patients with AFx still develop complications and require THA. Identifying negative predictors to help the management of fractures in elderly individuals is needed. Furthermore, the presence of negative predictors could represent an indication for primary THA.

A Lateral Opening Injection Tool Used In Percutaneous Vertebroplasty To Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study In 66 Cases

Background: This study aimed to assess the results of percutaneous vertebroplasty (PVP) with a lateral opening injection tool for treating asymptomatic osteoporotic vertebral burst fractures (OVBFs) patients.Methods: 66 patients diagnosed with acute asymptomatic OVBFs with a spinal canal occupational ratio under 20% were treated with bilateral PVP using a lateral opening injection tool in our study. The related clinical outcomes and images were assessed, including Visual Analogue Scale (VAS), vertebral height (VH) ratio (=fractured VH/ adjacent nonfractured VH), the bone union of the fractured vertebral posterior wall, bone cement distribution, and complications.Results: The VAS scores were 3.80±0.40 at postoperative one day and 0.59±0.41 at last follow-up, significantly lower than 8.37±0.49 at pre-operation (P<0.05). The vertical distribution of bone cement in 60 cases contacted the upper and lower endplates of fractured vertebras. There was no leakage of bone cement in the spinal canal or displacement of posterior wall fracture to the spinal canal in all cases. There was asymptomatic cement leakage in 7 cases. The mean anterior, middle and posterior vertebral height ratios were significantly increased after PVP compared with preoperative values in all patients (P<0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Three months postoperatively, the posterior wall of fractured vertebral bodies was healed in all cases according to CT images. Conclusions: PVP using a lateral opening injection tool was effective and safe for treating asymptomatic OVBF patients.

Acetabular Posterior Wall Fracture: How to Determine the Fragment Size

The article's abstract is not available.

A Novel Anatomical Locking Guide Plate in Treating Acetabular Transverse Posterior Wall Fracture: A Finite Element Analysis Study

Background: The acetabular transverse posterior wall fracture (ATPWF) is a classic type of associated acetabular fracture with an increasing prevalence worldwide. The optimal treatment for this complex facture remains a formidable challenge in orthopedics trauma. Our self-designed locking plate used to show a promising potential in treating acetabular fracture, but no direct comparison between our novel plate with traditional fixations are available.Materials and methods: The ATPWF model was constructed by the Mimics software using the volunteer’s cloud point data, and three internal devices were used to fix this model: the posterior-column locking plate with acterior-column screws (PCLP), double-column locking plates (DCLP), and the novel anatomical locking guidance plate (NALGP) with anterior-column screws and Magic screws. Then series of increasing downward vertical force (200N, 400N, and 600N) were loaded on above models. The stress distribution and peaks, and maximum displacements at two sites were assessed via a finite element analysis.Results: We found that the major stress concentrated on the middle and lower sections of the posterior plate and lag screws in all three groups after the fixation on the ATPWF. And the NAGLP with its screws stood the bigger stress under all loading force when compared with other two groups. Then the maximum displacement of three groups were evaluated, and NAGLP group were found to have less fracture fragment displacements than PCLP and comparable results to DCLP at both sites.Conclusion: Though our newly-designed plate with its screws showed larger stresses after fixation on the ATPWF, it also showed superiorities on the fracture stabilization over PCLP and comparable stability to DCLP, which might make the DCLP unnecessary for the treatment of ATPWF since DCLP would undoubtedly result in bigger surgical trauma and blood loss.

Modified Kocher-Langenbeck approach for the treatment of posterior wall or column acetabular fractures: The one-incision two-window method

Abstract The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach. Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach. Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse with posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients. Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.

Modified Kocher-Langenbeck approach for the treatment of posterior wall or column acetabular fractures: The one-incision two-window method

Abstract The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach. Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach. Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients. Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.