We retrospectively analyzed 22 patients pelvic CT, in whom the acetabular fracture were suspected in plain film. And compared and analyzed the computed tomogram findings and plain radiographic findings. The results were as follows. CT enables better evaluation of shape, extent, and degree of separation of fragment. CT was helpful in detecting the combined fracture and soft tissue injuries. CT showed intraarticular loose bodies, which were invisible on plain film. In patients with pelvic trauma, no necessary changing position during CT examination. CT was useful demonstrates the remnant of intraarticular osseous fragment and adequacy of reduction after surgery.
Acetabulum* ; Humans ; Retrospective Studies ; Soft Tissue Injuries

Acetabulum ; injuries ; surgery ; Fractures, Bone ; surgery ; Humans

Percutaneous pelvic fixation is possible with the advances in intraoperative fluoroscopic imaging and other technologies. Percutaneously inserted screws in medullary pubic ramus,iliac wing, and iliosacral bone can stabilize pelvic or acetabular disruptions directly mean while can diminish operative blood loss, shorten operative time, and allow patient's early activity. Complications associated with open surgical procedures are similarly avoided by using percutaneous techniques. Stable and safe percutaneous fixation techniques depend on accurate closed reduction, excellent intraoperative fluoroscopic imaging, and detailed preoperative planning. A thorough knowledge of pelvic osseous anatomy, injury patterns, deformities, and the related intraoperative imagery techniques are essential for doctors to fulfill the operation of percutaneous pelvic fixation. This paper presents an overview of the technique of percutaneous surgery of the pelvis and acetabulum.
Acetabulum ; injuries ; Fracture Fixation, Internal ; methods ; Humans ; Pelvic Bones ; injuries

PURPOSE: To evaluate the results of limited open reduction and screw fixation of acetabular fractures. MATERIALS AND METHODS: Six acetabular fractures were treated with fluoroscopic guided screw fixation. The mean age was 46 years old and mean follow-up period was 18 months. There were 3 anterior column fractures, 2 transverse fractures and 1 both column fracture. Anterior column screw fixation was used in 5 cases and posterior column fixation in 1 case. Limited ilioinguinal approach was used in 4 cases and percutaneous screw fixation in 2 cases. RESULTS: The mean union time was 16.6 weeks. The postoperative radiographic results revealed 2 cases with an anatomic reduction and 4 cases with an imperfect reduction. The clinical results showed 1 case with excellent, 4 cases with good and 1 case with fair. Regarding complication, there was 1 case of SI joint penestration without clinical symptoms. CONCLUSION: Limited open reduction and screw fixation can be a useful alternative treatment for acetabular fractures in patients with minimally displaced fracture, severe multisystem trauma and soft tissue injury not suitable to traditional treatment.
Acetabulum* ; Follow-Up Studies ; Humans ; Joints ; Soft Tissue Injuries

In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initialradiographs, we compared and analysed the CT findings and plain radiographic findings and plain radiographicfindings. The results were as follow: 1. In patients with multiple trauma, no further change in position wasrequeired during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plainradiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, andfemoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments.5. CT was helpful indetecting the associated fractures and soft tissue injuries. 6. CT also demonstrated theadequacy of reduction, the position of metallic fixation devices, and the presence or absence of remainingintraarticular osseous fragments after surgery.
Acetabulum ; Head ; Humans ; Multiple Trauma ; Retrospective Studies ; Soft Tissue Injuries

OBJECTIVETo explore morphological character and clinical significance of superior-posterior acetabular wall by anatomically measuring and quantitatively analyzing thickness of posterior acetabular wall, then provide a theoretical reference for clinical treatment of acetabular fracture.

METHODSFifteen adult formalin-preserved cadaveric pelvises (8 males and 7 females) were used for this investigation. Excess soft tissue was removed and the whole acetabular posterior walls were marked with "angle" sector method and the thickness was measured with caliper in different levels of the different split points. The measurement results were validated and analyzed statistically.

RESULTSAt 5 mm away from acetabular rim, the average thickness of superior-posterior acetablar wall fluctuated between (6.47±0.61) mm and (7.43±0.71) mm; the average thickness of inferior-posterior acetabuluar wall fluctuated between (5.62±0.51) mm and (6.33±0.61) mm; the average thickness of acetabular roof fluctuated between (7.71±0.74) mm and (8.27±0.99) mm. There was no statistical difference between average thickness of superior-posterior wall of acetabulum and inferior-posterior wall of acetabulum (P>0.05), but the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.05). At 10 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (8.81±0.67) mm and (13.35±0.89)mm; the average thickness of inferior-posterior acetabular wall fluctuated between (7.02±0.63) mm and (7.66±0.69) mm; the average thickness of acetabular roof fluctuated between (14.46±0.97) mm and (17.05±1.35) mm. Comparatively, the average thickness of superior-posterior acetabular wall was significantly larger than inferior-posterior wall of acetabulum (P<0.05), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.01). At 15 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (12.08±0.78) mm and (19.84±1.03) mm; the average thickness of inferior-posterior acetabular wall fluctuated between (10.17±0.76) mm and (11.12± 0.77) mm; the average thickness of acetabular roof fluctuated between (23.23±1.12) mm and (26.01±1.53) mm. Comparatively, the average thickness of superior-posterior wall of acetabulum was significantly larger than inferior-posterior acetabular wall (P<0.01), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P< 0.01).

CONCLUSIONThe thickness of entire acetabular posterior edge revealed an increasing tendency from inferior-posterior wall to the superior-posterior wall to acetabular roof. And this trend became more obvious with increasing distance away from acetabular rim. Therefore, the superior-posterior acetabular wall could not only maintain the stability of hip joint but also bear loading.

OBJECTIVE: To review the literature regarding diagnosis and treatment of labral tear. DATA SOURCES: A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy. STUDY SELECTION: For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted. RESULTS: Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown. CONCLUSIONS Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.
Acetabulum ; injuries ; Arthroscopy ; Hip Injuries ; Humans ; Rotator Cuff Injuries ; Rupture ; diagnosis

Accurate anatomical reduction of the displaced acetabular fractures has a great clinical importance because acetabulum is related to weight-bearing and their fractures can lead to serious major sequelae. There are controversies and a lot of problems with regard to the management of the displaced acetabular fractures. The purpose of our study is to analyze the clinical results of operative treatment of the displaced acetabular fractures and to establish guidelines for treatment of their fractures. A clinical analysis was performed on 19 patients with displaced unstable acetabular fractures who had been operated on and followed for minimum 1 year period at Asan Medical Center from September 1989 to August 1992. The results were as follows: 1. The most common type was posterior wall fracture according to Letournel's classification. 2. Excellent or good results were obtained in 84% according to Goodwin's assessment method. All of the elementary fracture.s presented excellent or good results, while fair or poor results were observed in some T-shaped fractures or transverse and posterior wall fracture. 3. Complications were observed in 5 cases, including ectopic ossification(2 cases), traumatic arthritis(1 case), avascular necrosis of femoral head(1 case) and deep wound infection(1 case). Those seemed to be related with severe acetabular injury and extensive approach. 4. Kocher-Langenbeck approach was satisfactory for reduction and fixation of posterior column in transverse fracture, while extended iliofemoral approach was necessary for fixation of both column in T-shaped fracture. 5. Reduction of fracture of ilium was prerequisite for reduction of acetabular articular surface. 6. In displaced unstable acetabular fractures, early surgical intervention shich includes accurate anatomical reduction, and rigid internal fixation should be undertaken, and early joint motion should be followed to restore the joint function and to decrease the complication rate.
Acetabulum ; Chungcheongnam-do ; Classification ; Humans ; Ilium ; Joints ; Methods ; Necrosis ; Weight-Bearing ; Wounds and Injuries

Open reduction and internal fixation of the displaced fractures of the acetabulum represents one of the greatest challenge in fracture surgery. The purpose of our study is to report the results of operative treatment and establish the guideline for the operative treatment of the displaced acetabular fractures with the analysis of the clinical and radiological results. This retrospective study reports the results of 21 fractures in 21 patients(19 male and 3 female) treated by open reduction and internal fixation from January 1990 to July 1994. The patients were followed up more than 1 year and mean length of follow-up was 2.3 years. According to Letournel's classification, we had 9 elementary fractures(42.8%) and 12 associated fractures(57.2%). Among the elementary fractures, the posterior wall fracture was the most common type(7 cases, 33.3%) and the transverse-posterior wall fracture was the most common type among associated fractures(4 cases, 19.0%). Surgical approaches were 14 Kocher-Langenbeck, 6 Ilioinguinal and 1 extended iliofemoral. Indirect reduction and specially designed reduction method using C-arm and radiolucent operating table were also helpful to achieve satisfactory reduction. Overall quality of clinical results was graded according to the D'Aubigne and Postel rating score. Satisfactory reduction was gained in 16 cases(76.1%). Unsatisfactory reduction was gained in 5 cases(23.8%). Among the cases within category of satisfactory reduction, there were 7 excellent and 8 good clinical results. But among unsatisfactorily reduced 5 cases, there were 2 good clinical results. It seems that the satisfactory operative reduction of the fracture is the factor that correlates with a satisfactory clinical result. There were complications such as 3 secondary osteoarthritis(14.2%), 3 wound infection(14.2%, 2 superficial and 1 deep), 2 iatrogenic nerve palsy(9.5%, 1 sciatic and 1 obturator nerve) and 1 intrapelvic protrusion acetabuli(4.7%) and no postoperative ectopic ossification.
Acetabulum ; Classification ; Follow-Up Studies ; Humans ; Male ; Methods ; Operating Tables ; Ossification, Heterotopic ; Retrospective Studies ; Wounds and Injuries

PURPOSE: To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. MATERIALS AND METHODS: We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intra-articular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). RESULTS: All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%), the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in the posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. CONCLUSION: Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients.
Acetabulum ; Dislocations ; Head ; Hip ; Hip Dislocation ; Humans ; Joints ; Muscles ; Retrospective Studies ; Soft Tissue Injuries