Acetabulum, as the important factor for weight bearing of the upper body, has its unique anatomic features and complicated physiological function. The integrity and stability of the lunata articular surface in the dome region of acetabulum, is the important base to bear the physiological function of acetabulum. The fracture related to this part will cause relation change of contact area and stress between head of femur and acetabulum. Furthermore, the deep anatomical position of the dome region, the complicated surrounding anatomical relation, and the irregular bony structure will also increase the difficulty of surgical treatment. Especially for some complicated comminuted or compressed fracture, even with good explosions, it is hard to get satisfied anatomical reduction. Consequently,forward traumatic arthritis has greater probability of occurrence. Therefore, the clinical research on the fracture in the dome region of acetabulum was getting more and more attention worldly. This paper intended to review the relation of fracture classifications and anatomic features, physiological function,diagnostic criteria,and also its clinical treating countermeasure.
Acetabulum ; injuries ; physiopathology ; surgery ; Fractures, Bone ; diagnosis ; physiopathology ; surgery ; Humans ; Prognosis ; Weight-Bearing

OBJECTIVETo investigate the changes of hipbone biomechanics after the resection of ischiopubic tumors and their relationships with the complications in the convalescent stage, and directing the postoperative pelvic reconstruction.

METHODSDICOM data were used to create an intact hipbone finite element model and postoperative model. The biomechanical indices on the same region in the two models under the same boundary condition were compared. The differences of displacement, stress, and strain of the two models were analyzed with statistical methods.

RESULTSThe distribution areas of the hipbone nodes' displacement, stress, and strain were similar before and after the simulated operation. The sacroiliac joint nodes' displacement (P=0.040) and strain (P=0.000), and the acetabular roof nodes' stress (P=0.000) and strain (P=0.005) of two models had significant differences, respectively.But the sacroiliac joint nodes' stress (P=0.076) and the greater sciatic notch nodes' stress (P=0.825) and strain (P=0.506) did not have significant differences.

CONCLUSIONSThe resection of ischiopubic tumors mainly affect the biomechanical states of the homolateral sacroiliac joint and acetabular roof. The complications in the convalescent stage are due to the biomechanical changes of the sacroiliac joint and the acetabular roof and disappearances of the stabilization and connection functions of the pubic symphysis and superior ramus of pubis.

Acetabulum ; physiopathology ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Pelvic Bones ; physiopathology ; Pelvic Neoplasms ; physiopathology ; surgery ; Sacroiliac Joint ; physiopathology

Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 +/- 0.57 m/sec2 preoperatively to 1.55 +/- 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20degrees could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head-neck deformities without any increased complication rate. We have encountered an obturator artery injury in one case and two intraoperative comminuted fractures. Although serious complications such as motor nerve palsy, deep infection, necrosis of the femoral head or acetabulum, and delayed union or nonunion of the ilium were reported, such complications have never occurred in our 700 cases so far.
Acetabulum/physiopathology/*surgery ; Hip Dislocation, Congenital/complications/physiopathology/*surgery ; Humans ; Osteoarthritis, Hip/etiology/physiopathology/*surgery ; Osteotomy/adverse effects/*methods ; Recovery of Function

OBJECTIVETo analyze the fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome.

METHODSFrom July 2005 to February 2007, 52 cases of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome were treated by two methods. Among them, 24 cases were treated by fenestration operation for articular facet reduction, bone grafing, anatomical reconstruction of the acetabular parastyle with internal fixation, included 17 males and 7 females with an average age of (35.2 +/- 6.4) years old; the other 28 cases were treated only anatomical reconstruction of the acetabular parastyle with internal fixation, included 19 males and 9 females with an average age of (36.4 +/- 4.8) years old. All the patients were evaluated with modified d'Aubigne-Postel clinical evaluation standard.

RESULTSAll patients gained bone healing. There were only 1 patient occurenced femoral nerve injury and recovered 2 months later. There were no other complications. All patients were followed up from 12 to 51 months (averaged in 31.5 months). According to modified d'Aubigne-Postel clinical evaluation standard, there were statistic difference between the two groups of patients in pain, walking, range of motion and total score. In fenestration operation group, the results were excellent in 13 patients, good in 9, fair in 1, poor in 1; in parastyle reduction group,the results were excellent in 9 patients, good in 11, fair in 6, poor in 2 (u=0.613, P<0.05).

CONCLUSIONFenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome is a feasible method for the recovery of hip joint function.

Acetabulum ; injuries ; physiopathology ; surgery ; Adult ; Aged ; Female ; Fractures, Compression ; physiopathology ; surgery ; Humans ; Joints ; injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Weight-Bearing ; Young Adult

OBJECTIVETo investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture.

METHODSFrom June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects.

RESULTSThere was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation.

CONCLUSIONThe effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.

Acetabulum ; injuries ; surgery ; Adult ; Arthroplasty, Replacement, Hip ; methods ; Femoral Fractures ; physiopathology ; surgery ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular

OBJECTIVETo explore the effectiveness and prognosis on surgical treatment of posterior hip dislocations complicated with fractures of femoral head and acetabulum.

METHODSSeventeen patients with posterior hip dislocations complicated with fractures of femoral head and acetabulum were reviewed in the study. All the patients were treated with manual reduction within 12 hours after injury. CT location was used before operation. Absorbable screw fixation was performed for the femoral head fractures, while plate fixation or resection was performed for acetabular fractures.

RESULTSAll the patients got bony union within 6 months after operation without femoral head necrosis. Evaluate joint function according to Modifie Daobigne and Postal clinical classification criteria, 8 patients got an excellent result, 7 good and 2 fair. The excellent and good rate was 88.2%.

CONCLUSIONSurgical treatment can have a satisfactory prognosis for patient with posterior femoral head and acetabulum.

Acetabulum ; injuries ; Adolescent ; Adult ; Female ; Femoral Fractures ; complications ; Follow-Up Studies ; Hip Dislocation ; complications ; physiopathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Treatment Outcome

PURPOSETotal hip replacement (THR) is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips. Acetabular fractures managed either conservatively or operatively by fixation tend to present later with secondary joint changes that require THR. In this study we evaluated the functional outcome and quality of life achieved by such patients.

METHODSOur study was carried out as a retrospective trial by recruiting patients who underwent THR from June 2006 to May 2012. A total of 32 patients were included with a mean age of 46.08 years ranging from (25-65) years. We evaluated the quality of life in the patients using scoring techniques of Short Musculoskeletal Functional Assessment (SMFA) and the 12-Item Short Form Health Survey (SF-12). Functional outcome was assessed using Harris Hip Score (HHS).

RESULTSThe mean HHS of the patients was 84.3 with a range from 56 to 100. The SMFA averaged 13.3. The SF-12 score averaged 49.1. The correlation of the HHS with SF-12 was positive (p =0.001) while with SMFA there was a negative correlation (p =0.001).

CONCLUSIONFrom this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.

Acetabulum ; injuries ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; physiopathology ; psychology ; surgery ; Humans ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo analyze the clinical effect of acetabular posterior wall fractures with reconstruction plate internal fixation.

METHODSFrom January 2001 to January 2006, 45 cases were studied retrospectively including, 31 males and 14 females. The age ranged from 19 to 68 years, mean 37.6 years. All patients of acetabular posterior wall fractures were treated by open reduction and internal fixation with reconstruction plate. All patients were reviewed retrospectively. All patients were treated with the Kocher-Langenbeck approach.

RESULTSForty-five patients were followed up for 12 to 48 months, averaged 26 months. By Matta's X-ray reduction criteria, there were 38 cases of anatomical reduction, 7 cases of satisfactory. By modified d'Aubigne clinical evaluation criteria, the clinical results were excellent in 30 cases, good in 10 cases and fair in 5 cases, excellent and good rate of clinical results was 88.9%. There were no infection and non-union. The complications included traumatic osteoarthritis in 4, aseptic necrosis of the femoral head in 2, heterotopic osteogenesis in 2 and deep venous thromboembolism in 1.

CONCLUSIONFractures of acetabular posterior wall with reconstruction plate internal fixation can gain good clinical results. The quality of fracture reduction, the time to surgery after injury, experience of surgical operation and the degree of fracture comminution are the factors influencing the operative results of posterior wall fractures of the acetabulum.

Acetabulum ; diagnostic imaging ; injuries ; physiopathology ; Adult ; Aged ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Pain ; Radiography ; Retrospective Studies ; Treatment Outcome

BACKGROUND: We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. METHODS: Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. RESULTS: The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. CONCLUSIONS: In spite of the early expression of symptoms and the short duration of the acetabular labral tears, the high rate of degenerative acetabular labral tears in sports patients is likely associated with repetitive injury after the expression of symptoms. Femoroacetabular impingement in sports patients is seemed to be a cause of the early occurrence of acetabular labral tears. Because the possibility of acetabular labral tears is high in femoroacetabular impingement, sports patients may need to undergo early screening for the diagnosis and care of femoroacetabular impingement.
Acetabulum/*injuries ; Adolescent ; Adult ; Aged ; Arthroscopy ; Athletic Injuries/classification/*complications/physiopathology/surgery ; Child ; Female ; Femoracetabular Impingement/*etiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rupture/classification/complications/surgery ; Sports ; Treatment Outcome ; Young Adult

Acetabulum ; injuries ; Adult ; Bone Plates ; Dermatologic Surgical Procedures ; Female ; Follow-Up Studies ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Traction ; Young Adult