Figure 1 - uploaded by Susan Mcdowell
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The portions of the pelvis and acetabulum highlighted in yellow are easily visualized with the modifi ed Ollier approach. More proximal portions of the ilium can be seen with more cephalad dissection of the gluteus medius.
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The purpose of this retrospective clinical study was to evaluate the rates of wound and neurologic complications and clinically significant heterotopic ossification, Brooker stage 3 and 4, with the modified Ollier transtrochanteric approach for the treatment of acetabular fractures. The study group comprised 94 consecutive patients (95 acetabuli) w...
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Background:
The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip.
Methods:
This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip...
Citations
... This technology allowed the authors to assess the articular surfaces of the femoral head and AC, examine the cartilaginous labrum of the AC, and perform reduction and fixation of fragments under intra-articular visual control [42]. It should be noted that many studies contain data on the results of using modified approaches to AC [12,35,37,39,45,46]. Wang P. et al. (2019), while studying the modified ilioinguinal access, noted that conventional approaches have serious complications associated with the duration of surgery, trauma, including the inguinal neurovascular bundle and lymphatic structures, large blood loss, and the development of surgical infections, hernias and heterotopic ossification. ...
... At the same time, the authors note that the modification of the ilioinguinal approach is a useful addition to the arsenal of surgery of the acetabulum and hip joint for certain types of fractures and clearly does not propose to replace the classical ilioinguinal approach, but rather to expand its versatility in specific cases [42]. A number of authors used the Stoppa modified approach technique and studied the results of treatment of AC fractures [12,25,39,43,45,48]. S. McDowell et al. (2012), in a retrospective clinical study, described the results of Olier's modified trans-trochanter approach in 95 cases of treatment of AC fractures. Among the advantages of the technology, the author pointed to a good overview of the proximal ilium and a complete view of the acetabulum [37]. ...
... A number of authors used the Stoppa modified approach technique and studied the results of treatment of AC fractures [12,25,39,43,45,48]. S. McDowell et al. (2012), in a retrospective clinical study, described the results of Olier's modified trans-trochanter approach in 95 cases of treatment of AC fractures. Among the advantages of the technology, the author pointed to a good overview of the proximal ilium and a complete view of the acetabulum [37]. J. Chen et al. (2019) believe that the lateral direct approach to the acetabulum is an alternative to the ilioinguinal approach in elderly patients [53]. ...
Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to
improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and
severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the
rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature
sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online
Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration
and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury
is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority
of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and
internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the
classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use
surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications
for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are
still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most
authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average
3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical
approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the
determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures
is the combined anterior and posterior approach.
... [16] TR incision is a surgical approach that should be abondened due to the high incidence of HO and infections. MT incision and its numerous disadvantages are reported in the literature, is not an approach that should be avoided as reported in the literature [8,17] because of leading shortened operational time, low incidence of HO and infections as demonstrated in the present study; also can be used as an alternative to extensile and combined approaches in fragmented, complicated fractures. ...
Background:
This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis.
Methods:
Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19-67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2-8 years) were performed at least for two years were included in this study.
Results:
Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3%of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher's p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461).
Conclusion:
It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.
Objective:
To determine if preoperative administration of venous thromboembolism (VTE) chemoprophylaxis (PPx) prior to pelvic and acetabular fracture surgery affects estimated blood loss (EBL), perioperative change in hemoglobin (ΔHgb), or transfusion rates.
Design:
Retrospective cohort study.
Setting:
Level 1 trauma center, southeastern United States.Patients/Participants": All pelvic and acetabular surgeries performed between 4/2014 and 2/2020.
Main outcome measurements:
EBL, immediate and 24h post-op ΔHgb, and intra-/post-op transfusion.
Results:
In all 267 surgeries were included; 97 pre- and 170 post-change. Median ISS was 17 before vs 14 after the change. One surgeon retired and two started during the study, producing differences in acetabular approaches. Median surgical duration was longer post-change. Cohorts were otherwise similar. No differences were observed in EBL, ΔHgb, or transfusion rates. Rates of VTE and surgical site complications were unchanged. No VTE-related deaths occurred. In the as-treated analysis (63 patients given LMWH <12h pre-op vs 190 patients not given PPx), no differences were observed.
Conclusions:
Administration of VTE PPx within 12h of pelvic and acetabular surgery had no effect on perioperative blood loss. This study is limited by changes in faculty, but it suggests that traumatologists need not advocate for holding VTE PPx before pelvic and acetabular trauma surgery.
Level of evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pelvic resections and hemipelvectomies are infrequently performed procedures mainly indicated for removal of primary malignancies of bone and soft tissue in the pelvis. Hindquarter amputations are also known as external hemipelvectomies, internal hemipelvectomies involve resection of the innominate bone with preservation of the leg, while modified internal hemipelvectomies involve resection of a portion of the innominate bone with preservation of the leg. The most common system used for classifying modified internal hemipelvectomies is a modification of that described by Enneking and Dunham in 1978, where the pelvis is broadly divided into the iliac wing, the periacetabular region, and the pubis. The complex anatomy of the pelvis and the frequent need for concurrent sacral or proximal femoral resection make surgery complex. Adherence to oncologic principles in deciding the appropriateness of limb salvage in planning pelvic resection is paramount. Safe oncologic margins should not be compromised in a bid to save a limb at the expense of poor surgical margins. Resections involving resection of sciatic nerve, femoral nerve, and/or the periacetabular region may result in insensate, weak, and unstable limbs that may leave limb salvage patients with poorer function, and amputations should be considered where two or more of those structures require resection. Complication rates range from 15% to 68% in the literature. Many complications can be anticipated, and they should be promptly managed when encountered. Owing to the complexity of these procedures, appropriate patient selection, careful preoperative planning, use of appropriate adjuvants, anticipation of and prompt management of potential complications, and involvement of other subspecialty colleagues, are all important aspects that should be considered. With these in mind, limb salvage surgery for pelvic sarcoma can be performed safely.
Iatrogenic nerve injury during surgery is a major source of concern for both patients and surgeons. This study aimed to identify the nerves most commonly injured during surgery, along with the commonly associated operative procedures. A literature search was conducted using the PubMed database to identify nerves commonly injured during surgery, along with the surgical procedure associated with the injury. The following 11 nerves, ranked in order with their associated surgical procedures, were found to be the most commonly injured: (a) intercostobrachial nerve in axillary lymph node dissections and transaxillary breast augmentations, (b) vestibulocochlear nerve in cerebellopontine tumor resections and vestibular schwannoma removals, c) facial nerve in surgeries of the inner ear and cheek region, (d) long thoracic nerve in axillary lymph node dissections, (e) spinal accessory nerve in surgeries of the posterior triangle of the neck and cervical lymph node biopsies, (f) recurrent laryngeal nerve in thyroid surgeries, (g) genitofemoral nerve in inguinal hernia and varicocele surgeries, (h) sciatic nerve in acetabular fracture repairs and osteotomies, (i) median nerve in carpal tunnel release surgeries, (j) common fibular nerve in varicose vein and short saphenous vein surgeries, and (k) ulnar nerve in supracondylar fracture surgeries. Although the root cause of iatrogenic nerve injury differs for each nerve, there are four unifying factors that could potentially decrease this risk for all peripheral nerves. These four influencing factors include knowledge of potential anatomical variations, visual identification of at‐risk nerves during the procedure, intraoperative nerve monitoring, and expertise of the surgeon.
Background:
The indications and technique for the transtrochanteric approach to the hip have evolved greatly since its initial popularization in the 1960s. The purpose of this systematic review was to assess current uses of this approach on the basis of indications, osteotomy technique, trochanteric fixation method, complications, and functional outcome.
Methods:
A comprehensive search of MEDLINE and Embase databases from January 2000 to July 2017 was performed in accordance with the PRISMA guidelines. Articles were divided into 3 major categories on the basis of the type of hip surgery performed: (1) primary arthroplasty, (2) revision arthroplasty, and (3) joint-preserving procedures. Patient data were then analyzed according to these 3 categories.
Results:
Seventy-six studies (5,028 hips), mainly of Level-IV evidence, were included. Four types of osteotomy were reported for a variety of indications. Rates of nonunion were 6.0% (303 of 5,028) across all studies, 4.2% (39 of 921) for primary arthroplasty, 6.7% (114 of 1,690) for revision arthroplasty, and 4.4% (56 of 1,278) for joint-preserving procedures. Rates of dislocation were 1.5% (14 of 921) for primary arthroplasty and 4.6% (77 of 1,690) for revision arthroplasty. The rate of osteonecrosis after joint-preserving procedures was 1.1% (14 of 1,278). Rates of deep infection were 1.1% (55 of 5,028) across all studies, 0.1% (1 of 921) for primary arthroplasty, 2.1% (36 of 1,690) for revision arthroplasty, and 0.6% (8 of 1,278) for joint-preserving procedures.
Conclusions:
The transtrochanteric approach remains useful in cases requiring extensile exposure of the acetabulum or femoral medullary canal. However, trochanteric complications continue to pose a clinical challenge.
Level of evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Introduction:
Pelvic fractures are not frequent, yet severe injuries, often associated to other lesions. Well defined diagnostic and therapeutic procedures are lacking, and their economical assessment is inadequate. The goal of this study is to propose the organization of a multidisciplinary center that can develop diagnosis, treatment, and follow up protocols.
Materials and methods:
25 patients were treated from August 2008 to July 2010, 5 women and 20 men, average age 34.5 years. Twenty patients had acetabular fractures (8 posterior wall fractures, 2 anterior column fractures and 10 mixed fractures, Judet and Letournel). Five patients suffered from diastasis symphisis pubis (three patients with a CAP type I, and 2 with a CAP type II, Young-Burgess).
Results:
Average delay between trauma and operation was 15.6 days. Average hospital stay after surgery was 45 days. Five had excellent results, 15 were good, and 4 presented poor results. One patient deceased. Four patients underwent hip arthroplasty 1 year after surgery.
Discussion:
It was essential to identify the collaborating units. The center aims at a uniform and rapid treatment for patients with lesions which are treated differently depending on the department of hospitalization and on the surgeon's experience. The target is to avoid treatment delays, costs and complications. The DRG evaluation grants the highest value to pelvis surgery. This should be followed by dedicated structures that can become reference centers.
Conclusion:
The results can be improved, but considering this is not well known context both clinically and economically, they can be seen positively.
