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Introduction: Displaced acetabular fractures in the elderly present significant treatment challenges. The 'fix and replace' concept involves open reduction and internal fixation of the acetabulum, providing bony stability to accept the press-fit of an acetabular cup, with a cemented femoral stem. This allows early mobilisation and the advantages this confers. This study of 57 patients treated with fix and replace describes our technique, outcomes, and survival analysis.Methods: A retrospective review of 57 'fix and replace' procedures in patients aged over 60 was performed. Data was collected on mechanism, fracture type, demographics, time to surgery, comorbidity index, complications, EQ-5D and Oxford hip scores (OHS). Radiographs were reviewed for fracture healing, implant loosening, cup migration, and heterotopic ossification.Results: 57 patients aged 60 to 95 had fix and replace surgery. The median ASA score was 3. The mean Charlson Index was 4.8. 45 patients had a low-energy fall, 6 had a road traffic accident, 3 fell off a bicycle, and 1 mechanism was unclear. The fracture patterns were anterior column posterior hemitransverse (67%), associated both columns (9%), posterior column (9%), posterior column and posterior wall (9%), and transverse (2%). The mean time to surgery was 8.4 days (0-14). 26 out of 57 (46%) received a blood transfusion. Mean length of stay was 17.6 days (7-86). The mean follow-up was 35.5 months. 4 dislocations were treated with closed reduction, whilst 1 required excision arthroplasty. 2 infections resolved with debridement, antibiotics, and implant retention (DAIR), whilst 1 required a two-stage revision. 1 acetabular component had migrated requiring revision. The median pre-injury OHS was 44 (26-48) compared to 37.3 (28-48) at 1 year. There were no deaths at 30-days, whilst at 1 year 7 patients had died. Kaplan Meier survival analysis showed mean survival was 1984.5 days. Implant survival was 90% at 1 year.Conclusion: While fix and replace is conceptually attractive, this medically complex patient group requires considerable support peri‑ and post-operatively. Further studies are required to provide clinicians with more information to decide on how best to provide a holistic management strategy for such injuries in this frail patient cohort. [ABSTRACT FROM AUTHOR]

Objectives: To explore the morphological pattern of T-shaped acetabular fractures (T-SAFs) by mapping the fracture line using 3D software.Material and Methods: We retrospectively reviewed 1298 consecutive patients with acetabular fractures, and a total of 56 T-SAF patients were enrolled. After the simulated reduction of each fracture in the software, the fracture lines of all patients were overlaid and plotted on a template. A frequency heat map was generated according to the differences in fracture line density distribution. According to the location of fracture lines, all cases were divided into three groups: posterior group, anterior group, extra-posterior group. In surgically treated patients, the surgical approach, fixation methods, and reduction quality were recorded or evaluated.Results: The transverse fracture line was sinuous without involving the acetabular roof, and the longitudinal fracture line sloped forward or backward along the edge of the acetabular fossa to split the obturator foramen. The anterior and posterior edges of the acetabular fossa, the transition zone of the acetabular roof and anterior wall, the transition zone of the superior pubic ramus and anterior wall, and the posterior wall near the greater sciatic notch were areas with high rates of fracture incidence. The posterior group included 26 patients (46.4%) and the distribution of fracture lines resembled a "T" or "Y". The anterior group included 25 patients (44.6%) and the distribution of fracture lines resembled a "7″. The extra-posterior group included 5 patients (8.9%) and the fracture lines run through the ischial body. The surgical strategies vary among different groups of T-SAF patients.Conclusion: Our findings shed light on the characteristics of fracture lines for T-SAFs and provide a reference for surgical treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Acetabular fractures are among the most complex orthopedic injuries, and their treatment and understanding have evolved remarkably in the last 50 years. Several factors affect the reduction quality of the surgically treated displaced acetabular fractures. Thus, this study aimed to identify these factors by analyzing patients' data.Patients and Methods: Retrospective data from fractures operated in one center over 8 years were analyzed. Patients with a mature skeleton who underwent open reduction and internal fixation and had a minimum follow-up period of 6 weeks were included. Non-displaced fractures were excluded from the study. Radiographic assessment of the reduction was performed before surgery and at follow-up using the method described by Borelli et al. The effects of age (<40 or >40 years), sex, initial displacement (< 20 mm or > 20 mm), time to surgery (<14 days or>14 days), fracture pattern (elementary or associated), number of associated fractures (< 3 or > 3), and associated pelvic injury were analyzed RESULTS: The study included 115 (83.9%) men and 22 (16.1%) women, with a mean age of 34.1 years (range 16-74 years). In the sixth week of follow-up, reductions were satisfactory in 96 (70.7%) patients and unsatisfactory in 41 (29.3%). The most prevalent patterns were the posterior wall (23.1%) and both column (15.7%). Linear regression showed that residual displacement was directly correlated with initial displacement (p = 0.027) but without association with reduction quality. Age, sex, and initial displacement had no effect on reduction quality, which is in contrast with longer time to surgery (p = 0.004), associated fracture pattern (p = 0.002), three or more associated fractures (p = 0.001), and presence of associated pelvic injury (p = 0.021).Conclusion: Attempting to shorten the time to operate the fractures can lead to better results for patients because the other factors associated with poor reduction are inherent the trauma and cannot be modified by the surgeon. [ABSTRACT FROM AUTHOR]

Aims: The acetabular morphology varies greatly among individuals, and hypoplasia is more common in Asia than in Europe. Dislocation after bipolar hip arthroplasty (BHA) for femoral neck fracture occurs at a constant rate, and is affected by the acetabular morphology. This study aimed to clarify individual differences in the acetabula of Asian patients with displaced femoral neck fractures.Patients and Methods: Fifty patients with displaced femoral neck fractures were assessed (50 fractured hips, 50 non-fractured hips). On CT corrected by the anterior pelvic plane, the 100 hips were assessed regarding acetabular coverage (six parameters), acetabular depth (two parameters), and acetabular opening angle (four parameters). Additional parameters related to the fracture and sex were examined. The percentile of each parameter was shown for all hips.Results: There was no patient with hip dysplasia defined as superior acetabular sector angle (SASA) less than 110° Compared with men, women had a significantly smaller anterior acetabular sector angle (AASA) (p = 0.016), and significantly larger acetabular inclination angle (p = 0.006) and acetabular index angle (p = 0.034). In the group with a normal SASA, seven hips (7.3%) had an anterior wall defect (AASA<50°) and five hips (5.2%) had a posterior wall defect (posterior acetabular sector angle<90°).Conclusion: Older adults with femoral neck fractures can have anterior wall and posterior wall defects, even if their SASA is normal. Hidden acetabular dysplasia may be related to post-BHA dislocation. So, our results suggest that is important to accurately evaluate the acetabulum of patients with femoral neck fracture before surgery. [ABSTRACT FROM AUTHOR]

We present a minimally invasive direct posterior, gluteal muscle splitting approach (PMS) as an alternative to the traditional Kocher-Langenbeck (KL) approach for posterior access to acetabular fractures. We believe it offers significant advantages and provides improved access while maximizing the range of fracture patterns that can be addressed through a posterior approach. One hundred and eighty-four consecutive patients treated with this approach by the senior author (RMS) between 2001 and 2018 were reviewed. The most common individual fracture pattern addressed was a posterior wall (66/36%) but more complex combination fracture types were the dominant group (106/58%), and included transverse with posterior wall, posterior wall / posterior column, and T types. A radiographically congruent reduction was consistently obtained at surgery, without any operative sciatic nerve palsies and a comparable heterotopic bone formation rate to previous reports. We have reviewed all 120 patients who were followed beyond 6 months and noted the hip replacement conversion rates to be different with each fracture type. The rate was highest with Transverse/ posterior wall injuries (36%), 16% of the posterior wall injuries were converted, a history of dislocation was not specifically associated with conversion. We believe this approach improves the posterior access to the acetabulum, but this study also confirms the poor prognosis of specific groups of higher energy multi-fragmentary, posterior acetabular injuries and suggests the need for a classification system that better predicts the prognosis for the hip joint. LEVEL OF EVIDENCE: 4. [ABSTRACT FROM AUTHOR]

• Posterior wall acetabular fractures of intermediate size remain a treatment conundrum, often requiring EUA to determine fracture stability. • Clinical care would be improved if surgical necessity could be determined without this intervention. • In this study, a novel CT-based measurement system is used to characterize acetabular geometry and its influence on fracture stability. • Unstable fractures have a statistically significantly more cranial fracture exit point, a lower percentage of femoral head coverage. • Fracture size, classic indices of dysplasia, and acetabular morphology did not help with distinguishing between stable and unstable fractures. Traumatologists are unable to predict hip instability based on CT scans and standard radiographs in posterior wall (PW) fractures comprising <50–60 % of the wall, necessitating an examination under anesthesia (EUA). Risk factors for instability have not been clarified, but acetabular dysplasia has been theorized as a potential etiology. Unfortunately, dysplasia is difficult to evaluate in the traumatic setting. The purpose of this study was to compare acetabular morphology between unstable and stable fractures with a novel method to detect dysplasia. Patients ≥ 18 years old with a PW fracture that underwent an EUA from 2013 to 2023 were retrospectively identified. For our experimental measurements, the axial distances on CT between the acetabular dome, lateral acetabular opening, and femoral head vertex were recorded. Acetabular geometry was quantified at these levels. Conventional dysplasia metrics (e.g., Tonnis angle) were obtained. Variables were compared between stable and unstable fractures. 58 patients met inclusion criteria with 42 stable versus 16 unstable fractures. Unstable fractures had higher distances between the acetabular dome and femoral head vertex (p > 0.05). They had more cranial fracture exit points (p = 0.0015), lower femoral head coverage (p = 0.0102), and lower posterior acetabular sector angles (p = 0.0281). No other differences in acetabular geometry, demographics, injury characteristics, or other markers of dysplasia were identified. Unstable hips demonstrated a more recessed acetabular dome when compared to stable hips. Posterior acetabular femoral head coverage and cranial fracture exit point may be related to hip instability. A larger sample size is needed to validate these findings. [ABSTRACT FROM AUTHOR]

• We anatomically investigated an approach in which the skin incision is made directly above the dorsal column of the acetabulum. • The area from the greater sciatic notch to the base of the ischial tuberosity could be exposed using this approach. • An 8-hole plate could be placed from the gluteal ridge to the base of the ischium through a 9.3 ± 0.7 cm skin incision. • This approach can be a useful minimally invasive approach for acetabular fractures. In this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens. Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed. Mean skin incision length was 9.3 ± 0.7 (range, 8.0–10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases. We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures. [ABSTRACT FROM AUTHOR]

The ideal timing of acetabular fractures fixation remains contentious. Early immediate fixation was thought to increase the surgery duration and blood loss while facilitating earlier mobilization and shorter hospital stay; and vice versa for the late fixation after 7 days. The purpose of this review was to compare the impact of early (defined as within 48 hours) versus later definitive fixation of acetabular fractures on postoperative outcomes. It was found that early surgical treatment has certain advantages with regards to blood loss, operative time, and LOS especially in patients with lower ISS. However, further studies are necessary to provide more evidence in terms of long-term outcomes. [ABSTRACT FROM AUTHOR]

Fractures of the pelvic ring and acetabulum generally result after high energy trauma. Pelvic fractures, especially, are considered complex injuries from a therapeutic point of view, in relation to the frequent coexistence of skeletal and / or parenchymal lesions affecting other areas, and the abundant bleeding invariably associated with the latter. The systematic study of these injuries, starting from the 1950s, has led to a significant prognostic improvement, while generally remaining a non-negligible degree of disability. The knowledge of the characteristics of the lesions and of the classification systems, as well as an accurate assessment of the anatomo-functional repercussions, represent therefore the fundamental prerequisites for the correct assessment of physical damage. Herein, we aim to examine whether the medico-legal assessment parameters of physical damage being used in Italy and Europe are appropriate and consistent with the complexity of similar injuries. [ABSTRACT FROM AUTHOR]

Background: Surgical hip dislocation has been described as an excellent method for reduction and fixation of acetabular fractures. It allows a 360-degree access to the acetabulum and acetabular dome. However, reproducibility of this technique is still a concern. The primary outcome of this study was to investigate the short term functional and radiological outcome with the use of surgical hip dislocation in acetabular fractures. The secondary outcome was to describe different indications and methods of reduction using this technique.Methods: This is a retrospective consecutive case series for the use of surgical hip dislocation in acetabular fractures. Between July 2013 and February 2017, we used this technique to manage 36 cases of acetabular fractures. Two patients were lost to follow up leaving 34 patients eligible for the study. All surgeries were done by a 5-years and a 10-years' experience surgeons in pelvic and acetabular trauma surgeries. Through Gibson approach, we used the technique of surgical hip dislocation as described by the Bernese group. Different methods of fracture reduction were used. Intraoperative grading of cartilage injury was done using Disler's grading system. Postoperative fracture reduction was evaluated using the criteria described by Matta. Clinical evaluation was done using the modified Merle d'Aubigne ́ and Postel system.Results: The mean intra-operative blood loss was about 700 ± 35.4 ml. The mean units of blood transfused were 1 ± 0.1 unit. The mean surgical time was 135 ± 11.7 minutes. Anatomical reduction was achieved in 27 patients (79.4%). At a mean of 30 ± 16.8 months (median = 26 and IQR 22) follow up, the functional score was excellent in 5 (14.7 %), very good in 8 (23.5%), good in 9 (26.5%), fair in 2 (5.8%), and poor in 10 (29.4%) patients. Four patients (11.7%) developed AVN at a mean of 8 months postoperatively. Conversion to THA was done in 5 patients (14,7%). Trochanteric osteotomy showed osseous healing in all cases. No patient developed nerve injury or infection. One patient developed severe (grade III) heterotopic ossification.Conclusions: Besides the indications of surgical hip dislocation mentioned before as reduction of the anterior column in T and Transverse fractures, associated femoral head fractures, intraarticular fragments, and labral injuries, it can be used in other indications as entrapped posterior wall, roof impaction, pure impaction injuries and cranial extension of the posterior wall fractures. The technique is reproducible; however, the learning curve is steep and needs to be performed by experienced acetabular trauma surgeons. [ABSTRACT FROM AUTHOR]

Background: Delayed presentation of pelvic-acetabular fractures is a common scenario in developing countries and there is usually a delay of more than 24 h in their presentation.Objectives: We aim to comparatively analyse early(<24 h) versus delayed (>24 h) thromboprophylaxis with low molecular weight heparin (LMWH) in prevention of deep venous thrombosis (DVT) in Pelvic Acetabular fractures.Methods: Patients of pelvic-acetabular fractures who presented during 1 year of study period were divided into 2 groups after exclusion of patients with contraindications for thromboprophylaxis. Group A included patients who received LMWH prophylaxis within 24 h of injury. Group B included patients who received LMWH prophylaxis after 24 h of injury. All patients underwent CT venography at day 14 and were followed up with doppler ultrasound on 4th and 8th week.Results: 110 patients with pelvic-acetabular fractures were included after exclusion of 61 patients. 4 out of 29 patients in group A (13.8%) and 12 out of 81 patients (14.8%) in group B developed DVT. There was no significant difference in incidence of DVT between Group A and B (P value-0.893).Conclusion: There was no difference between early and delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma. [ABSTRACT FROM AUTHOR]

• The displacement and construct stiffness of two posterior wall buttress plates with a.standard fixation method using conventional and calcaneal plates were compared. • The calcaneal plate group demonstrated better stability along the fracture line after dynamic and static loading conditions. • This study might contribute that calcaneal buttress plates are biomechanically viable options when the fragment was on the acetabulum's superior posterior, inferior posterior, and inferior rim. Increased posterior wall acetabular fractures among older adults, require precise treatment to restore stability to the joint, lower the risk of degenerative arthritis, and enhance overall functional recovery. The purpose of this study was to compare the fixation stability and mechanical characteristics of calcaneal buttress plate and conventional reconstruction plate under different loading condition. Typical acetabular posterior wall fractures were created on twenty synthetic hemipelvis models. They were fixed with calcaneus plate and reconstruction plate. Dynamic and static tests were performed. Displacements of fracture line and stiffness were calculated. After dynamic loading, calcaneus plate fixation has significantly less displacement than the reconstruction plate on the superior posterior wall. Under static loading condition, the calcaneus plate group has significantly less displacement than the reconstruction plate group on the inferior posterior part of the fracture. The average stiffness values of the calcaneus plate group and the reconstruction plate group were 265.16±53.98 N/mm and 167.48±36.87 N/mm, respectively and a statistically significant difference was found between the two groups. The calcaneal plate group demonstrated better stability along the fracture line after dynamic and static loading conditions. Especially when the fragment was on the acetabulum's superior posterior, inferior posterior, and inferior rim, Calcaneal buttress plates offer biomechanically effective choices. [ABSTRACT FROM AUTHOR]

Pelvis fractures are among the most difficult fractures to manage and treat for Orthopedic surgeons. Anatomic reduction is the main goal to reach in the acetabular fractures' treatment. The following study compares clinical outcomes and complications of Ilioinguinal versus modified Stoppa approach in Open Reduction and Internal Fixation (ORIF) of anterior column acetabulum fractures. A comparative analysis on 90 patients undergoing ORIF on acetabular fracture has been performed. Patients have been divided into two groups. The first group was treated by Ilioinguinal approach (n = 48), the second group by modified Stoppa approach (n = 42). The following parameters have been compareted: quality of fragment reduction; operative time; peri‑ and post-operative blood loss; complications; clinical and radiographic outcomes. The modified Stoppa approach has shown a shorter mean operative time (146 min vs 175 min), fewer complications (14/48 vs 6/42), less blood loss both in the perio-operative phase (0.8 Hb pt vs 1.3 Hb pt) than in postoperative one (1.1 Hb pt vs 1.5 Hb pt), a lower rate of nerve, infections and critical complications. On the other hand, the ilioinguinal approach has showed better results in terms of quality of fracture reduction (43/48 patiens with anatomical or near anatomical reduction vs. 37/42). No significant differences concerning vascular lesions, clinical and functional outcomes have been found between the two groups. The modified Stoppa approach results in shorter operative time, less intra-operative blood loss and fewer complications than the ilioinguinal one. Greater anatomic reduction is achieved by Ilioinguinal approach; however, this does not necessarily translate into better clinical and functional outcomes which, overall, are comparable in the two analysed approaches. In conclusion, the modified Stoppa approach is deemed to be a better alternative in treating these fractures. [ABSTRACT FROM AUTHOR]

• Spring-locking plate fixation method demonstrated satisfactory outcomes for treatment of posterior acetabular wall fractures • This technique provides rigid fixation. • Use of variable-angle locking screws minimizes the risk of intra-articular perforations. This retrospective study evaluated the outcomes of variable-angle locking compression plate, mesh plate, or footplate box fixation for posterior acetabular wall fractures. The study included nine patients with unstable posterior acetabular wall fractures who underwent internal fixation with the "spring-locking plate fixation method" between January 2015 and December 2019. Patient demographics, fracture classifications, surgical details, radiological and clinical evaluations, and complications were collected from electronic medical records. Statistical analyses were performed to assess the relationship between preoperative and postoperative dislocations. The mean age of the patients was 46 years, and the majority were men (88.9%). Fracture types included posterior wall fractures and posterior column plus posterior wall fractures. The mean operative time was 246 min and the mean blood loss was 663 mL. The surgical approaches included the Kocher–Langenbeck, Ganz trochanteric flip, and transtrochanteric approaches. Variable-angle locking compression plate mesh plates and footplate box type implants were used for fixation. The mean preoperative dislocation was 23 mm, which was significantly reduced to 1 mm immediately post-operation and at the final observation. The bone fusion rate was 100% and radiological and clinical evaluations revealed favourable outcomes. Complications were minimal, with mild heterotopic ossification observed in four patients. The spring-locking plate fixation method demonstrated satisfactory outcomes for the treatment of posterior acetabular wall fractures. This technique provides rigid fixation. Furthermore, the use of variable-angle locking screws minimizes the risk of intra-articular perforations. Despite limitations such as a small sample size and the absence of a control group, the results suggest that the spring-locking plate fixation method may be valuable in managing these fractures. [ABSTRACT FROM AUTHOR]

Background: Posterior wall fractures are the most frequent and account for up to 25% of all acetabular fractures, open reduction and internal fixation by a Kocher Langenbeck approach is the gold standard for this injury but even with anatomic reduction poor outcomes are higher than expected, The present study proposes a technique for open reduction and internal minimizing soft tissue and periosteal injury through a modified Kocher-Langenbeck and spring plate fixation.Methods: This case series, descriptive, longitudinal study assessed the clinical and functional outcomes of patients with isolated posterior wall fractures of the acetabulum, the study included 24 consecutive patients from January to December 2018 who underwent open reduction and internal fixation with spring plates by a Rotator Sparing Kocher Langenbeck approach RESULTS: Clinical and radiographic assessment at 3 and 12 months using the Harris Hip Score (HHS), Merle d'Aubigné and Postel (MDP) score, and EQ-5D-3L score.Results: Twenty-four patients were included in the study (5 females [20.8%], 19 males [79.2%]; mean age, 33.5 ± 13.1 years; range: 15-64 years). 41.7% of patients were admitted for hip dislocation, with 75% of these presenting a displacement greater than 20 mm; 21% for marginal impaction; 8.3% for acetabular dome involvement; and 25% for femoral head involvement. Based on the HHS, MDP, and EQ-5D-3L scores, the 12-month follow-up showed excellent outcomes in 95.8% of patients, and only one patient presented a poor functional outcome that was associated with posttraumatic arthrosis due to sequelae of femoral head necrosis.Conclusions: Excellent and good outcomes are considerably higher with this technique compared to previous papers in the literature. It is still early to assess femoral head necrosis and osteoarthritis, but these are promising results.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Aims: Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries.Patients and Methods: Of the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.Results: 569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).Conclusion: This is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has been unable to elucidate the exact factors that contribute to hip instability in the setting of posterior wall acetabular fractures. The purpose of this study was to determine the influence of posterior wall fracture fragment size and fracture angle on the stability of the hip joint in a cadaveric model.Methods: Six fresh human cadavers (12 hips) were used. Specimens underwent pre-procedure CT evaluation and were then randomized to one of three groups: posterior wall fragment size (FS) of 15%, 20% and 25%. Osteotomies were performed starting at a fracture angle (FA) of 40°. The specimens underwent an exam under anesthesia (EUA). If the hip remained stable, the fracture angle was increased in 20° increments and re-tested until it became unstable.Results: In the group with a FS of 15%, all hips were stable with a FA of 40°. Increasing the FA to 60° caused all hips to be unstable (subluxation or dislocation). In the group with a FS of 20% and 25%, all hips were unstable with a FA of 40°.Conclusion: In all specimens, a FS of 15% and FA of 40° were stable on EUA. Varying combinations of increasing FS size and increasing FA were all unstable. This study provides data for a CT-based measurement to predict hip instability in the setting of posterior wall acetabular fractures based on FS and FA. More research is required to validate this data in a clinical setting. [ABSTRACT FROM AUTHOR]

Introduction: Up to 25% of acetabular fractures have poor functional outcomes in short-term follow-up. The aim of our study is to analyze predictors related to poor outcome in surgically treated acetabular fractures. Damage to the femoral head cartilage and poor fracture reduction has been reported as predictors to total hip arthroplasty (THA).Material and Methods: retrospective study of 207 consecutive patients with acetabular fractures, over a fourteen-year period. Demographic data, fracture pattern according to AO/OTA, complications related to surgery and predictor variables were analyzed.Results: Analyzing predictor variables, we observed seagull sign, femoral head dislocation, femoral osteochondral damage, acetabular marginal impaction, poor acetabular roof congruency after surgery (p < 0.001) and postoperative fracture congruence (>3mm) (p < 0.023) statistically related to the need of a THA during follow-up. Age (p = 0,98), Sex(p = 0,27), AO-OTA classification (p = 0,10), type of dislocation (p = 0,25), surgical approach (p = 0,57), time to surgery (p = 0,66) and posterior wall involvement (p = 0,06) were not related to THA. Most frequent complication was nerve injury, affecting 22 patients (20.18%). Only seventeen patients (15.6%) needed a THA at an average time of 6 years after initial open reduction and internal fixation.Conclusion: Femoral head damage and dislocation, fracture reduction, and seagull sign were the strongest predictors related to THA after surgical treatment of acetabular fractures. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to analyze and describe the fracture patterns of the acetabular posterior wall based on quantitative measurements of the fracture characteristics.Materials and Methods: Computed tomography images of 51 patients with acetabular posterior wall fractures from an initial cohort of 216 acetabular fractures were imported into a three-dimensional (3D) virtual software. The reconstructed 3D images were utilized to evaluate the following: (i) fracture line mapping on the inner articular and retro-acetabular surfaces, (ii) common zones of fracture and marginal impaction, and (iii) categorization by location and pattern of comminution. The clock-face position was applied for description: the midpoint of the transverse acetabular ligament served as the +180° reference point, and the 0° reference point was set perpendicular to the ligament. The fracture angle on the articular surface was defined as the intersection between the start and end points. The fracture span on the retro-acetabular surface was defined as the ratio of the perpendicular distance, which is between the fracture beak and acetabular rim, to the entire length, which is from the edge to the rim. Quantitative measurements were performed, and the fracture patterns were analyzed. A color scale bar was used to visualize the common and marginal impaction zones.Results: The articular surface mapping of all the cases demonstrated that the average starting point of the fracture line was +6.2° (±12.8°) and the endpoint was 96.7° (±13.3°), and the average fracture angle was 119.6° (±7.6°) with 80.6% of the fragments having angles within 18.7-117°. The retro-acetabular surface mapping demonstrated that the average fracture span was 0.65 ±0.20, and 61.7 % of the fracture lines were located within 0.6 to 0.9. Marginal impaction was found in 21 cases (21/51, 41.2%; range: between +7° and +105°).Conclusion: The fracture maps showed fracture patterns and recurrent fracture zones on the articular and retro-acetabular surfaces. However, there was no remarkable pattern of marginal impaction.Level Of Evidence: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Introduction: Recent large series of patient-reported outcomes after acetabulum fracture are limited, and potentially modifiable risk factors may be unidentified. The goal of this study was to describe patient and injury factors which negatively influence functional outcomes following operative management of acetabular fractures.Methods: 699 patients with acetabular fractures were treated with open reduction and internal fixation (ORIF). Musculoskeletal Function Assessment (MFA) questionnaire was completed after a minimum 12 months post-injury by 283 adults. MFA scores range from 1 to 100 and higher scores represent greater dysfunction. Factors were assessed for potential association with MFA scores, and univariate and multiple linear regression analyses were performed.Results: Survey respondents were more severely injured than non-respondents, with more chest injury (38% vs 22%, p<0.001) and higher Injury Severity Score (19.3 vs 16.8, p=0.003). Patients were 69% male with mean age 44.0 years. Approximately one-third were smokers (31%), while 14% had comorbid diabetes mellitus type II. The majority of injuries occurred during a motor vehicle collision (65%); low-energy mechanisms were rare (4.2%). The most common fracture pattern was isolated posterior wall (23%), followed by transverse/posterior wall (21%). Heterotopic ossification (HO) was noted in 22%: Brooker 1: 29.5%, 2: 23.0%, 3: 32.8%, and 4: 14.8%. Tobacco use (β = 18.4, p<0.001), obesity (β = 0.39, p=0.009), diabetes (β = 8.2, p=0.029), post-traumatic arthrosis (PTA) (β = 5.94 p=0.035), and increasing HO severity (β = 8.93, p<0.001) were independently associated with worse MFA scores. Tobacco use had the strongest association, followed by the severity of HO.Conclusion: In a large series of patient-reported functional outcomes following fixation of acetabular fractures, tobacco use, obesity, comorbid diabetes, PTA, and HO were associated with worse MFA scores. Further study to mitigate HO should be considered.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Objectives: Open reduction and internal fixation of both columns is considered the treatment of choice for displaced anterior column with posterior hemitransverse (ACPHT) fractures in non-geriatric patients. Plate fixation of one column combined with lag screw fixation of the other column allows to decrease operative time and approach-related morbidity compared to conventional both column plating. The aim of this biomechanical study was to evaluate whether single column plate plus other column lag screw fixation confers similar stability to both column plate fixation. Physiological loads were simulated using both the single-leg stance (SLS) as well as the sit-to-stand (STS) loading protocols.Methods: A clinically relevant ACPHT fracture model was created using fourth-generation composite hemipelves. Fractures were stabilized with three different fixation constructs: (1) anterior column plate plus posterior column screw fixation (AP+PCS), posterior column plate plus anterior column screw fixation (PP+ACS) and anterior column plate plus posterior column plate fixation (AP+PP). Specimens were loaded from 50 to 750 N with a ramp of 100 N/s. Fracture gap motion (FGM) and relative interfragmentary rotation (RIFR) between the three main fracture fragments were assessed under loads of 750 N using an optical 3D measurement system.Results: STS loading generally resulted in higher mean FGM and RIFR than STS loading in the AP+PCS and AP+PP groups, while no significant differences were found in the PP+ACS group. Compared to conventional both column plate fixation (AP+PP), PP+ACS displayed significantly higher FGM and RIFR between the iliac wing and the posterior column during SLS loading. No significant differences in FGM and RIFR were identified between the AP+PCS and the AP+PP group.Conclusion: Overall, single column plate plus other column lag screw fixation conferred similar stability to conventional both column plate fixation. From a clinical point of view, AP+PCS appears to be the most attractive alternative to conventional AP+PP for internal fixation of ACPHT fractures. [ABSTRACT FROM AUTHOR]

Transverse and T-type acetabular fractures are high energy fractures that may be associated with a disruption of the pelvic ring. While several studies report upon clinical findings and outcomes associated with combination injuries of the pelvic ring and acetabulum, there are limited reports discussing surgical treatment strategies for reduction and stabilization. Herein we focus on describing reduction and stabilization techniques of transverse or transverse-variant acetabular fractures with an associated ipsilateral partial disruption of the sacroiliac joint. [ABSTRACT FROM AUTHOR]

Background: According to the classification of Judet and Letournel, all double column acetabular fractures will certainly involve the disruption of the quadrilateral plate (QLP). Accurate reduction and reliable fixation of QLP is the key to obtain a normal congruent hip joint and avoid postoperative arthritis. The aims of this study were to assess the biomechanical properties of a novel dynamic anterior plate-screw system (named DAPSQ) and to compare its biomechanical stability with buttress-plate construct.Methods: Double column acetabular fractures involving the QLP were created on cadaveric pelvic specimens and subsequently stabilized with (1) a pre-contoured side-specific DAPSQ titanium plate and 4 quadrilateral screws (Group A) or a 12-hole suprapectineal pelvic reconstruction plate combined with a 9-hole 1/3 tube buttress plate (Group B). These constructs were mechanically loaded on ZwickZ 100 testing machine. Construct stiffness and displacement amounts of the two fixation methods in the condition of dynamic axial loading conditions were measured.Results: As the axial loading force increased from 200 N to 800 N, the longitudinal displacement of each pelvic specimen increased linearly and Group B was found to have significantly higher displacement than Group A (p<0.05). In the 600 N physiological loading, the construct stiffness values of Groups A and B were 139.4 ± 37.4 N/mm and 101±18.3 N/mm, respectively. Group A is 27% stiffer than Group B(p<0.05).Conclusions: In this in vitro biomechanical study, DAPSQ plate and quadrilateral screws fixation of a double column acetabular fracture involving the QLP resulted in a better fixation construct than the traditional suprapectineal pelvic reconstruction plate and 1/3 tube buttress plate fixation. [ABSTRACT FROM AUTHOR]

• The complex acetabular fracture anatomy offers several hazards such as vessel/nerve iatrogenic lesion when treated by percutaneous procedures. • There is a paucity of information on the measurement of the safety anterior column corridor. There are differences between men and women anatomy. • A standard 6.5 mm cannulated screw may perforate cortical bone in up to 35% of the patients. • Preoperative templating of the percutaneous fixation provides safety regarding the diameter of the chosen implant. • A CT scan-based technique to perform measurement of the anterior acetabular column corridor and implant templating is presented. A proper evaluation of the narrowings and length of the anterior acetabular column would offer better predictability and precision for implant insertion in the case of an acetabular fracture. To determine the diameter and length of the safety corridor of the anterior column of the acetabulum in patients with available pelvic computed tomography (CT), analyze the obtained measurements against those of a standard 6.5-mm implant, and verify possible sex differences regarding these measurements. A secondary aim was to develop a method for measurement of the anterior column of the acetabulum based on CT images. In 200 CT scans of hemipelvises we measured the diameter of two areas of narrowing and the length of the safety corridor of the anterior column. The images were submitted to multiplanar reformatting adjusted to a plane orthogonal to the bone corridor, drawn at the level of the superior pubic ramus. Measurement #1 had a mean value of 8.12 (2.27) mm in the overall sample and median values of 9.03 (7.76–10.48) mm in men and 6.77 (5.44–7.19) mm in women. Measurement #2 had a mean value of 7.29 (2.19) mm and median values of 8.23 (7.18–9.82) mm in men and 5.9 (4.65–7.19) mm in women. Measurement #3 had a mean value of 109.53 (13.66) mm in the overall sample and median values of 117.17 (112.9–122.9) mm in men and 100.91 (90.95–111.17) mm in women (p <0.001 all three measurements). Measurement #1 was smaller than 6.5 mm in 22.5% of the patients (of whom 90% were women). Measurement #2 was smaller than 6.5 mm in 35% of the patients (of whom 80% were women). This study proposed an anatomic evaluation of the anterior column of the acetabulum using conventional CT images The areas of narrowing in the anterior column had an average of 8.12 mm at the level of the pubic tubercle and 7.29 mm at the level of the acetabular fossa. The mean length of the safety corridor was 109.53 mm. In 35% of the cases, a 6.5 mm percutaneous screw would have violated the cortical bone of the safety corridor. [ABSTRACT FROM AUTHOR]

• The literature lacks intraoperative landmarks to increase the accuracy for anterior-column screw insertion, preventing misplacement. • The four-step surgical technique is a helpful and effective strategy to achieve the expected goals and avoid complications. • In the majority of patients, the entry point of the drill-bit is exactly in the topography or just lateral the nutrient foramen of the ilium. Antegrade fixation of posterior column fractures of the acetabulum is challenging due to the narrow corridor and risk of screw misplacement. Although both antegrade and retrograde lag screws have been previously described for posterior column fracture fixation, the literature lacks a standardized technique for correct and safe screw placement, especially in an antegrade fashion. This technical note aims to optimize intraoperative images during posterior screw insertion using the antegrade technique, according to predetermined landmarks to save surgical time, decrease radiation exposition, and prevent surgical complications. [ABSTRACT FROM AUTHOR]

Background: Acetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS.Method: An 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually.Results: Advantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method.Conclusion: This novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed. [ABSTRACT FROM AUTHOR]

Surgical management of acetabular fractures is now commonplace for almost all displaced or unstable fractures. Over the last 20 years however, the patient population has aged, and there have been significant changes to safety in motor vehicles and the work-place, and people's activity types and levels have changed. The surgical specialty has also developed with time, and as a result acetabular fracture surgery today is different to 20 years ago. We have repeated a meta-analysis originally published by Giannoudis et al in 2005, to evaluate contemporary aspects of acetabular fracture patients, injury mechanisms, management, complications and functional outcomes. This paper compares data from the last 15 years to that published in 2005. We have analysed a total of 8389 fractures from 8372 patients. The mean patient age has risen from 38.6 to 45.2. A change in injury mechanisms is seen, with road traffic accidents now accounting for 66.5% of cases (previously over 80%), and a rise in the number of fractures caused by falls from 10.7 to 25.8%. There has been a marked change in the fracture types seen, with a significant rise in anterior column-based fractures (Anterior column and Anterior column posterior hemi-transverse), whilst all other fracture patterns have fallen over time. Surgery is now taking place earlier, the Kocher-Langenbeck and Ilioinguinal approaches remain the major surgical approaches used, but the Anterior Intra-Pelvic approach has become relatively common. The most significant change in complications is a substantial drop in iatrogenic nerve damage, particularly to the sciatic nerve. Post-traumatic osteoarthritis remains the major complication of this injury, with 16.9% of cases developing Matta grade III/IV changes by 44 months in this review. Heterotopic ossification also remains a common problem. Despite these changes over time, functional outcomes after acetabular fracture appear to remain similar, although there is still a lack of good quality data on medium and longer-term functional outcomes from which to assess this. [ABSTRACT FROM AUTHOR]

To compare the amount of displacement and rigidity at the fracture line under static & dynamic axial loading and torsional stress of conventional cannulated screw (CS), plate screw fixation including inter-fragmentary screw (PL), and talon cannulated compression device or talon screw in other words (TS) in posterior column fracture models. Synthetic hemipelvis bone models presenting a posterior column fracture were used in this study. Group PL, CS, and TS were created with ten bone models prepared for each group for dynamic and static loading tests and another ten for torsional tests. Rigidity and displacement amounts before and after loading were measured at the reference points AL, BL, and CL, located at the acetabulum's top, middle, and bottom, respectively. Torsional tests for each group were used to calculate torsional rigidity and maximum torque values. In dynamic axial loading tests, Group CS showed more displacement than PL at the BL point (p = 0,032) and Group TS at AL (p = 0,032) and CL (p = 0,004) points. In static axial loading tests, Group CS significantly displaced more than TS at AL and CL points (p = 0,05 and p = 0,014, respectively). Group PL and Group TS exhibited similar behavior in dynamic, static axial loading tests and torsional rigidity. The maximum torque that Group PL could withstand was statistically significantly higher than the other two groups (p <0,001). Talon cannulated screws had promising results in posterior column fractures of the acetabulum, which may decline the need for open surgery for stable fixation. [ABSTRACT FROM AUTHOR]

• TPW fractures independently increase PJI risk after acetabular fracture conversion THA compared to other fracture patterns at 1-year follow-up. • More tests are necessary for indolent septic arthritis as a cause for conversion to improve outcomes after conversion THA in high-risk patients. • Novel management/treatment of TPW patients either at the time of ORIF and/or conversion THA procedure are needed to reduce PJI risk. Acetabular fracture subtypes are associated with varying rates of subsequent conversion total hip arthroplasty (THA) after open reduction internal fixation (ORIF) with transverse posterior wall (TPW) patterns having a higher risk for early conversion. Conversion THA is fraught with complications including increased rates of revision and periprosthetic joint infections (PJI). We aimed to determine if TPW pattern is associated with higher rates of readmissions and complications including PJI after conversion compared to other subtypes. We retrospectively reviewed 1,938 acetabular fractures treated with ORIF at our institution from 2005 to 2019, of which 170 underwent conversion that met inclusion criteria, including 80 TPW fracture pattern. Conversion THA outcomes were compared by initial fracture pattern. There was no difference between the TPW and other fracture patterns in age, BMI, comorbidities, surgical variables, length of stay, ICU stay, discharge disposition, or hospital acquired complications related to their initial ORIF procedure. Multivariable analysis was performed to identify independent risk factors for PJI at both 90-days and 1-year after conversion. TPW fracture had higher risk of PJI after conversion THA at 1-year (16.3% vs 5.6%, p = 0.027). Multivariable analysis revealed TPW independently carried increased risk of 90-day (OR 4.89; 95% CI 1.16–20.52; p = 0.03) and 1-year PJI (OR 6.51; 95% CI 1.56–27.16; p = 0.01) compared to the other acetabular fracture patterns. There was no difference between the fracture cohorts in 90-day or 1-year mechanical complications including dislocation, periprosthetic fracture and revision THA for aseptic etiologies, or 90-day all-cause readmission after the conversion procedure. Although conversion THA after acetabular ORIF carry high rates of PJI overall, TPW fractures are associated with increased risk for PJI after conversion compared to other fracture patterns at 1-year follow-up. Novel management/treatment of these patients either at the time of ORIF and/or conversion THA procedure are needed to reduce PJI rates. Therapeutic Level III (retrospective study of consecutive patients undergoing an intervention with analyses of outcomes). [ABSTRACT FROM AUTHOR]

Introduction: Intra-articular distal humeral fractures involving both columns require double-plate fixation. In orthogonal plate fixation, screws from the medial plate reach the radial column, while screws from the dorsolateral plate run posterior-anterior, not creating interdigitation. The Synthes LCP-DHP system has an orthogonal plate configuration that enables dorsolateral plating with support, as the radial and ulnar columns are linked via interdigitation of the distal screws. We hypothesized that the transcondylar screw from the posterolateral plate, which interdigitates with screws from the medial plate, enables more rigid stabilization of orthogonal plating in distal humeral AO type C fractures.Methods: A previous study reported the biomechanical properties of orthogonal plate fixation using an AO type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap using artificial bones (Kudo et al., Injury, 2016). We performed a biomechanical study of the dorsolateral plate with support, and inserted one 2.7-mm locking screw through the support in the lateral-to-medial direction, creating interdigitation of the distal screws. A 0-200 N axial load was applied separately to the radial and ulnar columns. We calculated the stiffness of both columns, and the anterior displacement of the condylar fragment. We compared the biomechanical properties of orthogonal plating with versus without interdigitation.Results: There were no significant differences between the two groups in radial or ulnar axial compression. The ulnar column was stiffer than the radial column in both groups. There were no significant differences between groups in the angular displacements of the capitellum or trochlea. The capitellum moved more anteriorly than the trochlea during axial compression in both groups.Discussion: The radial and ulnar columns were linked via interdigitation of the distal screws by adding one transcondylar screw from the dorsolateral plate, which did not affect radial column stiffness or capitellar anterior movement under axial compression. In the orthogonal configuration, axial compression induced more anterior displacement of the capitellum than the trochlea, which may induce secondary fragment or screw dislocation on the dorsolateral plate or nonunion at the supracondylar level.Conclusions: The transcondylar screw from the dorsolateral plate did not affect axial compression of the radial column or capitellar anterior displacement. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the long-term clinical outcomes and complications following an acetabular fracture associated with a posterior hip dislocation compared to those without dislocation.Patients& Methods: A retrospective cohort study of 113 patients (mean age 42 (14-95), 77% male) with acetabular fracture dislocations compared to 367 patients with acetabular fractures without dislocation (mean age 54 (16-100), 66% male) treated from 1988 to 2010. Patient characteristics, complications, reoperations, and conversion to total hip arthroplasty (THA) were recorded. Long term patient reported outcomes (Oxford Hip Score and SF-12) were measured at mean follow up 9.7 years (5-26).Results: At long-term follow up 12/113 (11%) patients had died and 22/113 (19%) were lost. Isolated posterior wall fracture was the most common fracture associated with dislocation. Patients with dislocation were more likely to be younger and male with higher Injury Severity Scores (ISS). There was no significant difference in radiographic post-traumatic osteoarthritis development between fractures with and without dislocation (p = 0.246). Sciatic nerve palsy (12% Vs 1%, p < 0.001) and avascular necrosis (AVN) (11% Vs 1%, p < 0.001) were more common when dislocation was present. AVN was associated with increasing age and hypotension on arrival to the emergency department. Ten-year native hip survival was worse following fracture dislocations compared to fractures without dislocation: 75.1% (65.7-84.5 95% CI) Vs 90.7% (87.0-94.4), p < 0.001. Significant predictors of THA requirement were older age, particularly age >55 years at fracture, and increased ISS. Long-term OHS was worse in fractures with dislocations (33.6 ± 13.1 Vs 37.0 ± 14.0, p = 0.016).Conclusion: Acetabular fractures with an associated dislocation have worse long-term functional outcomes with higher rates of complications and conversion to late THA compared to acetabular fractures without a dislocation. [ABSTRACT FROM AUTHOR]

We describe the methodical and possibilities of 3D surgical printing in preoperative planning for a total hip arthroplasty in acetabular deformity after acetabular fractures, showing a case of a 43-year-old with posttraumatic arthritis after both column fracture of the left acetabulum that was treated non operatively, supporting the do it yourself mode. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to biomechanically compare three different fixation methods for the fixation of anterior column posterior hemitransverse type acetabular fracture (ACPHT).Methods: ACPHT fracture models were created on twenty-four foam cortical shell artificial hemipelvis models. Three fixation methods were assessed - Group 1: posterior column lag screws over a suprapectineal plate; Group 2: Posterior column lag screws over a suprapectineal plate and an infrapectineal plate; Group 3: A suprapectineal plate and a vertical infrapectineal plate. Stiffness and displacement amounts of fixation methods under dynamic and static axial loading conditions were measured.Results: In the dynamic and static tests, Group 3 showed the less stable fixation compared to Group 2. There was no statistically significant difference between the stiffness values of the fixation groups. In the static tests, there was no statistically significant difference between Group 1 and 2, although less displacements were obtained in Group 2.Conclusions: A combination of posterior lag screws over a suprapectineal plate and an infrapectineal plate supporting the pelvic brim along both sides of the linea terminalis resulted in a better fixation construct than a suprapectineal plate accompanying with a vertical infrapectineal plate provide better stability with less fracture displacement. [ABSTRACT FROM AUTHOR]

Introduction: Biomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures.Methods: Thirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta's radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset.Results: Fifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12-24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups.Conclusion: Single poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome. [ABSTRACT FROM AUTHOR]

Introduction: The (modified) Stoppa approach for acetabular fracture surgery has gained significant popularity and early results have been encouraging but clinical outcome at extensive follow-up is scarce. The purpose of this study is to provide an update on our experience with this approach for operative treatment of acetabular fractures and to assess clinical outcome at mid-term follow-up.Methods: In this retrospective study, all patients treated operatively for an acetabular fracture using the Stoppa approach over a 10-year period were included. Surgery details were reviewed and patients were contacted and requested to return for follow-up. Primary outcome was native hip survivorship, secondary outcome measures included; functional outcome (Merle d'Aubiginé, Harris hip) scores, health-related quality of life (short-form 36) and radiographic outcome (heterotopic ossification, hip osteoarthritis).Results: Forty-five patients received operative fixation for 47 acetabular fractures using the Stoppa approach. Complications requiring surgical intervention were found in one patient (with a vascular lesion) intra-operatively and 3 patients (with wound infections (2) and diffuse bleeding (1)) post-operatively. Follow-up was 83% and 29/39 (74%) native hips survived at mean 59 months (SD 49) postoperatively. Excellent-good functional scores were found in 88% (Merle d'Aubiginé) and 76% (Harris hip) of patients who had retained their native hip. Most (6/8) short-form 36 indices in these patients were comparable to population norms. Of 29 native hips with radiographic follow-up (mean 59 months (SD 49), 4 (86%) had no-minimal radiographic abnormalities.Conclusion: This study confirms that the Stoppa approach is a safe and effective technique for acetabular fracture fixation. Moreover, at mid-term follow-up, this approach is associated with satisfactory results in terms of hip survivorship as well as functional and radiographic outcome. As such, our findings reinforce the notion that this less invasive technique presents a valuable alternative to the ilioinguinal approach for the surgical treatment of acetabular fractures. [ABSTRACT FROM AUTHOR]

Background: Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures.Methods: We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years.Results: Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre.Conclusion: Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. [ABSTRACT FROM AUTHOR]

Purpose: Information on the incidence of acetabular fractures of the pelvis is limited. Epidemiological data is often based on specific trauma registers, individual trauma centres or on trends of all pelvic fractures grouped together. The primary aim of this study was to determine the incidence and trends of hospital-treated acetabular fractures in the Finnish population from 1997 to 2014. The secondary aim was to assess the trauma mechanisms involved.Methods: The Finnish National Hospital Discharge Register collects inpatient data from all public and private medical institutions in Finland and covers the entire Finnish population of 5.5 million. For this study, we selected all persons 18 years of age or older who were admitted to hospital for the treatment of an acetabular fracture between 1997 and 2014. The main outcome variable was the annual number of patients hospitalised with a main or secondary diagnosis of acetabular fracture of the pelvis.Results: The overall crude incidence of acetabular fractures increased slightly (from 6.4/100 000 persons/year to 8.1/100 000 persons/year) from 1997 to 2014 while the age-standardised incidence rate remained at a similar level (7.1/100 000/persons/year in 1997 and 7.2/100 000/persons/year in 2014). An incidence increase was observed in the elderly population, whereas the incidence of acetabular fractures in the younger population (mostly high energy traumas) remained stable. The most frequent trauma mechanism for acetabular fractures was fall on the same level (47%).Conclusions: The incidence of acetabular fractures increased slightly in Finland between 1997 and 2014. This increase was observed especially in the elderly population and the ageing of the population largely explains the rise. The incidence of acetabular fractures in the younger population decreased. The most common trauma mechanism was falling on the same level. [ABSTRACT FROM AUTHOR]

Background& Objectives: As the overall health and life expectancy increases in the United States, the incidence of fragility fractures in elderly patients also continues to increase. Given their medical comorbidities and decreased bone mineral density, acetabular fractures in the elderly population present a significant challenge to the orthopaedic trauma surgeon. The anterior column posterior hemitransverse (ACPHT) fracture pattern is a common fracture pattern in this population, and is often associated with central subluxation/dislocation of the femoral head with articular impaction. This study sought to delineate the most stable fixation construct in ACPHT fracture patterns in the elderly population.Materials and Methods: The sample consisted of 3 groups of synthetic hemipelves (N=15), which were tested in order to compare stiffness by measuring motion at fracture lines under applied loads. The three groups of unique quadrilateral plate fixation were as follows: a specialty quadrilateral surface plate; 4 long peri-articular screws parallel to the quadrilateral surface into the ischium,; and an 8 hole infrapectineal buttress plate. Digital imaging system measured construct motion under load. Construct stiffness was estimated by linear regression of load between 50 and 850N versus average relative motion (average of relative motion at 200 points along the line of the osteotomy). Permanent deformation was estimated as the magnitude of relative motion upon unloading.Results: Using ANOVA with Tukey's test to determine construct stiffness in loading, the group long peri-articular screws was found to have significantly higher stiffness than either of the other groups. Maximal fracture displacement was located at the intersection of the low transverse fracture line in the posterior column and the free quadrilateral surface fragment.Conclusions: Results indicate that the best fixation construct for this ACPHT acetabular fracture pattern includes independent lag screws across the anterior column and a pelvic brim plate with long periarticular screws maximizing posterior column fixation and preventing medialization of the free quadrilateral fragment. Although there are potential patient considerations that may complicate the placement of all 4 long screws, in most patients one or more of these screws can be safely placed in order to help prevent secondary displacement. [ABSTRACT FROM AUTHOR]

Closed reduction and percutaneous screw fixation (CRIF) of iliac crescent fractures and fractures of the anterior column of the acetabulum has become an established method in the treatment of these injuries. After reduction, safe insertion of a guide wire is a key step during this procedure. We present a technique that can facilitate introducing the guide wire under fluoroscopic guidance and allow for decreased radiation exposure. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the results of open reduction and internal fixation in a large series of posterior wall fractures of the acetabulum and to identify the factors that affect the outcomes in this case series. One hundred twenty-one patients who had undergone open reduction and internal fixation of a fracture of the posterior wall of the acetabulum were assessed at a mean of 53 months (range, 24-163) after surgery. The functional outcome was evaluated with use of the modified Merle d'Aubigne scoring system, the Harris Hip Score (HHS), and the Short Form-36 Health Survey (SF-36) questionnaire. Final follow-up radiographs were graded according to Matta's radiologic criteria. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional and radiographic outcome. The quality of fracture reduction on postoperative radiographs was anatomical in 115 hips (95.0%), satisfactory in 6 cases (5.0%), and unsatisfactory in none. Final modified d'Aubignè scores were excellent in 45 hips (40.2%), good in 52 (46.4%), fair in 7 (6.3%), and poor in 8 (7.1%). Mean HHS was 91.5±8.9 (48-100). The SF-36 scores were similar with respect to age and sex-matched norms, but physical domains in males remained lower in comparison with the normal population. The early reduction of an associated hip dislocation and quality of surgical reduction were strong positive predictors of functional and radiographic outcomes at follow-up, whereas associated injuries and the existence of pre-operative nerve palsy were negative predictors of patients' functionality. This study of surgically treated fractures of the posterior wall of the acetabulum has shown that functional and radiographic results are satisfactory in most patients, provided that prompt reduction of an associated hip dislocation and anatomical reduction of the fracture are carried out. Associated injuries and nerve lesions affect the final functional outcome. [ABSTRACT FROM AUTHOR]

Introduction: Quadrilateral plate fractures constitute one of the most challenging components of acetabular fractures. The objective of this study is to describe and evaluate the novel technique of buttress screw fixation of the quadrilateral plate component of the acetabular fractures.Patients& Methods: Forty cases of acetabular fracture with associated quadrilateral plate component were included in the study. Mean age was 35 years (range, 16-68years), with a mean follow-up 16.4 months (range, 9-36months). Fixation of the quadrilateral plate was achieved by one or more buttress screws. The screws were inserted through the reconstruction plate, and placed close to the edge of the pelvic brim. To effectively achieve the 3-point fixation principle, the screw was inserted through the plate hole then outside the bone rubbing on the pelvic surface of the quadrilateral plate.Results: Anatomical reduction of the quadrilateral plate component of the fractures was achieved in all but one patient. The modified Merle D'Aubigné and Postel score was excellent in 13 cases, good in 23 cases, fair in three cases, and poor in one case. No screw displacement or failures were observed during follow-up evaluation. No major complications related to this technique were observed in this series.Conclusion: Buttress screw fixation of the quadrilateral plate fracture component in associated acetabular fractures is a safe and effective technique for reduction and fixation of these challenging fractures with no major complications related to this novel technique. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only.Methods: We conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D'Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification).Results: The study showed no significant differences in all preoperative variables (P>0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P>0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8±2.5mm (range: 24-35mm), 71.5±5.4% (range: 65-88%), 23.0±2.3mm (range: 17-28mm). The mean posterior wall fracture displacement is 5.0±3.2mm (range: 0-11mm). There was no difference regarding the quality of reduction between the two groups (P>0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P>0.05). There was no difference in rate of complications between the two groups (P>0.05).Conclusions: Lag screws fixation of posterior wall through single ilioinguinal approach in associated both column fractures of acetabulum is a safe and effective method. Our results shown that the presence of posterior wall fracture in cases of associated both column fractures does not compromise the clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility of the use of 3D-printed guiding templates for accurate placement of plates and screws for internal fixation of acetabular fractures.Methods: 3D models of the pelvises of 14 adult cadavers were reconstructed using computed tomography (CT). Twenty-eight acetabular fractures were simulated and placement positions for plates and screw trajectories were designed. Bending module was obtained by 3D cutting; guiding template was manufactured using 3D printing, and the plate was pre-bent according to the bending module. Plates and screws were placed in cadaveric pelvises using the guiding template, and 3D model was reconstructed using CT. The designed and real trajectories were matched using 3D registration including the coordinates (entry and exit points) of designed trajectory. The number of qualified points with different accuracy levels was compared using Chi-squared test.Results: Sixty-four plates and 339 screws were placed with no cortical breach. The absolute difference of the X, Y, and Z coordinates between the designed and real entry points were 0.52±0.45, 0.43±0.36, and 0.53±0.44mm, respectively. The corresponding values for the exit points were 0.83±0.67, 1.22±0.87, and 1.26±0.83mm, respectively. With an accuracy degree ≥1.9mm for the entry points and ≥3.8mm for the exit points, there was no significant difference between the designed and the real trajectories.Conclusion: The 3D-printed guiding template helped achieve accurate placement of plates and screws in the pelvis of adult cadavers. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures.Methods: From July 2007 to April 2014, 47 patients aged over 55 years were treated via the TIMI approach; these patients were included in the present prospective study. The patients' characteristics, data, and early phase of care were assessed during acute care. A radiological evaluation comprised pre- and postoperative CT scans and x-rays, including Judet views at follow-up. Follow-up examinations were performed after 6 and 24 months and comprised a clinical and radiological examination and an evaluation of hip function (Harris Hip Score) and health-related quality of life (EQ-5D).Results: The mean age of the patients was 74±11years, with a gender ratio of 35/12 (m/f). The average operation time was 93±30min, and perioperative blood loss amounted to 858±463ml. In total, five (11%) complications associated with the operative procedure occurred, and revision surgery was necessary in three patients. We observed no wound infections, abdominal wall hernias or cases of heterotopic ossification in our sample. The Harris Hip Score at six months after surgery was 81, and it slightly improved to 84 after 24 months. The mean EQ5D index was 0.91 at six months after surgery and 0.92 at 24 months after surgery.Conclusion: The TIMI approach represents a valuable alternative to the ilioinguinal and modified Stoppa approach for the treatment of acetabular fractures located in the anterior column, which are often observed in geriatric patients.Level Of Evidence: Therapeutic Level II (Prospective cohort study). [ABSTRACT FROM AUTHOR]

Background: The psoas minor partially inserted to the superior pelvic brim. And the plate used to fix the acetabular fracture has always been positioned at the pelvic brim after reduction through the Stoppa approach. However, there are few studies depicting the clinical significance of the psoas minor. The purpose of this paper was to explore the relationship between the insertion of the psoas minor tendon at the pelvic brim (IPMTPB) and screw placement through the Stoppa approach.Materials and Methods: Fifteen cadavers were dissected for adequate exposure to IPMTPB in our study. However, not all specimens had a psoas minor. For the specimens with IPMTPB, the posterior and anterior edges were used as the first and second entry points, dividing the area from the sacroiliac joint to the pubic symphysis into three zones (d1, d2 and d3). The average proportion of each zone was obtained after measurement the three zones, to locate the two entry points for the specimens without a psoas minor. From the longitudinal Stoppa incision, the first wire was inserted horizontally, and the second wire was placed vertical to the bone surface. Fluoroscopy and computed tomography (CT) were conducted to examine the relationship between the wires and the acetabulum.Results: There was a psoas minor in sixteen hemipelvises (53.33%). After measurement and calculation, we determined that the average proportions of zones d1, d2, and d3 were 28.03%, 29.14%, and 42.83%, respectively. For all specimens, the wires were successfully inserted, and the trajectories of the wires were outside the hip joint cavity.Conclusions: IPMTPB could be used as an anatomic landmark of safe zones for screw placement through the Stoppa approach. For cases without a psoas minor, the zones for extra-articular screw placement could be determined through the measurements in this paper. [ABSTRACT FROM AUTHOR]

T-shaped acetabular fractures are challenging injuries. The goal of surgical treatment is to achieve a stable and a concentric reduction of the femoral head under the anatomically reduced weight-bearing dome. There is an ongoing debate about the ideal approach and fixation method for T-shaped fractures. In this study, a group of 34 patients with T-shaped acetabular fractures were treated by posterior plating and anterior column screw. All patients, were followed for at least two years or until hip replacement. The aim of this prospective cohort study was to report the rate of postoperative radiological results together with the early clinical outcome. Anatomical reduction was achieved in 62%, satisfactory reduction of the anterior column with restoration of hip congruency in 82% with excellent to good clinical outcome in 75% of cases. We used classification regression trees (CART) to select the important predictors and generate hypotheses on interaction among them. Residual anterior column displacement >3.5mm was associated with poor clinical results. In cases with residual displacement <3.5mm, the presence of a posterior wall fracture was an independent negative predictor. [ABSTRACT FROM AUTHOR]

Objective: The fluoroscopically-guided procedure of antegrade posterior lag screw in posterior column fixation through anterior approach is technique-dependent and requires an experienced surgeon. The purpose of this study was to establish the safe zone for the antegrade posterior lag screw by using computational analysis.Method: The virtual three-dimensional model of 178 hemi-pelvises was created from the CT data (DICOM format) by using Mimics® program, and were used to measure the safe zone of antegrade lag screw fixation on the inner table of the iliac wing, and the largest diameter of cylindrical implant inside safe zone. The central point (point A) of the cylinder was assessed and was compared with the intersection point (point B) between the linea terminalis and the anterior border of the sacroiliac articulation.Results: The safe zone was triangular with an average area of 670.4mm2 (range, 374.8-1084.5mm2). The largest diameter of the cylinder was a mean 7.4mm (range, 5.0-10.0mm). When height was under 156.3cm, the diameter of the cylindrical implant was smaller than 7.0mm (p<0.001, regression coefficient=0.09). The linear distance between points A and B was 32.5mm (range, 19.2-49.3mm). Point A was far enough away from the well-positioned anterior column plate to prevent collision between the two.Conclusion: The safe zone was shaped like a triangle, and was large enough for multiple screws. Considering the straight-line distance between points A and B, the central screw can be fixed without overlapping with the well-positioned anterior column plate at the point between holes 2 and 3. [ABSTRACT FROM AUTHOR]

Background: In this study we describe the morphology of the posteromedial fragment in pertrochanteric fractures using 3D CT scans and answer two questions 1) Do differences exist between the 3D CT appearances of posteromedial fragments and the depictions made in the AO classification 2) Does the posteromedial fragment affect stability in pertrochanteric fractures, in terms of fracture collapse?Methods: Preoperative CT scans of eight 31-A1 and fifty 31-A2 fractures were analysed. The presence of PM fragment, its fragmentation, greater trochanter (GT) involvement, lesser trochanter (LT) fragment size (in terms of its posterior and medial extent as well as LT length), LT fragment displacement (in terms of medial displacement and rotation) were determined. All fractures were treated with a DHS. Fracture collapse was determined on postoperative radiographs. The relationship between fracture collapse and patient factors including age, gender, fracture type (A1 versus A2), characteristics of the posteromedial fragment, and the presence of a lateral wall fracture were determined.Results: Three out of eight 31-A1 fractures demonstrated a separate GT fragment (three part fracture). Out of the 50 31-A2 fractures, 12 had a single PM fragment, which included the LT and GT in continuity. The more common four part fractures seem to form by further fragmentation of this basic form. In A2 fractures, the GT was almost always broken and the broken fragment comprised a mean 56% of normal GT. The LT fragment involved an average of 74% of the posterior wall, and an average of 36% of the medial wall of the proximal femur. Larger LT fragments were less displaced as compared to smaller fragments. Univariate regression analyses revealed that fracture collapse was significantly correlated with fracture type (A1 versus A2, p 0.036), GT size (p 0.002) and the presence of a lateral wall fracture (p<0.001).Conclusions: This study revealed some important differences between the 3D CT appearances and AO classification of pertrochanteric fractures. Further, neither fragmentation of the posteromedial fragment, nor the size of the lesser trochanter fragment was found to predict stability in pertrochanteric fractures. A perioperative lateral wall fracture is the main determinant of stability in these fractures. [ABSTRACT FROM AUTHOR]

Introduction: Anatomical reduction of displaced acetabular fracture is not without its' limitations and complications. This study is conducted to assess clinical and radiological outcomes as well as complications of treating displaced acetabular fractures with emphasis on anatomical reduction in weight-bearing area, mainly the posterior column, and imperfect reduction of the anterior column is acceptable. However, stability of both columns is mandatory.Methods: It was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36-68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12-38.7 months). Mean operation time was 160min (range: 75-320min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded.Result: 65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported.Conclusions: Imperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities. [ABSTRACT FROM AUTHOR]

Background: Trochanteric osteotomies are performed in conjunction with standard approaches to improve surgical exposure during open reduction and internal fixation (ORIF) of acetabular fractures. The literature on total hip arthroplasty reports nonunion rates as high as 30% associated with trochanteric osteotomies; however, few data exist regarding the outcomes of trochanteric osteotomies for acetabular fracture surgery. Our hypotheses were 1) patients receiving trochanteric osteotomies during ORIF of acetabular fractures have a low rate of nonunion of the osteotomy fragment, and 2) hip abduction precautions are not necessary with digastric type osteotomies.Patients and Methods: A retrospective review was conducted to identify patients with acetabular fractures between July 2002 and June 2010 (n=734 fractures) who required trochanteric osteotomies (n=64, 9% of fractures). Forty-seven met inclusion criteria of adequate follow-up (>56days). No excluded patient experienced a complication. Fractures were classified using the Letournel-Judet classification system.Results: Only seven (20%) of 35 patients who received digastric osteotomies had hip abduction precautions applied during the postoperative period. All study patients were shown to have radiographic union at the trochanteric osteotomy site (100% union rate, n=47). Hip abduction precautions intended to protect the osteotomy site and reduce the risk of nonunion and fixation failure were infrequently applied to patients with digastric osteotomies (20%) in this cohort. Multiple protective factors against nonunion were present in this study population compared with previous arthroplasty studies from other institutions.Conclusions: Trochanteric osteotomies are not associated with a significant nonunion rate, and digastric osteotomies might be safely managed without hip abduction precautions. [ABSTRACT FROM AUTHOR]