In a pure transverse fracture, the anterior and posterior columns may be reduced through a single approach. The head of the femur is a ball like bone structure that attaches to the rest of the femur by a section of bone called the. The acetabulum is a cup like socket formed by the connection of the three bones that make up our hip. A patients guide to femoroacetabular impingement fai of.
Pdf controversies in treatment of acetabular fracture. Although simplicity is suggested in its most basic understanding as a containing device for the femoral head, the acetabulum in reality is a complex and elegantly designed structure. The acetabulum is the deep, cupshaped structure that encloses the head of the femur at the hip joint fig. Once the anterior column has been reduced, the posterior column will follow the reduction and can be. Outcome of surgical treatment for displaced acetabular fractures. A surgical approach will be selected with the expectation that. More importantly, how the hip capsule is managed during surgical interventions. The computed tomographic ct and conventional radiographic appearances of the acetabulum are correlated for assessment of acetabular fractures according to the judet and letournel classification system, a system widely used by orthopedic surgeons performing fracture reduction and external fixation of the acetabulum. To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. Judet preface to the french edition it is a long time since we first attempted surgical treatment of fractures of the acetabulum accompanied by displacement, with the aim of restoring perfect articulation. After dislocation of the left femoral head, the acetabular.
The acetabulum is reamed to the correct size using the offset reamer fig. Preop left and postop right radiograph of the patient with goodexcellent result. Often the result of a traumatic incident such as a motor vehicle accident or a bad fall, pelvic and acetabular fractures require rapid and precise treatment and, in some cases, one or more surgical procedures. The ao and synthes took this into consideration in developing the pelvic implant and instrument sets. Acetabulum a deep semispherical socket cavity in the lateral surface of the hip, with which the femoral head articulates, located at the convergence of the ilium, ischium, and pubis. The shells are available in sizes 48mm80mm, and offer the option of alumina ceramic or crossfire or x3 polyethylene inserts.
The acetabularquadrant system provides the surgeon with a simple intraoperative guide to the safe transacetabular placement of screws during primary and revision acetabular arthroplasty. Orthopedics abstractmetastatic involvement of the pelvis, and in particular the acetabulum, is a common finding among patients with metastatic osseous disease. Fractures of the pelvis and acetabulum by marvin tile 1. The deformations and stresses acting on the acetabular rim have not been very precisely documented. Fractures of the pelvis and acetabulum by marvin tile. Surgical approaches to the acetabulum and modifications in t.
Significant potential post operative complica tions. Only the cutting edge spherical reamer should be used to prepare the acetabulum for trident acetabular components. The ilium forms the upper boundary, providing a little less than twofifths of the structure of the acetabulum. It is a ball and socket joint, with the femur top of the leg bone sitting inside the acetabulum hip socket. Surgical approaches for fractures of the acetabulum part 2. Surgical dislocation of the hip is rarely undertaken. Pdf surgical dislocation of the adult hip a technique.
When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged. Men are affected by camtype impingement more often than. The primary landmark of the hip and acetabulum is the anterior superior iliac spine asis. We aimed to present a surgical landmark that is located in close proximity to the usual location of labral pathology as an alternative to the midpoint of the transverse acetabular ligament as a reference point. The acetabulum contains anterior and posterior walls or rims but is open inferiorly as the acetabular notch fig 2, movie 1. Acetabulum fractures pelvic ring fractures sacrum fractures ilium fractures. Michael nogler, in surgical treatment of hip arthritis, 2009. Exposure of the acetabulum is accomplished by placing the leg back on the table in slight flexion and external rotation. Surgical anatomy of the pelvic vasculature, with particular. Refer to table 1 for insert and shell compatibility and sizing options.
Click download or read online button to get surgical exposures in orthopaedics book now. The acetabulum is functionally comprised of two columns anterior and posterior and two walls anterior and posterior. But most of the time, it occurs by itself and is the main problem. Hip pathology requiring surgical intervention varies from osteoarthritis to oncologic diseases. Xrays of acetabular fractures are taken from a number of different angles to show the pattern of the fracture and how out of place the bones are displacement. The purpose of this study was to qualitatively and quantitatively describe arthroscopically relevant anatomy of the acetabulum. Surrounding the adult acetabulum are several boney landmarks that can be used internally and externally as a guide for the position of the native anatomy. Outcome of surgical treatment for displaced acetabular. To obtain optimal component positioning in the reaming process, a 4520 abductionanteversion alignment guide can.
Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. Excision of the labrum and osteophytes allows for proper visualization of the bony anatomy and improves ease of. Anatomy of the acetabulum the adult acetabulum contains components of the ilium, ischium, and pubis, which together form the innominate bone 5. This clarity also helps in selecting the surgical approach.
We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. The hip joint is a ball and socket joint that not only allows flexion and extension, but also rotation of the thigh and leg figure 1. Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. The acetabulum is the socket of the ballandsocket hip joint. Contributing a little more than twofifths of the structure is the ischium, which provides lower and side boundaries to the acetabulum. Hip joint capsular anatomy, mechanics, and surgical. These fracture types can easily be remembered by recalling the basic functional anatomy of the acetabulum. This socket meets with the femoral head of the femur bone to form the hip joint. Elementary fractures involve a single wall, involve a single column, or are purely transverse. Such treatment demands an exact reconstitution of the anatomy of the acetabulum and pelvic bone. However, before surgical intervention on a fractured acetabulum can be accepted as a means of treatment, accurate diagnosis based on radiology is essential. Once the anterior column has been reduced, the posterior column will follow the reduction and can be palpated indirectly. Acetabulum definition of acetabulum by medical dictionary.
Surgical approaches for fractures of the acetabulum. Jul 26, 20 this becomes important when choosing a surgical approach to the acetabulum. In order to treat these injuries successfully, the surgeon must be welltrained andor have some years of experience as a pelvis specialist workshop or specimen lab training is. After examination of the plain films as well as the ct scan the surgeon should be knowledgeable of the precise anatomy of the fracture he or she is dealing with. Because of the complex anatomy of the pelvis, a ct scan is commonly ordered for acetabular fractures. Pelvis and acetabulum orthopaedic trauma association ota. Learning hub for surgical training and assessment for residents.
The three bones are initially separated by a yshaped triradiate. A patients guide to femoroacetabular impingement fai of the hip sometimes camtype impingement occurs as a result of some other hip problem e. Hip joint capsular ligaments serve a fundamental role in balancing functional mobility and joint stability. May 10, 2016 the 3d ct virtual model and 3d print life size models of fractures acetabulum also need the basic understanding of the fracture anatomy and are helpful only when such clear understanding is present. Breaks in the pelvis or acetabulum of the hip joint are among the most serious injuries treated by orthopedic surgeons. Surgical anatomy of the pelvic vasculature, with particular reference to acetabular. Within this framework, acetabular fractures are classified into two broad categories.
The purpose of the present study was to evaluate the complications and functional and radiological outcomes of our anterior surgical approaches modified stoppa and ilioinguinal in displaced fractures of the acetabulum. Pelvic vascular injury is a serious complication associated with acetabular component setting with screw fixation in cementless. An understanding of hip anatomy and, in particular, the potentially dangerous neurovascular structures that are avoided in most exposures, must be understood to help avoid complications that may thwart an otherwise safe surgical procedure. Pre op right and postop left radiograph of years old boy who was operated 68 days after polytrauma injury.
It combines aspects of approaches which have been reported previously. Surgical management of fracture of acetabulum 76 p j m h s vol. The hip joint is a ball and socket joint that not only allows flexion and extension, but also rotation of. Modified stoppa approach for surgical treatment of acetabular. Apr 09, 2016 medical imaging anatomy course rego now open. An anatomical study of the acetabulum with clinical. This study is aimed to concentrate on the outcome of surgical treatment for displaced acetabular fracture in the local setting. Pdf surgical anatomy of the pelvic vasculature, with particular. Preop and postop xrays were done in all patients under going acetabular surgery with follow up for 24 months. Materials and methods this is a retrospective clinical study 30 patients in the orthopedic department, hospital sultanah bahiyah. Pinnacle hip solutions polyethylene surgical technique depuy synthes joint reconstruction 9 femoral neck osteotomy perform a femoral neck osteotomy based upon the protocol for the selected femoral prosthesis figure 7. The three bones are initially separated by a yshaped triradiate cartilage that begins to fuse after puberty. The surgical approaches and operative techniques described on the pages to follow are for the treatment of complex injuries to the pelvis structures.
Surgical exposures in orthopaedics download ebook pdf, epub. Your digital gateway to expertise, education, and innovation. Excision of the labrum and osteophytes allows for proper visualization of the bony anatomy and improves ease of reaming. Radiographic evaluation, anatomy and classification of acetabular fractures v05. A surgical approach will be selected with the expectation that the entire reduction and fixation can be performed. It is interesting to note that the acetabulum is formed by a combination of all three bones of the pelvis. Heavily lined with articular cartilage, it is the only part of the acetabulum that normally contacts the femoral head. This landmark lies superior and just lateral to the acetabulum in the coronal plane. Elementary fractures include wall, column, and transverse fractures.
Pelvic fracturesacetabular fractures hospital for special. This site is like a library, use search box in the widget to get ebook that you want. After a trial, the curved cup impactor is used to site the cup in place fig. Published studies of the human hip make frequent reference to the normal pelvis and acetabulum. The posterior area of the acetabulum, excluding its central portion, appeared to be the safety zone for acetabular screw fixation in japanese cadavers. Surgical approaches for fractures of the acetabulum part 1 v05. All three bones of the pelvis the ilium, ischium, and pubis together form the acetabulum. Trident acetabular system psl surgical protocol figure 3 45 figur e 2 step 3a. Acetabulum fractures archives trauma international. Pdf acetabular anatomy and the transacetabular fixation. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided.
For example, the bone can break straight across the socket or shatter into many pieces. If screws are placed or the locking screw is inserted, a flexible screw driver is used. Department of orthopedic surgery, eulji university hospital, eulji university college of medicine, daejeon, korea. Hip slowly flexed past 90 with progressive manual force. With attention to detail and a fundamental knowledge of periacetabular anatomy, these complications can usually be avoided. A more detailed account of pelvic anatomy is best found in anatomy texts 1. Aug 19, 2019 the modified stoppa approach ensures access to the medial wall of the acetabulum, quadrilateral surface, and internal pelvis. The surgical approaches and operative techniques described on the pages to. Surgical anatomy of the pelvic vasculature, with particular reference to acetabular screw fixation in cementless total hip arthroplasty in asian population. One with a locking screw that is independent of the provisional liner fig. However, other than qualitative descriptions we found no clinically applicable published references describing a normal pelvis and acetabulum. The lunate surface is the horseshoeshaped articular superior surface of the acetabulum. The perforate acetabulum is a cupshaped opening on each side of the pelvic girdle formed where the ischium, ilium, and pubis all meet, and into which the head of the femur inserts. Pdf acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture.
Surgical approaches to the acetabulum and modifications in. Normal acetabular anatomy for acetabular fracture assessment. Surgical approaches to fractures of the acetabulum. Surgical exposures in orthopaedics, 3e was highly commended in the orthopaedics category of the 2004 bma book competition. Pdf an interactive surgical planning tool for acetabular fractures. Jul 22, 2008 published studies of the human hip make frequent reference to the normal pelvis and acetabulum. Each approach has its limitations, and the potential morbidity associated with these exposures can be daunting.
Surgical exposures in orthopaedics download ebook pdf. The 3d ct virtual model and 3d print life size models of fractures acetabulum also need the basic understanding of the fracture anatomy and are helpful only when such clear understanding is present. First revised by rafael neiman, md and sean nork in 2007. Pdf surgical anatomy of the pelvic vasculature, with. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur the acetabulum is a cavity situated on the outer surface of the hip bone, also called the. Although the anatomy of hip capsular ligaments has been well described in the literature 14, the knowledge of its characteristics and contributions toward hip mechanics and disease processes are evolving. Pelvic vascular injury associated with acetabular screw fixation is one of the serious complications of cementless total hip arthroplasty tha. Such treatment demands an exact reconstitution of the. Acetabulum, showing the cupshaped cavity a, and its articulation with the femur b. There are three bones of the os coxae hip bone that come together to form the acetabulum.
Insert the ball hex driver into the hole in the strike plate of the straight handle or the hole at the distal tip of the curved handle and turn to advance the threaded shaft until the threads are exposed figures 10 and 11. Outcomes of surgical management of acetabular fractures. The modified stoppa approach ensures access to the medial wall of the acetabulum, quadrilateral surface, and internal pelvis. Rehabilitation guidelines for surgical hip dislocation the hip joint is composed of the femur the thigh bone and the acetabulum the socket which is from the three pelvic bones. Surgical exposures of the acetabulum are complex and require significant skill and indepth knowledge of pelvic anatomy. This becomes important when choosing a surgical approach to the acetabulum. As in other conditions, classification also aids in the accurate understanding of these sometimes complex fractures. Hip joint capsular anatomy, mechanics, and surgical manageme. The lunate surface is the horseshoeshaped articular superior surface of the.
The hip joint, or acetabulum, is responsible for many movements including walking, bending and crouching. It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular. Trident tritanium acetabular system surgical protocol. The complex anatomy of the pelvic ring and acetabulum involve complex surgical exposures and demands exact anatomical reduction to achieve positive functional results.
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