Corrigendum to "Delayed presentation of complex acetabular fractures: Review of literature on outcome of internal fixations with reference to extended ilio-femoral approach" [J Clin Orthop Trauma 11(6) (2020) 1082-1089].
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SUBMITTER: Das CP
PROVIDER: S-EPMC8122388 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveDelayed presentation of complex acetabular fractures isn't uncommon. Surgical treatment of such fractures demand special consideration with respect to surgical approach, reduction techniques, fixation and avoidance of complications. This paper intends to review the literature with regard to the suggested treatment modalities and the reported outcome in late presentations and conclude any recommendations appropriate to the practice in current times.BackgroundDisplaced fractures of acetabulum, when remained untreated for more than three weeks, pose significant challenge to fracture reduction due to rapid callus formation. In 1976, Letournel described the "Extended Ilio-Femoral Approach"(EIFA) to provide adequate exposure for effective reduction of such fractures. It offered greater exposure of both anterior and posterior columns through a single window, which allowed more precise and controlled reduction of the complex fractures under vision. But despite early enthusiasm in its practice, there has been a steep decline in its application due to reported higher risk of complications. Despite the challenges, the accuracy of fracture reduction in complex acetabular fractures with late presentation was found to be superior in EIFA than the reduction that were achieved by other approaches. Hence a debate to find out the utility of this approach for late reconstruction of complex acetabular fractures (in the face of reported risks of complications) is worthwhile especially in younger patients, who are not suitable candidates for an acute hip replacement surgery and who need their native hip to function well at least for a few years, for their professional and personal high demand activities in their active youthful period.MethodsThe articles for review were retrived using Google Scholar for data retrieval as Pubmed didn't yield any meaningful results due to paucity of publication in this subject. There were only very few papers in the English literature since 1979, which focused on this condition and were considered for this review. We have included our experience on using EIFA in late presentations of complex acetabular fractures spanning from 1999 to 2019, an experience over two decades to this report.ResultsIt was observed that despite delayed presentation, good articular reduction was possible by using EIFA even in complex acetabular fractures. Ultimate functional outcomes were directly related to the accuracy of fracture reduction thus achieved. The risk of heterotrophic ossification in EIFA, though emphasized as significant in the published literature, was found to be least of a problem in our experience.DiscussionSurgical fixation in delayed cases of complex acetabular fractures was found to be challenging. The choice of surgical approach was found to have a great bearing on the accuracy of fracture reduction and long term functional outcome. In complex acetabular fractures, despite delay in presentation, precise reduction of such fractures was found to be possible when operated using EIFA. CONCLUSION: It was concluded that Every effort must be made to reconstruct the displaced fractures of acetabulum, even in the complex types,despite when they present late, provided the fracture fits into the selection criteria described by Letournel and operated using EIFA. This is very much appropriate to younger patients, who are not great candidate for total hip replacement surgery.
| S-EPMC7656467 | biostudies-literature
Project description:PurposeTo find out whether the intramedullary fixations are superior to the extramedullary fixations in treating unstable femoral intertrochanteric fractures (UFIFs).MethodsThe meta-analysis of randomized controlled trials (RCTs) was conducted by searching the PubMed, Cochrane Library, and Embase databases to evaluate functional scores, surgical outcomes, and adverse events in adult patients receiving intramedullary fixations in comparison to extramedullary fixations. Risk ratio (RR) or weighted mean difference (WMD)/standard mean difference (SMD) with 95% confidence intervals (CIs) were calculated as effect sizes.ResultsA total of 18 RCTs, comprising 2414 patients, were included in this meta-analysis. Primary efficacy outcome: Parker scores [weighted mean difference, 1.10, 95% confidence interval (CI), 0.64-1.55; P < .0001] and Harris hip scores [risk ratio, 1.24, 95%CI, 1.09 -1.41; P = .0008] were higher in the intramedullary fixation group. Moreover, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group. Other secondary efficacy outcome: No significant differences were found between the 2 groups in terms of fluoroscopy time, mortality, cut-out, nonunion, superficial wound infection, later fracture, and reoperation.ConclusionsThis meta-analysis suggested that intramedullary fixation is more effective and safer than extramedullary fixation in treating UFIFs. Furthermore, blood loss, operative time, length of incision, hospital stay, and implant failure were superior in the intramedullary fixation group.
| S-EPMC6750238 | biostudies-literature
Project description:Femoral head fractures associated with acetabular fractures are usually treated by an open method. After a closed reduction of a hip dislocation, open reduction and internal fixation of acetabular fractures usually depend on the type of acetabular fracture. Acetabular fractures associated with femoral head fractures, torn labrums, or osteochondral fractures are often managed simultaneously by a posterior approach. The patient in this study was referred to us because of pain and limited motion after open reduction and internal fixation of an acetabular fracture. Postoperative computed tomography showed remnant osteochondral fragments located in the cotyloid fossa. Using hip arthroscopy, we found a torn labrum and multiple osteochondral fragments in the cotyloid fossa. The avulsed torn labrum was reattached with 2 anchors through the midanterior portal. Osteochondral fragments were curetted and removed. This article reviews the treatment of the torn labrum and multiple fragments after acetabular fracture reduction. The patient recovered immediately and had a satisfactory outcome. We conclude that hip arthroscopy is a valuable option for treating femoral head fracture dislocations associated with acetabular fractures.
| S-EPMC3834644 | biostudies-literature
Project description:Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine.From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty.We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group.No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers.The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.
| S-EPMC4602385 | biostudies-literature
Project description:UNLABELLED: Restoration of femoral offset and acetabular inclination may have an effect on polyethylene (PE) wear in THA. We therefore assessed the effect of femoral offset and acetabular inclination (angle) on acetabular conventional (not highly cross-linked) PE wear in uncemented THA. We prospectively followed 43 uncemented THAs for a minimum of 49 months (mean, 64 months; range, 49-88 months). Radiographs were assessed for femoral offset, acetabular inclination, and conventional PE wear. The mean (+/- standard deviation) linear wear rate in all THAs was 0.14 mm/year (+/- 0.01 mm/year) and the mean volumetric wear rate was 53.1 mm(3)/year (+/- 5.5 mm(3)/year). In THAs with an acetabular angle less than 45 degrees , the mean wear was 0.12 mm/year (+/- 0.01 mm/year) compared with 0.18 mm/year (+/- 0.02 mm/year) in those with a reconstructed acetabular angle greater than 45 degrees . Reproduction of a reconstructed femoral offset to within 5 mm of the native femoral offset was associated with a reduction in conventional PE wear (0.12 mm/year versus 0.16 mm/year). Careful placement of the acetabular component to ensure an acetabular angle less than 45 degrees in the reconstructed hip allows for reduced conventional PE wear. LEVEL OF EVIDENCE: Level II, prospective study. See Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2758973 | biostudies-other
Project description: Not available
| S-EPMC7567145 | biostudies-literature
Project description:INTRODUCTION:Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. METHODS:Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. CONCLUSION:Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.
| S-EPMC7454634 | biostudies-literature
Project description:Acetabular fractures after seizures are uncommon, and fewer than 30 cases are described in the literature. We present a patient with bilateral acetabular fractures after a seizure, with bilateral quadrilateral plate destruction and protrusio deformity. The patient underwent delayed staggered bilateral total hip arthroplasty 3 months after initial injury, with use of the femoral head as autograft for the protrusio deformities.
| S-EPMC7303498 | biostudies-literature
Project description:Acetabular labral tears are a known cause of hip pain in the young, active patient. Labral tears can be due to trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degenerative pathology. Paralabral cysts are relatively common in association with labral tears of the hip, with cysts seen on magnetic resonance imaging studies in as many as 50% to 70% of patients with labral tears. In some cases the cysts can become sizeable and cause neurovascular compression. Nonoperative interventions for the management of paralabral cysts in the shoulder and knee have shown high recurrence rates. In the shoulder and knee, arthroscopic debridement of paralabral cysts has shown good results with lower recurrence rates and resolution of neurovascular function. In the hip there is limited literature regarding surgical management of paralabral cysts. We present a surgical technique for arthroscopic decompression of acetabular paralabral cysts combined with labral repair.
| S-EPMC4427643 | biostudies-literature
Project description:BackgroundAcetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment.Methods7 patients (5 male and 2 female; median age 53 y (25 to 92 y)) with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture.The workflow included following steps: (1) Formation of a patient-specific bone model from preoperative computed tomography scans, (2) interactive virtual fracture reduction with visuo-haptic feedback, (3) virtual fracture fixation using common osteosynthesis implants and (4) measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available.The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition.ResultsPreoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach. In 3 cases with osteopenic bone patient-specific prebent fixation plates were helpful in guiding fracture reduction. Additionally, anatomical landmark based measurements were helpful for intraoperative navigation.ConclusionThe presented prototype planning tool for pelvic surgery was successfully integrated in a clinical workflow to improve patient-specific preoperative planning, giving visual and haptic information about the injury and allowing a patient-specific adaptation of osteosynthesis implants to the virtually reduced pelvis.
| S-EPMC2923114 | biostudies-literature