Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Fractures of the Acetabulum 11 articles

Articles

What Is the Frequency of Nerve Injuries Associated With Acetabular Fractures?

Wolfgang Lehmann MD, Michael Hoffmann MD, Florian Fensky MD, Jakob Nüchtern MD, Lars Großterlinden MD, Emin Aghayev MD, Helmar Lehmann MD, Fabian Stuby MD, Johannes M. Rueger MD

Acetabular fractures and surgical interventions used to treat them can result in nerve injuries. To date, only small case studies have tried to explore the frequency of nerve injuries and their association with patient and treatment characteristics. High-quality data on the risk of traumatic and iatrogenic nerve lesions and their epidemiology in relation to different fracture types and surgical approaches are lacking.

Are Quadrilateral Surface Buttress Plates Comparable to Traditional Forms of Transverse Acetabular Fracture Fixation?

Brian J. Kistler MD, Ian R. Smithson MD, Seth A. Cooper MD, Jacob L. Cox MD, Aniruddh N. Nayak MS, Brandon G. Santoni PhD, H. Claude Sagi MD

Several construct options exist for transverse acetabular fracture fixation. Accepted techniques use a combination of column plates and lag screws. Quadrilateral surface buttress plates have been introduced as potential fixation options, but as a result of their novelty, biomechanical data regarding their stabilizing effects are nonexistent. Therefore, we aimed to determine if this fixation method confers similar stability to traditional forms of fixation.

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Reza Firoozabadi MD, MA, Timothy J. O’Mara MD, Alan Swenson MD, Julie Agel MA, ATC, John D. Beck MD, Milton Routt MD

Heterotopic ossification (HO) is a common complication of the operative treatment of acetabular fractures. Although the surgical approach has been shown to correlate with the development of ectopic bone, specific risk factors have not been elucidated.

CT-generated Radiographs in Obese Patients With Acetabular Fractures: Can They Be Used in Lieu of Plain Radiographs?

Philip M. Sinatra MD, Berton R. Moed MD

Acetabular fracture diagnosis is traditionally made with AP and oblique pelvic plain radiographs. Obesity may impair diagnostic accuracy of plain radiographs. New CT reconstruction algorithms allow for simulated radiographs that may eliminate the adverse imaging effects of obesity.

Is Preoperative Radiation Therapy as Effective as Postoperative Radiation Therapy for Heterotopic Ossification Prevention in Acetabular Fractures?

Michael T. Archdeacon MD, MSE, Albert d’Heurle MD, Nicole Nemeth MD, Bradley Budde MD

Prophylactic approaches to prevent heterotopic ossification after acetabular fracture surgery have included indomethacin and/or single-dose external beam radiation therapy administered after surgery. Although preoperative radiation has been used for heterotopic ossification prophylaxis in the THA population, to our knowledge, no studies have compared preoperative and postoperative radiation therapy in the acetabular fracture population.

Modifier 22 for Acetabular Fractures in Morbidly Obese Patients: Does It Affect Reimbursement?

Patrick F. Bergin MD, Christopher Kneip MD, Christine Pierce MD, Stephen T. Hendrix MD, Scott E. Porter MD, Matthew L. Graves MD, George V. Russell MD

Modifier 22 in the American Medical Association’s Current Procedural Terminology (CPT) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined.

A Surgical Approach Algorithm for Transverse Posterior Wall Fractures Aids in Reduction Quality

Yelena Bogdan MD, Shashank Dwivedi MS, Paul Tornetta MD

Transverse posterior wall fractures are difficult to treat and historically have been associated with stiffness, posttraumatic arthritis, and pain, which correlate with the reduction. The Kocher–Langenbeck approach is used most often, whereas the extended iliofemoral approach has been reserved for more complex injury patterns. The latter approach has substantially more risks. No data to our knowledge exist on the use of sequential anterior and posterior approaches for this pattern.

Managing Acetabular Fractures in the Elderly With Fixation and Primary Arthroplasty: Aiming for Early Weightbearing

Mark Rickman MD, MBChB, FRCS, James Young MBBS, MRCS(Eng), Alex Trompeter MBBS, BSc, FRCS(Tr&Orth), Rachel Pearce RGN, BSc, Mark Hamilton FRCA

Osteoporotic acetabular fractures in the elderly are becoming more common. Regardless of treatment, most patients are managed with a period of protected weightbearing, even if a THA has been performed. We have tried to treat these patients analogously to geriatric femoral neck fractures in a way that allows immediate full weightbearing.

The Epidemiology and Injury Patterns of Acetabular Fractures: Are the USA and China Comparable?

Cyril Mauffrey MD, FACS, FRCS, Jiandong Hao MD, PhD, Derly O. Cuellar MD, Benoit Herbert MD, Xiao Chen MD, Bo Liu MD, Yingze Zhang MD, Wade Smith MD, FACS

Acetabular fractures are rare injuries in heterogeneous patient groups, making it difficult to develop adequately powered prospective single-center clinical trials in the USA or Europe. Chinese trauma centers treat a high volume of these injuries, and if the patient population and injury patterns are comparable to those in the USA, this might support development of multicenter studies in Level I trauma centers in the two countries.

Treatment of Acetabulum Fractures Through the Modified Stoppa Approach: Strategies and Outcomes

Mark J. Isaacson DO, Benjamin C. Taylor MD, Bruce G. French MD, Attila Poka MD

Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures.