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International Orthopaedics

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Open Access 01-04-2021 | Acetabular Fracture | Review Article

Fractures of the acetabulum: from yesterday to tomorrow

Authors: Matej Cimerman, Anže Kristan, Marko Jug, Matevž Tomaževič

Published in: International Orthopaedics | Issue 4/2021

Abstract

Purpose

The aim of this article is to present history, state of the art, and future trends in the treatment of acetabular fractures.

Methods

Review of recent and historical literature.

Results

Acetabular fractures are difficult to treat. The first descriptions of this injury already appeared in ancient Greek history, but intensive development started in the second half of the twentieth century after Judet and Letournel’s seminal work. Their classification is still the gold standard today. It is actually a pre-operative planning system and is used to determine the most appropriate surgical approach. The therapy of choice for dislocated fractures is open reduction and internal fixation. Recent modern techniques based on high-tech computerized planning systems and 3D printing have been successfully integrated into orthopaedic trauma practice.

Conclusion

There is no ideal surgical approach for acetabulum fracture treatment, so new approaches have been developed in recent decades. The best outcome series have shown good or excellent results, between 70 and 80%.

Laird A, Keating JF (2005) Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg Br 87:969–973. https://doi.org/10.1302/0301-620X.87B7.16017CrossRefPubMed

Ziran N, Soles GLS, Matta JM (2019) Outcomes after surgical treatment of acetabular fractures: a review. Patient Saf Surg 13:16. https://doi.org/10.1186/s13037-019-0196-2CrossRefPubMedPubMedCentral

Homer KB (1998) The Iliad, Reissue edition. Penguin Classics, New York

Pearson JR, Hargadon EJ (1962) Fractures of the pelvis involving the floor of the acetabulum. J Bone Joint Surg Br 44-B:550–561CrossRefPubMed

Prevezas N (2007) Evolution of pelvic and acetabular surgery from ancient to modern times. Injury 38:397–409. https://doi.org/10.1016/j.injury.2007.01.035CrossRefPubMed

Schroeder WE (1909) Fracture of the acetabulum with displacement of the femoral head into the pelvic cavity. Q Bull Northwest Univ Med Sch 11:9–42PubMedCentral

Urist MR (1948) Fracture-dislocation of the hip joint; the nature of the traumatic lesion, treatment, late complications and end results. J Bone Joint Surg Am 30A:699–727CrossRefPubMed

Elliott RB (1956) Central fractures of the acetabulum. Clin Orthop 7:189–202PubMed

Knight RA, Smith H (1958) Central fractures of the acetabulum. J Bone Joint Surg Am 40-A:1–16 passimCrossRefPubMed

10.

White G, Kanakaris NK, Faour O et al (2013) Quadrilateral plate fractures of the acetabulum: an update. Injury 44:159–167. https://doi.org/10.1016/j.injury.2012.10.010CrossRefPubMed

11.

Eichenholtz SN, Stark RM (1964) Central acetabular fractures; a review of thirty-five cases. J Bone Joint Surg Am 46:695–714CrossRefPubMed

12.

Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer-Verlag, Berlin HeidelbergCrossRef

13.

Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 46:1615–1646CrossRefPubMed

14.

Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum. Acta Orthop Belg 30:285–293PubMed

15.

Barnes SN, Stewart MJ (1976) Central fractures of the acetabulum: a critical analysis and review of literature. Clin Orthop Relat Res 276–281

16.

Carnesale PG, Stewart MJ, Barnes SN (1975) Acetabular disruption and central fracture-dislocation of the hip. A long-term study. J Bone Joint Surg Am 57:1054–1059CrossRefPubMed

17.

Letournel E, Judet R (1981) Fractures of the Acetabulum. Springer-Verlag, Berlin Heidelberg

18.

Tannast M, Najibi S, Matta JM (2012) Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am 94:1559–1567. https://doi.org/10.2106/JBJS.K.00444CrossRefPubMed

19.

Butler BA, Lawton CD, Hashmi SZ, Stover MD (2019) The relevance of the Judet and Letournel acetabular fracture classification system in the modern era: a review. J Orthop Trauma 33:S3–S7. https://doi.org/10.1097/BOT.0000000000001401CrossRefPubMed

20.

Beaulé PE, Dorey FJ, Matta JM (2003) Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability. J Bone Joint Surg Am 85:1704–1709CrossRefPubMed

21.

Ohashi K, El-Khoury GY, Abu-Zahra KW, Berbaum KS (2006) Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology 241:386–391. https://doi.org/10.1148/radiol.2412050960CrossRefPubMed

22.

Visutipol B, Chobtangsin P, Ketmalasiri B et al (2000) Evaluation of Letournel and Judet classification of acetabular fracture with plain radiographs and three-dimensional computerized tomographic scan. J Orthop Surg (Hong Kong) 8:33–37. https://doi.org/10.1177/230949900000800107CrossRef

23.

Patel V, Day A, Dinah F et al (2007) The value of specific radiological features in the classification of acetabular fractures. J Bone Joint Surg Br 89:72–76. https://doi.org/10.1302/0301-620X.89B1.18069CrossRefPubMed

24.

Ly TV, Stover MD, Sims SH, Reilly MC (2011) The use of an algorithm for classifying acetabular fractures: a role for resident education? Clin Orthop Relat Res 469:2371–2376. https://doi.org/10.1007/s11999-011-1925-8CrossRefPubMedPubMedCentral

25.

Kanthawang T, Vaseenon T, Sripan P, Pattamapaspong N (2020) Comparison of three-dimensional and two-dimensional computed tomographies in the classification of acetabular fractures. Emerg Radiol 27:157–164. https://doi.org/10.1007/s10140-019-01744-6CrossRefPubMed

26.

Boudissa M, Orfeuvre B, Chabanas M, Tonetti J (2017) Does semi-automatic bone-fragment segmentation improve the reproducibility of the Letournel acetabular fracture classification? Orthop Traumatol Surg Res 103:633–638. https://doi.org/10.1016/j.otsr.2017.03.018CrossRefPubMed

27.

Hansen E, Marmor M, Matityahu A (2012) Impact of a three-dimensional “hands-on” anatomic teaching module on acetabular fracture pattern recognition by orthopaedic residents. J Bone Joint Surg Am 94:e1771–e1777. https://doi.org/10.2106/JBJS.K.00840CrossRefPubMed

28.

Alton TB, Gee AO (2014) Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res 472:35–38. https://doi.org/10.1007/s11999-013-3375-yCrossRefPubMed

29.

Mauffrey C, Stacey S, York PJ et al (2018) Radiographic evaluation of acetabular fractures: review and update on methodology. J Am Acad Orthop Surg 26:83–93. https://doi.org/10.5435/JAAOS-D-15-00666CrossRefPubMed

30.

Burk DL, Mears DC, Kennedy WH et al (1985) Three-dimensional computed tomography of acetabular fractures. Radiology 155:183–186. https://doi.org/10.1148/radiology.155.1.3975401CrossRefPubMed

31.

Clarke-Jenssen J, Wikerøy AKB, Røise O et al (2016) Long-term survival of the native hip after a minimally displaced, nonoperatively treated acetabular fracture. J Bone Joint Surg Am 98:1392–1399. https://doi.org/10.2106/JBJS.15.01154CrossRefPubMed

32.

Matta JM, Anderson LM, Epstein HC, Hendricks P (1986) Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res 230–240

33.

Olson SA, Matta JM (1993) The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma 7:402–413. https://doi.org/10.1097/00005131-199310000-00002CrossRefPubMed

34.

Mears DC, Velyvis JH, Chang C-P (2003) Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res 173–186. https://doi.org/10.1097/00003086-200302000-00026

35.

Mast J, Jakob R, Ganz R (1989) Planning and reduction technique in fracture surgery. Springer-Verlag, BerlinCrossRef

36.

Mast JW (1983) Preoperative planning in the surgical correction of tibial nonunions and malunions. Clin Orthop Relat Res 26–30

37.

Cimerman M, Kristan A (2007) Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury 38:442–449. https://doi.org/10.1016/j.injury.2007.01.033CrossRefPubMed

38.

Citak M, Gardner MJ, Kendoff D et al (2008) Virtual 3D planning of acetabular fracture reduction. J Orthop Res 26:547–552. https://doi.org/10.1002/jor.20517CrossRefPubMed

39.

Hu Y, Li H, Qiao G et al (2011) Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data. Injury 42:1121–1124. https://doi.org/10.1016/j.injury.2011.01.014CrossRefPubMed

40.

Kovler I, Joskowicz L, Weil YA et al (2015) Haptic computer-assisted patient-specific preoperative planning for orthopedic fractures surgery. Int J Comput Assist Radiol Surg 10:1535–1546. https://doi.org/10.1007/s11548-015-1162-9CrossRefPubMed

41.

Wang H, Wang F, Newman S et al (2016) Application of an innovative computerized virtual planning system in acetabular fracture surgery: a feasibility study. Injury 47:1698–1701. https://doi.org/10.1016/j.injury.2016.05.006CrossRefPubMed

42.

Chana-Rodríguez F, Mañanes RP, Rojo-Manaute J et al (2016) 3D surgical printing and pre contoured plates for acetabular fractures. Injury. https://doi.org/10.1016/j.injury.2016.08.027

43.

Tetsworth K, Block S, Glatt V (2017) Putting 3D modelling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects. SICOT J 3:16. https://doi.org/10.1051/sicotj/2016043CrossRefPubMedPubMedCentral

44.

Hurson C, Tansey A, O’Donnchadha B et al (2007) Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury 38:1158–1162. https://doi.org/10.1016/j.injury.2007.05.020CrossRefPubMed

45.

Upex P, Jouffroy P, Riouallon G (2017) Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res 103:331–334. https://doi.org/10.1016/j.otsr.2016.11.021CrossRefPubMed

46.

Tomaževič M, Kristan A, Kamath AF, Cimerman M (2019) 3D printing of implants for patient-specific acetabular fracture fixation: an experimental study. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-019-01241-y

47.

Rickman M, Varghese VD (2017) Contemporary acetabular fracture surgery: treading water or swimming upstream? Bone Joint J 99-B:1125–1131. https://doi.org/10.1302/0301-620X.99B9.BJJ-2017-0185.R1CrossRefPubMed

48.

Cutrera NJ, Pinkas D, Toro JB (2015) Surgical approaches to the acetabulum and modifications in technique. J Am Acad Orthop Surg 23:592–603. https://doi.org/10.5435/JAAOS-D-14-00307CrossRefPubMed

49.

Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 81–106

50.

Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78:1632–1645CrossRefPubMed

51.

Giannoudis PV, Grotz MRW, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br 87:2–9CrossRefPubMed

52.

Ochs BG, Marintschev I, Hoyer H et al (2010) Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury 41:839–851. https://doi.org/10.1016/j.injury.2010.04.010CrossRefPubMed

53.

Briffa N, Pearce R, Hill AM, Bircher M (2011) Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint Surg Br 93:229–236. https://doi.org/10.1302/0301-620X.93B2.24056CrossRefPubMed

54.

Harris AM, Althausen P, Kellam JF, Bosse MJ (2008) Simultaneous anterior and posterior approaches for complex acetabular fractures. J Orthop Trauma 22:494–497. https://doi.org/10.1097/BOT.0b013e3181830d2aCrossRefPubMed

55.

Stöckle U, Hoffmann R, Südkamp NP et al (2002) Treatment of complex acetabular fractures through a modified extended iliofemoral approach. J Orthop Trauma 16:220–230. https://doi.org/10.1097/00005131-200204000-00002CrossRefPubMed

56.

Griffin DB, Beaulé PE, Matta JM (2005) Safety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulum. J Bone Joint Surg Br 87:1391–1396. https://doi.org/10.1302/0301-620X.87B10.16538CrossRefPubMed

57.

Moed BR (2010) The modified Gibson posterior surgical approach to the acetabulum. J Orthop Trauma 24:315–322. https://doi.org/10.1097/BOT.0b013e3181c4aef8CrossRefPubMed

58.

Gautier E, Ganz K, Krügel N et al (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 82:679–683. https://doi.org/10.1302/0301-620x.82b5.10426CrossRefPubMed

59.

Ganz R, Gill TJ, Gautier E et al (2001) Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83-B:1119–1124. https://doi.org/10.1302/0301-620X.83B8.11964CrossRef

60.

Siebenrock KA, Gautier E, Ziran BH, Ganz R (1998) Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma 12:387–391. https://doi.org/10.1097/00005131-199808000-00004CrossRefPubMed

61.

Masse A, Aprato A, Rollero L et al (2013) Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res 471:4056–4064. https://doi.org/10.1007/s11999-013-3228-8CrossRefPubMedPubMedCentral

62.

Tannast M, Krüger A, Mack PW et al (2010) Surgical dislocation of the hip for the fixation of acetabular fractures. J Bone Joint Surg Br 92-B:842–852. https://doi.org/10.1302/0301-620X.92B6.22994CrossRef

63.

Massè A, Aprato A, Alluto C et al (2015) Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res 473:3744–3751. https://doi.org/10.1007/s11999-015-4352-4CrossRefPubMedPubMedCentral

64.

Hirvensalo E, Lindahl J, Böstman O (1993) A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res 28–32

65.

Cole JD, Bolhofner BR (1994) Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res 112–123

66.

Sagi HC, Afsari A, Dziadosz D (2010) The anterior intra-pelvic (modified Rives-Stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 24:263–270. https://doi.org/10.1097/BOT.0b013e3181dd0b84CrossRefPubMed

67.

Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br 92:250–257. https://doi.org/10.1302/0301-620X.92B2.22488CrossRefPubMed

68.

Gras F, Marintschev I, Grossterlinden L et al (2017) The anterior intrapelvic approach for acetabular fractures using approach-specific instruments and an anatomical-preshaped 3-dimensional suprapectineal plate. J Orthop Trauma 31:e210–e216. https://doi.org/10.1097/BOT.0000000000000829CrossRefPubMed

69.

Rocca G, Spina M, Mazzi M (2014) Anterior combined endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: a new proposal. Injury 45(Suppl 6):S9–S15. https://doi.org/10.1016/j.injury.2014.10.016CrossRefPubMed

70.

Meena S, Sharma PK, Mittal S et al (2017) Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures; a systematic review and meta-analysis. Bull Emerg Trauma 5:6–12CrossRefPubMedPubMedCentral

71.

Keel MJB, Ecker TM, Cullmann JL et al (2012) The Pararectus approach for anterior intrapelvic management of acetabular fractures an anatomical study and clinical evaluation. J Bone Joint Surg Br 94-B:405–411. https://doi.org/10.1302/0301-620X.94B3.27801CrossRef

72.

Keel MJB, Siebenrock K-A, Tannast M, Bastian JD (2018) The Pararectus approach: a new concept. JBJS Essent Surg Tech 8

73.

Keel MJB, Tomagra S, Bonel HM et al (2014) Clinical results of acetabular fracture management with the Pararectus approach. Injury 45:1900–1907. https://doi.org/10.1016/j.injury.2014.10.040CrossRefPubMed

74.

Kelly J, Ladurner A, Rickman M (2020) Surgical management of acetabular fractures - a contemporary literature review. Injury. https://doi.org/10.1016/j.injury.2020.06.016

Title: Fractures of the acetabulum: from yesterday to tomorrow
Authors: Matej Cimerman
Anže Kristan
Marko Jug
Matevž Tomaževič
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keyword: Acetabular Fracture
Published in: International Orthopaedics / Issue 4/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04806-4

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Springer Medicine

Fractures of the acetabulum: from yesterday to tomorrow

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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