Feb 21, 2015 in treatment of acetabular fracture, the following controversy is raised. Acetabular fractures, anatomy and implications for treatment. Treatment of metastatic lesions localized in the acetabulum. Treatment planning requires an indepth analysis of patients general condition, stage of cancer, and prognosis. Rosemont, il, american academy of orthopaedic surgeons, 2015. The acetabular labrum is a fibrocartilaginous structure that attaches to both the anterior and posterior aspects of the transverse acetabular ligament and is then securely tethered to the hyaline cartilage of the acetabular periphery through a transition zone. Posterioranterior glide of the femoral head within the acetabulum is a joint mobilization procedure described in orthopaedic physical therapy texts, yet there is no published evidence that the joint structures of the hip allow such movement. It lies at the point where the ilium, ischium, and pubis are joined by the triradiate cartilage, which later fuses to form the innominate bone. Pioneering work was done by letournal and judet in 1964 2. The four day intensive cme course is developed for orthopaedic trauma surgeons and fellows. As the pediatric skeleton matures, changes in anatomy and physiology influence injury pattern, diagnosis, treatment, and complications. We feel that a systematic, stepwise approach to classifying acetabular fractures. American academy of orthopaedic surgeons, american orthopaedic association, ao foundation, orthopaedic trauma association.
Anterior superior dislocation of the hip is rare in comparison. Pdf an interactive surgical planning tool for acetabular fractures. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. Unlike the treatment of pelvic ring injuries, however, the treatment of fractures of the acetabulum has not altered much over the last decade. Anatomical variance in acetabular anteversion does not predict hip fracture patterns in the elderly. Normal acetabular anatomy for acetabular fracture assessment. Additional notes and information are provided by many authors in the meeting notes section of. In order to approach fractures of the acetabulum safely and with maximum ease, it is necessary to understand the pathologic anatomy. Because of the complex anatomy of the pelvis, a ct scan is commonly ordered for acetabular fractures. After a background understanding of the classification of judet and letournel and the radiographic anatomy of the pelvis, the majority of acetabular fractures are readily classified by utilizing the steps as outlined above. The relative merit of each surgical option must be considered, and the decision is often. Part 1 of a lecture on acetabular fractures anatomy, evaluation and classification by dr muhammad abdelghani.
Article pdf available in journal of orthopaedic surgery and research 51. Pdf controversies in treatment of acetabular fracture. Pdf acetabulummorphological and morphometrical study. As techniques improve, imaging is being used more and more in the treatment of acetabular fractures. Typically, the artificial ball with its stem is made of a strong metal or ceramic, and the artificial socket is made of polyethylene a durable, wearresistant plastic or metal backed with a plastic liner. Posterioranterior glide of the femoral head in the. Acetabulum repaired, even incongruent one, provides good support and stability to hip arthroplasty. An 80yearold female suffering from right hip pain was referred to our hospital. Congenital hip dysplasia barlows and ortolanis maneuvers barlows test identifies unstable hip that lies in the reduced position but can be passively dislocated and hence unstable less than 2% of infants will have a. The lectures have been compressed, for ease of download. An understanding of anatomy, physiology and classification systems will help in the assessment of the stability of the fracture pattern and the patient. Chief of orthopedic trauma, bellevue hospital nirmal tejwani, md, mpa is a member of the following medical societies. Treatment for acetabular fractures often involves surgery to restore the normal anatomy of the hip and stabilize the hip joint. Modified stoppa approach for surgical treatment of acetabular.
Pelvis, acetabulum, complete articular, associated both column fracture qualifications are optional and applied to the fracture code where the asterisk is located as a lowercase letter within rounded brackets. Introduction to biomaterials in orthopaedic surgery 1. Value of 3d ct in classifying acetabular fractures during. External rotation of the femur causes increased conspicuity of the lesser. The poly can have a 10, 15, or 20 lip liner depending on the manufacturer. The three bones are initially separated by a yshaped triradiate cartilage that begins to fuse after puberty.
In turn, the sciatic buttress extends posteriorly from the anterior and posterior columns to become the articular surface of the sacroiliac joint, a a fig. Acetabulum fractures archives trauma international. Orthopaedic surgery the fourth edition of this wellknown and highly regarded book by marvin tile et al. Gain a better understanding of the relevant anatomy and surgical challenges during this dynamic handson skills course. Pelvis, acetabulum, complete articular, associated both column fracture qualifications are optional and applied to the fracture code where the asterisk is located as a lowercase letter. The head of the femur rests within the acetabulum of the pelvis. This website provides free medical books for all this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine. The acetabulum is enclosed by the anterior and the posterior columns like the two limbs of an inverted y see the images below. The acetabular labrum is an inverted horseshoe appearing structure with t he transverse acetabular ligament joining the inferior attachments.
Biomechanics, anatomy, pathology, imaging and clinical. Although it was not popular until 1982, the trend of treatment evolved dramatically. Apr 28, 2016 until recently, the treatment of metastatic lesions localized in the pelvis was limited to radiotherapy which effectively decreased pain but did not restore the ability to load the affected joint. Hip replacement surgery involves replacing the femur head of the thighbone and the acetabulum hip socket. Pdf acetabular anatomy and the transacetabular fixation. The upper part is composed of femoral head, femoral neck, greater. Outcome of surgical treatment for displaced acetabular fractures. It consists of 1 the capsular side, which is made up of dense connective. They improved the understanding of morphology and popularized surgical principles for management of these injuries. For ease of approach we have considered the relevant anatomy under the headings bony anatomy, ligaments and capsular anatomy, neurovascular anatomy and muscular anatomy figure 4 5. The acetabulum is the socket of the ballandsocket hip joint. Threedimensional ct scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system. Femoroacetabular impingement fai is a condition in which extra bone grows along one or both of the bones that form the hip joint giving the bones an irregular shape. They systematically classified acetabular fractures and developed a logical line of.
Anatomy, preoperative evaluation, approaches, and operative techniques to avoid complications johnpaul h. Nelson md, faaos, carolyn taliaferro blauvelt, in a manual of orthopaedic terminology eighth edition, 2015. It is also referred to as a ball and socket joint and is surrounded by muscles, ligaments, and tendons. Apr 28, 2016 metastatic lesions localized in the periacetabular area cause troublesome pain and reduced mobility of the patients. A surgical approach will be selected with the expectation that. The classification scheme developed by judet et al. Lehman, dc, mba, dabco university of bridgeport college of chiropractic hip anatomy palpation point tenderness edema symmetry hip rom hip contracture tests thomas test supine passive hip flexion contralateral hip and knee flexion indicates a positive test for hip contracture. B the doctor uses a specialized tool to manipulate the bone fragment to gain access to the acetabulum. Rapid identification and reduction is critical, as prolonged dislocation increases the risk. Congenital hip dysplasia barlows and ortolanis maneuvers barlows test identifies unstable hip that lies in the reduced position but can be passively dislocated and hence unstable less than 2% of infants will have a positive barlow test. It joins to the pelvis acetabulum to form the hip joint. Surgical approaches for fractures and injuries of the pelvic ring mara l.
Orthopaedic trauma fellowshiptrained surgeons, and experienced orthopaedic. Flattened acetabular cavity permits dislocation or subluxation of the femur head. Diagnosis, indications, treatment strategies ebook description enclosed within the deep and complex structures of the hip joint and the surroundings, acetabular fractures confront the orthopaedic surgeon with great challenges. In the evaluation of the five most common acetabular fractures, assessment of the obturator ring, followed by the iliopectineal and ilioischial lines and iliac wing, for fracture allows accurate classification. Radiotherapy effectively decreases pain, yet it does not restore the ability to load the joint.
Highenergy fractures of the pediatric pelvis are particularly concerning given the reported mortality rates ranging from 3. Mont, md a major neurovascular injury during total hip arthroplasty tha is uncommon. All three bones of the pelvis the ilium, ischium, and pubis together form the acetabulum. A, surfacerendering 3d ct of pelvis in lateral view with femur and right hemipelvis removed shows. These joints support body weight and allow for a wide range of movement of the femur.
Rubash, journalthe journal of bone and joint surgery. Acetabular fractures are still difficult fractures to manage and are a major challenge to treating orthopaedic surgeon 1. Letournal and judet put forth the two column theory of acetabulum anatomy. The relative infrequency and complexity of acetabular fractures.
Brown et al reported the use of computergenerated threedimensional 3d computed tomography ct moving images for preoperative planning and screwpin insertion, as well as the use of stereolithography wax or plastic 3d model of bony anatomy to develop a computer. Pelvis and acetabulum orthopaedic trauma association ota. We help you diagnose your acetabulum case and provide detailed descriptions of how to manage this and hundreds of other. Not everyone who receives a hip prosthesis needs to know every small detail of his or her prosthesis but the cup that commonly is placed in the acetabulum actually forms half of the prosthesis and does therefore deserve a little more of attention than we normally give it. Pelvic and acetabular trauma orthopaedics and trauma. Bony anatomy the cupshaped acetabulum is formed by the innominate.
Hip joint orthopaedic tests orthopedics dx 611 james j. Biomaterials in orthopaedic surgery asm international. Multimedia health education gastro intestinal system hip anatomy unit. Acetabular fractures are a challenging topic for radiologists and orthopedists.
This socket meets with the femoral head of the femur bone to form the hip joint. The hip joint is the largest weightbearing joint in the human body. Current overview of neurovascular structures in hip arthroplasty. The pdf of the article you requested follows this cover page. Fracture and dislocation classification compendium 2007. Ao publication orthopedics books collection 27 books. For the model there was established raising of sss in front of the acetabulum 14. Highenergy fractures of the pelvis and acetabulum in pediat. Management of acetabulum fractures trauma international. These areas generally have the thickest articular cartilage. Structurally, the hip is a very stable joint, supported by one of the strongest ligament systems in the body and a very deep acetabulum. Current overview of neurovascular structures in hip. They systematically classified acetabular fractures and developed a logical line of thinking for dealing with these fractures. During the operation, your doctor will reconstruct the normal anatomy of the hip jointaligning the bone fragments to restore the surface of the acetabulum, and fitting the femoral head into the hip socket.
One exception has been the elegant description of the vascular anatomy of the hip and the development of the trochanteric flip osteotomy. Hear the authors discuss fractures of the pelvis and acetabulum. Hip anatomy the joint the hip or coxafemoral joint includes the concave acetabulum of the innominate of the pelvis and the convex head of the femur 1 table 12. 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. They are ballandsocket joints that connect the torso to the legs. The acetabulum is a cup like socket formed by the connection of the three bones that make up our hip. The thigh bone or femur and the pelvis join to form the hip joint. Orthopaedic knowledge online journal 2009, accessed april 2015. The lunate surface is the horseshoeshaped articular superior surface of the. The rest of the acetabulum is formed by a curved, crescentmoon shaped surface, the lunate surface, where the joint is made with the head of the femur. Nirmal tejwani, md, mpa professor of orthopedic surgery, new york university hospital for joint diseases. Pdf acetabulum is a cup shaped depression on the outer surface of constricted central part of hip bone.
The course follows the same tradition as letournel. Most acetabular fractures are not operated on right way. Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. 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. Over time this friction can damage the joint, causing pain and limiting activity.
Department of orthopedic surgery, eulji university hospital, eulji university college of medicine, daejeon, korea. Acetabular anatomy and the transacetabular fixation of. Apr 29, 2020 the superior aspect of the acetabulum and that of the femoral head bear the greatest pressures. A in a periacetabular osteotomy, four cuts are made in the pelvic bone. Additional notes and information are provided by many authors in the meeting notes section of the ppt, so users may wish to check there for further content.
Radiographic evaluation, anatomy and classification of acetabular fractures. At the lower part of the acetabulum is the acetabular notch, which is continuous with a circular depression, the acetabular fossa, at the bottom of the cavity of the acetabulum. The goals of acetabular revision are to restore anatomy and provide. Crosssectional view of the normal hip joint damien et al. Jan 06, 2017 the standard poly liner is a neutral face hemispherical design to allow maximal range of motion the goal is to provide a large implant rom so that the tha falls within the motion circle allowed by native hip anatomy. The acetabulum is formed by a portion of the innominate bone. What the orthopedic surgeon wants to know1 hip dislocation is an important orthopedic emergency usually seen in young patients who have experienced highenergy trauma, often resulting in significant longterm morbidity.
Letournel classification system, a system widely used by orthopedic surgeons performing fracture reduc tion. We help you diagnose your acetabulum case and provide detailed descriptions of how to manage this and hundreds of other pathologies. 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. Avoiding complications in acetabular and pelvic fractures. Any injury or disease of the hip will adversely affect the joints range of motion and ability to bear weight.
The concave acetabulum and the rounded femoral head of the hip joint, in addition to the anatomical relationship between the femur and the pelvis, particularly in the upright position, make this joint incongruent. May 01, 2012 orthopedics the complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. Timothy a coughlin bmbs bmedsci mrcs specialist registrar. Sep 01, 2000 orthopedics revision arthroplasty of the acetabulum is one of the most challenging problems in orthopedic surgery today. Acetabular fractures classification of letournel and judet.
She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. Acetabular and pelvic fractures kenneth graf, md director of orthopedic trauma cooper university health systems. From the lateral aspect of the pelvis, the innominate osseous structural support of the acetabulum may be conceptualized as a two column construct forming an inverted y. We made angle measurements using a custommade goniometer attached to an acetabular window trial stryker orthopaedics. The acetabulum is the deep, cupshaped structure that encloses the head of the femur at the hip joint fig. 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. In my series, i have always strive to do a restitution of the acetabulum. To view power point presentations for download, click here. It has been suggested that variances in the anatomy of the acetabulum determine the type of hip fracture in elderly patients. Surgical treatment involving resection of metastatic lesions and joint reconstruction using bone grafts is burdened with a high rate of complications. Anatomical variance in acetabular anteversion does not. Because they do not fit together perfectly, the bones rub against each other during movement. Avoiding complications in acetabular and pelvic fractures kenneth graf, md director of orthopedic trauma cooper university health systems.
Pdf acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture. It is interesting to note that the acetabulum is formed by a combination of all three bones of the pelvis. After the classic paper of judet et al1, in 1964, surgeons understandings and concepts of treatment have changed. Ao publication orthopedics books collection 27 books pdf for free. Because of the complex acetabular anatomy, various classification schemes have been suggested, but the judetletournel. Part 2 pelvic limbs kevin benjamino dvm, dacvs pvma spring clinic 2018 objectives identify common juvenile orthopedic diseases for the pelvic limb be able to accurately diagnose and discuss the medical and surgical options to owners give an accurate prognosis for these common orthopedic issues.