Artikel
Restoration of the acetabular volume correlates with central sub-luxation of the hip in acetabular fractures involving the anterior column
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Autoren
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Viola Natalie Freigang
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
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Antonia Suhren
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
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Lisa Bode
- Universitätsklinkum Freiburg, Klinik für Orthopädie und Unfallchirurgie, Freiburg, Germany
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Volker Alt
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
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Florian Baumann
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Unfallchirurgie, Regensburg, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
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Objectives: Management of an acetabular fracture is a challanging procedure. Open reduction and internal fixation (ORIF) is the standard treatment for acetabular fractures. Evaluation of the quality of reduction can be difficult in fractures with comminution zones like in geriatric patients with reduced bone quality. Aim of this study was to measure the intra-acetabular volume in pre- and post-operative computed tomography (CT) of acetabular fracture patients with involvement of the anterior collumn.
Methods: We conducted a radio-volumetric study measuring the 3D volume of the acetabulum before and after ORIF in 31 patients. Primary outcome was the volume of the acetabulum in cm³ (Figure 1 [Fig. 1], Figure 2 [Fig. 2]). We also measured the volume of the un-injured contra-lateral acetabulum to get a baseline value. We correlated the radio-volumetric results with the radiographic outcome after 12 months regarding osteo-arthritis and the central subluxation of the femoral head.
Results and conclusion: Median age in 31 patients was 61.2 years (±14.2). There were 17 patients with an associated anterior collumn plus hemi-transverse, 10 patients with a both-collumn fracture and 4 patients with an isolated anterior collumn fracture. ORIF led to a decrease in acetabular volume by 17.8% (±17.8), however, comparing the postoperative volume to the volume of the un-injured contra-lateral side, there was still a mean difference of 21.2% (±16.8).
Regarding the 12 month follow-up, there were three groups:
- Group A (n=10) with no central subluxation and no arthroplasty (mean volume 3.9 ±4.8)
- Group B (n=10) with a central subluxation but no arthroplasty (mean volume 25.3 ±12.9)
- Group C (n=11) who had undergone arthroplasty within the first 12 months (mean volume 33.8 ±13.0)
There was a significant difference between the groups regarding the difference in volume of the post-operative and the un-injured contra-lateral side (p<0.001).
Restoration of the 3D acetabular volume determines a favorable outcome after acetabular fracture. The cut-off value seems to be between 15–20% of the un-injured side. Surgeons should aim to reduce the volume of the acetabulum by fracture reduction. In comminuted fractures, evaluation of the intra-acetabular volume could be a valuable predictor for a postoperative subluxation and osteo-arthritis. Further studies are needed to confirm this finding.
