Occult Acetabular Fractures in Elderly Patients: A Report of Three Cases

Kakar, Rahul; Sharma, Himanshu; Allcock, Paul; Sharma, Piyush Kumar

doi:10.1177/230949900701500225

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…Acetabular injuries are followed by polytrauma in 20% -50% of cases. In 36% of cases, acetabular fracture is accompanied with injury of the lower extremities ( 2 ). Classification of acetabular fractures by Judet and Letournel is used as a guide to treatment and as a comparison method regarding the results of other authors.…”

Section: Introductionmentioning

confidence: 99%

Controversies in Treatment of Acetabular Fracture

Grubor¹,

Krupić²,

Biščević³

et al. 2015

Med Arh

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Introduction:Acetabular fractures treatment represents a great controversy, challenge and dilemma for an orthopedic surgeon.Aim:The aim of the paper was to present the results of treatment of 96 acetabular fractures in the Clinic of Traumatology Banja Luka, in the period from 2003 to 2013, as well as to raise awareness regarding the controversy in the methods of choice in treating acetabulum fractures.Material and methods:The series consists of 96 patients, 82 males and 14 females, average age 40.5 years. Traffic trauma was the cause of fractures in 79 patients (85%), and in 17 patients (15%) fractures occurred due to falls from height. Polytrauma was present in 31 patients (32%). According to the classification of Judet and Letournel, representation of acetabular fractures was as follows: posterior wall in 32 patients, posterior column in 28, anterior wall in 4, anterior column in 2, transverse fractures in 8, posterior wall and posterior column in 10, anterior and posterior wall in 6, both- column in 4 and transversal fracture and posterior wall in 2 patients. 14 patients were treated with traction, that is, 6 patients with femoral traction and 8 patients with both lateral and femoral traction. 82 patients (86.4%) were surgically treated. Kocher-Langenbeck approach was applied in the treatment of 78 patients. In two patients from the Kocher-Langenbeck’s approach, the Ollier’s approach had to be applied as well. Two acetabular were primarily treated with Ollier’s approach. Extended Smith- Peterson’s approach was applied 4 times, and Emile Letournel’s (ilioinguinal) approach 14 times.Results:Functional outcome (after follow-up of 18 months), according to the Harris hip score of surgical treatment in 82 patients, was as follows: good 46 (56%), satisfactory 32 (39%) and poor 4 (5%). Results of acetabulum fractures treated with traction were: good 8 (57%), satisfactory 4 (28%) and poor 2 (15%). According to the Brook’s classification of heterotopic ossification, periarticular hetero-tropic calcifications after surgical treatment were: 0° in 65 patients (79%), I-II° in 9 patients (11%) and III-IV ° in 8 patients (10%). Calcifications in 14 patients treated with traction of heterotopic ossification by Brook-s classification were as follows: 0° in 10 patients (72%), I-II ° in 3 patients (22%) and III-IV° in 1 patient (6%).Conclusion:At the occurrence of acetabular fracture, it is necessary to start the treatment immediately, with an obligatory application of thromboembolic and antibiotic prophylaxis. Conservative treatment is acceptable if the dislocation of fracture is less than 5 mm. Indications for surgical treatment are incongruent or unstable fractures with verified dislocation greater than 5 mm, as well as when the radiography measured by JM Matta shows incongruence of acetabular roof less than 40° in all planes. Kocher-Langenbeck approach is the choice of surgical approach for the management of posterior column / wall, and Letournel’s (ilioinguinal) approach is the choice for the management of anterior wall/column.

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Section: Introductionmentioning

confidence: 99%

Controversies in Treatment of Acetabular Fracture

Grubor¹,

Krupić²,

Biščević³

et al. 2015

Med Arh

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“…Kakar et al [7] reported three cases of occult acetabular fractures following a fall, identified only after further imaging due to ongoing discomfort and difficulty walking. There was an ipsilateral THA present in one of these patients.…”

Section: Discussionmentioning

confidence: 99%

Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Radha

Shenouda²,

Hazlerigg³

et al. 2013

Case Reports in Orthopedics

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Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR). The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation.

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“…[13] were the fractures evident on the initial plain radiographs. All patients had suffered a previous fall and were unable to bear weight.…”

Section: Discussionmentioning

confidence: 99%

“…Such additional studies may include Judet view radiographs, bone scanning, computed tomographic scans or magnetic resonance imaging [13, 14]. In our cases, the x-rays were repeated after the initial mis-diagnosis; no CT-scan was needed as secondary displacement occurred in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in some cases an antecedent of trauma is not known [10], making diagnosis easily missed [11]. Although early diagnosis is very important, since delayed management and early failures with subsequent salvage surgery can cause higher morbidity [4, 12], very few papers have been published on occult acetabular fractures [9-1, 13-15]. In this paper we present three cases of non-traumatic occult acetabular fractures in patients older than 75 years.…”

Section: Introductionmentioning

confidence: 99%

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Occult Acetabular Fracture in Elderly Patients

Guerado

Cano²,

Cruz³

2012

TOORTHJ

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Acetabular fractures in the elderly are increasingly common; however, an antecedent of trauma may not be known, and the diagnosis easily missed. Early identification and prompt management are needed in order to minimise morbidity rates, but little has been published on occult acetabular fracture.In this paper we present three cases of occult acetabular fracture in patients older than 75 years. All three are females and had previously been operated on the ipsilateral hip with an implant (two proximal femur fractures treated with a proximal intramedullary femoral nail, and one case of total joint replacement); these acetabular fractures could be related to the existence of a stress shielding mechanism.We believe that whenever an elderly patient feels groin pain, and anteroposterior pelvis X-rays are normal, oblique Judet projections (obturator and iliac) should be obtained. In any case, displacement will make any fracture evident within a few weeks.

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Occult Acetabular Fractures in Elderly Patients: A Report of Three Cases

Cited by 8 publications

References 11 publications

Controversies in Treatment of Acetabular Fracture

Controversies in Treatment of Acetabular Fracture

Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Occult Acetabular Fracture in Elderly Patients

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