Part 2: outcome of acetabular fractures and associated prognostic factors—a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation

International audienceQUESTIONS/PURPOSES:The aim of this study was to identify prognostic factors associated with a poor quality of reduction and their relationships.METHODS:Data from medical charts for all patients admitted with acetabular fractures operated by open reduction and internal fixation (ORIF) from 2005 to 2014 were extracted. A total of 156 patients with a mean age of 40.3 years were included. All patients were reviewed at six months of follow-up. The prognostic factors analyzed were clinical and radiological factors. A new radiological parameter was also studied: the scanographic roof-arc angle. Specific statistical analysis was performed using a logistic regression model.RESULTS:Using a multivariate analysis logistic regression model: roof impaction (p = 0.001; OR = 6.59; CI 95% [2.01-20.97]), transverse + posterior wall (p = 0.03, OR = 2.52; CI 95% [1.46-13.65]) and surgeons in training (p = 0.02; OR = 1.24; CI 95% [1.07-3.32]) were three independent prognostic factors. Lower values of medial and posterior scanographic roof-arc angle were associated with unsatisfactory reduction. A significant association between unsatisfactory reduction and posterior roof arc angle < 61° was found.CONCLUSIONS:Three independent prognostic factors associated with a risk of unsatisfactory reduction in ORIF for acetabular fractures were identified: roof impaction, transverse + posterior wall fracture and surgeons in training. Scanographic roof-arc angle seems to be a new prognostic factor. Level of Evidence Level 4 retrospective study

Total Talar Prosthesis Replacement after Talar Extrusion

International audienceDislocation of the talus is a serious and extremely rare injury, with 86 cases reported in the published data in 20 years. The reference standard for case management involves replacement of the dislocated talus to restore the height and function of the tibiotalar joint. The risk of avascular necrosis remains very high, and the standard treatment in such cases is tibiotalar arthrodesis. We report the case of total dislocation of the talus, which was treated with the insertion of a custom total talar prosthesis affixed directly to the tibial cartilage at 6 months after injury. At the 2-year follow-up point, the preliminary results were rather encouraging, with well-functioning activity and an improved American Orthopaedic Foot and Ankle Society foot function scale score increasing from 11 to 77 of 100 and a Short-Form 36-item Health Survey score increasing from 17 to 82. Much longer follow-up periods are necessary to evaluate longer term trends

Outcomes of acetabular fractures in the elderly: a five year retrospective study of twenty seven patients with primary total hip replacement

International audienceOpen reduction and internal fixation (ORIF) in osteoporotic acetabular fractures is quite difficult with high risk of implant failure. Total hip arthroplasty (THA) may be an effective option for treating acetabular fractures in appropriately selected patients, with immediate full weightbearing. The aim of the study was to evaluate the functional outcomes of primary THA for acetabular fractures in elderly patients.METHODS:Between 2010 and 2015, 27 elderly patients operated for acetabular fractures by primary THA were included. The surgical technique associated plate stabilization of both acetabular columns with THA using an acetabular reinforcement cross-plate. Mean age was 68.5 years (57-84) and mean ASA was 2 (1-3). The mean follow-up was four years.RESULTS:The mean Harris score was 70.4 ± 23 (24-90), and the mean Postel-Merle Aubigné (PMA) score was 14.3 ± 4 (7-18). For 17 patients with rank of pre-operative Devane 4, the post-operative rank was unchanged (p < 0.05). Twenty patients (74%) were satisfied by the surgical treatment. Twenty post-operative complications (74%) were found. Two patients died during follow-up (7%).CONCLUSIONS:Primary THA for acetabular fracture in the elderly population might be a good therapeutic option that allows return to the previous daily life activity. Three patients (11%) became bedridden, and four patient's skiers (15%) returned to skiing. However, this surgery is difficult and selection of elderly patients, i.e., with acetabular fractures who are expected to get a poor result with ORIF, i.e., fracture patterns with posterior wall lesion and marginal impaction, for primary THA in an experienced centre provides satisfactory clinical results