Firoozabadi, J Orthop Trauma 2015 - Determining Stability in Posterior Wall Acetabular Fractures

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Determining Stability in Posterior Wall Acetabular Fractures

Firoozabadi, Tornetta, et al.·J Orthop Trauma·2015·53 citations·Diagnostic study

Purpose

To determine if the radiographic parameters of femoral head coverage by the intact posterior wall, acetabular version, and location of the fracture or a history of dislocation were determinates of hip stability in patients with posterior wall acetabular fractures.

Methods

Design: Retrospective review.

Setting: Level I trauma hospital.

Patients: 185 consecutive patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures.

Intervention: Patients underwent dynamic stress fluoroscopic examination under general anesthesia to determine hip stability.

Main Outcome Measures: A number of radiographic measurements were performed, and an examination under anesthesia served as a standard to compare stable versus unstable hips.

Results

Examination under anesthesia (EUA) determined 116 hips to be stable and 22 hips as unstable.
Moed and Keith method of wall size measurements and cranial exit point of fracture was statistically different between stable and unstable hips.
23 percent of the unstable hips had wall sizes less than 20%.
Average cranial exit point of fracture from dome was 5.0 mm in the unstable group and 9.5 mm in the stable group, and fractures that extend into the dome demonstrate a statistically significant increase in hip instability.

Conclusions

Determination of hip stability can be challenging in patients with posterior wall acetabular fractures. Our data suggest that the location of the exit point of the fracture in relation to the dome of the acetabulum is a radiographic marker that can be used to aid physician in determining stability, and wall sizes less than 20% is not a reliable indicator of stability.

Level of evidence: Diagnostic Level II. Copyright remains with the authors and publisher.

Determining Stability in Posterior Wall Acetabular Fractures

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Determining Stability in Posterior Wall Acetabular Fractures

Firoozabadi, Tornetta, et al.·J Orthop Trauma·2015·53 citations·Diagnostic study

Purpose

To determine if the radiographic parameters of femoral head coverage by the intact posterior wall, acetabular version, and location of the fracture or a history of dislocation were determinates of hip stability in patients with posterior wall acetabular fractures.

Methods

Design: Retrospective review.

Setting: Level I trauma hospital.

Patients: 185 consecutive patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures.

Intervention: Patients underwent dynamic stress fluoroscopic examination under general anesthesia to determine hip stability.

Main Outcome Measures: A number of radiographic measurements were performed, and an examination under anesthesia served as a standard to compare stable versus unstable hips.

Results

Examination under anesthesia (EUA) determined 116 hips to be stable and 22 hips as unstable.
Moed and Keith method of wall size measurements and cranial exit point of fracture was statistically different between stable and unstable hips.
23 percent of the unstable hips had wall sizes less than 20%.
Average cranial exit point of fracture from dome was 5.0 mm in the unstable group and 9.5 mm in the stable group, and fractures that extend into the dome demonstrate a statistically significant increase in hip instability.

Conclusions

Determination of hip stability can be challenging in patients with posterior wall acetabular fractures. Our data suggest that the location of the exit point of the fracture in relation to the dome of the acetabulum is a radiographic marker that can be used to aid physician in determining stability, and wall sizes less than 20% is not a reliable indicator of stability.

Level of evidence: Diagnostic Level II. Copyright remains with the authors and publisher.

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