Subscribe to RSS
DOI: 10.1055/a-1085-2717
Asymptomatic and Unnoticed Intra-articular Screw Over 18 Years after Fracture of the Posterior Wall of the Acetabulum – a Question of Stability?
Microinstability after Acetabular Fracture Article in several languages: English | deutsch![](https://www.thieme-connect.de/media/zfo/202103/lookinside/thumbnails/10-1055-a-1085-2717_ou5470_en-1.jpg)
Abstract
Fractures of the posterior wall of the acetabulum occur in a frequency of 25 – 30%. Multifragmentary fractures involving 40 – 50% of the acetabular surface, the quality of reduction as well as involvement of cartilage and acetabular labrum are considered to have an impact on the development of a reduced posterior stability of the hip joint. This results in a shift of the main weight bearing area with development of a posttraumatic osteoarthritis. In the presented case, a 42-year old male patient was operated on 18 years ago due to a posterior acetabular wall fracture. Retrospectively, one of the screws was located partially intraarticular. However, the patient was asymptomatic over the 18-year period. The first consultation was due to unspecific symptoms of osteoarthritis of the right hip joint especially during flexion and external rotation. Due to only mild radiological signs of osteoarthritis, we indicated only the removal of the intraarticular screw. The symptoms postoperatively switched to a feeling of instability, so a total hip arthroplasty was performed. Since the operation, the patient is asymptomatic regarding the hip joint. The intraarticular screw seemed to stabilize the hip joint. This case demonstrates the importance of a good posterior guidance for the stability of the hip joint on one hand. On the other hand, it demonstrates the minor stress load of the posterior acetabular region, especially after fracture of the posterior wall. Therefore, a good posterior guidance should be one major aim of treatment of posterior acetabular wall fractures.
Publication History
Article published online:
03 February 2020
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Moed BR, Ajibade DA, Israel H. Computed tomography as a predictor of hip stability status in posterior wall fractures of the acetabulum. J Orthop Trauma 2009; 23: 7-15
- 2 Olson SA, Finkemeier CG. Posterior wall fractures. Oper Tech Orthop 1999; 9: 148-160
- 3 Judet R, Letournel E. Fractures of the Acetabulum. 2nd ed.. ed. Berlin: Springer; 1993
- 4 Harnroongroj T, Suangyanon P, Tharmviboonsri T. et al. Posterior acetabular arc angle of the femoral head assesses instability of posterior fracture – dislocation of the hip. Int Orthop 2013; 37: 1141-1145
- 5 Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996; 78: 1632-1645
- 6 Baumgaertner MR. Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg 1999; 7: 54-65
- 7 Saterbak AM, Marsh JL, Nepola JV. et al. Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 2000; 14: 230-237
- 8 Noguchi Y, Miura H, Takasugi S. et al. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior weight-bearing area: an arthroscopic observation. Arthroscopy 1999; 15: 496-506
- 9 Firoozabadi R, Spitler C, Schlepp C. et al. Determining stability in posterior wall acetabular fractures. J Orthop Trauma 2015; 29: 465-469
- 10 Burnett RS, Della Rocca GJ, Prather H. et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 2006; 88: 1448-1457
- 11 Ragnarsson B, Mjöberg B. Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand 1992; 63: 511-514
- 12 Chuckpaiwong B, Suwanwong P, Harnroongroj T. Roof-arc angle and weight-bearing area of the acetabulum. Injury 2009; 40: 1064-1066
- 13 Olson SA, Bay BK, Chapman MW. et al. Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am 1995; 77: 1184-1192
- 14 Yoo JH, Hwang JH, Chang JD. et al. Management of traumatic labral tear in acetabular fractures with posterior wall component. Orthop Traumatol Surg Res 2014; 100: 187-192
- 15 Kalisvaart MM, Safran MR. Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg 2015; 2: 123-135
- 16 Ferguson SJ, Bryant JT, Ganz R. et al. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000; 33: 953-960
- 17 Ikeda T, Awaya G, Suzuki S. et al. Torn acetabular labrum in young patients. Arthroscopic diagnosis and management. J Bone Joint Surg Br 1988; 70: 13-16
- 18 Ferguson SJ, Bryant JT, Ganz R. et al. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003; 36: 171-178