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Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics...
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Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 September 2023) | Viewed by 5346

Special Issue Editor

Prof. Dr. Florian Baumann

E-Mail Website
Guest Editor
Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
Interests: pelvic fracture management; acetabulum fractures; hip surgery; pediatric trauma

Special Issue Information

Dear Colleagues,

Surgical management of pelvic and acetabulum fractures can be challenging. Demographic changes in industrial societies have led to a dramatic increase in pelvic and acetabulum fractures in the elderly. This trend goes along with a shift in fracture patterns and treatment strategies. In the past, pelvic and acetabulum fractures were mainly caused by high-energy trauma in young patients. Nowadays, the majority of fractures of the pelvis and acetabulum occur in elderly patients after simple falls. Poor bone quality and frailty are complicating the management of these fractures. However, innovative instruments and anatomic implants have led to significant improvements in the treatment of pelvic and acetabulum fractures. Digital imaging technology such as 3D imaging and post-processing of radiographic images have changed diagnostic and therapeutic processing in trauma care. New applications such as automated fracture detection, three-dimensional planning, surgical navigation, and additive manufacturing of surgical instruments are just the beginning of a digital revolution in pelvic and acetabulum fracture management. Improved visualization technology can provide a better understanding of the surgical anatomy of the pelvis and may enable the surgeon to achieve greater safety by individualization of the fracture care. Prospective studies on patient-related outcome measurement (PROM) have to prove the superiority of these new applications. 

This Special Issue puts a spotlight on novel insights in diagnostics and treatment of fractures of the pelvis and the acetabulum.

Prof. Dr. Florian Baumann
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pelvic fracture
  • acetabulum fracture
  • reconstructive hip surgery
  • surgical navigation
  • 3D imaging technology
  • patient-related outcome management

Published Papers (5 papers)

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Research

12 pages, 1392 KiB  
Article
Early Stabilization Does Not Increase Complication Rates in Acetabular Fractures of the Elderly: A Retrospective Analysis from the German Pelvis Registry
by Stephan Regenbogen, Iris Leister, Alexander Trulson, Lisa Wenzel, Jan Friederichs, Fabian M. Stuby, Andreas Höch, Markus Beck and Working Group on Pelvic Fractures of the German Trauma Society
J. Clin. Med. 2023, 12(22), 7043; https://doi.org/10.3390/jcm12227043 - 11 Nov 2023
Viewed by 712
Abstract
Background: The incidence of acetabular fractures in geriatric patients has increased. Although there are strong data supporting the early operative treatment of hip fractures in geriatric patients, the optimal timing for acetabular fractures remains unclear and for several reasons, delayed treatment after [...] Read more.
Background: The incidence of acetabular fractures in geriatric patients has increased. Although there are strong data supporting the early operative treatment of hip fractures in geriatric patients, the optimal timing for acetabular fractures remains unclear and for several reasons, delayed treatment after trauma is common. Methods: A retrospective analysis of the German Pelvis Registry between 2008 and 2017 was performed. Ultimately, 665 patients with fractures of the anterior column or anterior column and posterior hemitransverse were enrolled. Patients above and below 65 years of age with these fracture types were analyzed regarding surgery day (within 48 hours, between 2 and 4 days, after 4 days), complication rate, reduction quality, and hospital stay. Results: The complication rate of the geriatric group was twice as high as that of younger patients; however, this finding was independent of the timing of surgery. Reduction quality and hospital stay were independent of surgical timing. Conclusions: In contrast to other fracture types, such as proximal femur fractures, the timing of surgery for acetabular fractures does not have a significant impact on the patient’s outcome. The optimal time for surgery cannot be determined using the current data. However, as expected, there is a significantly higher risk for postoperative complications in the geriatric population. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
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11 pages, 18839 KiB  
Article
The Association between Acetabulum Fractures and Subsequent Coxarthrosis in a Cohort of 77 Patients—A Retrospective Analysis of Predictors for Secondary Hip Osteoarthritis
by Rafał Wójcicki, Tomasz Pielak, Jakub Erdmann, Piotr Walus, Bartłomiej Małkowski, Jakub Ohla, Łukasz Łapaj, Michał Wiciński and Jan Zabrzyński
J. Clin. Med. 2023, 12(20), 6553; https://doi.org/10.3390/jcm12206553 - 16 Oct 2023
Viewed by 1108
Abstract
Objective: the aim of this study was to document the occurrence of THA after acetabulum surgery and examine the factors that predict its occurrence. Methods: This study included 77 consecutive patients who were admitted for acetabulum fracture surgery between 2012 and 2019. The [...] Read more.
Objective: the aim of this study was to document the occurrence of THA after acetabulum surgery and examine the factors that predict its occurrence. Methods: This study included 77 consecutive patients who were admitted for acetabulum fracture surgery between 2012 and 2019. The inclusion criteria were acetabular fractures and indications for operative management. The exclusion criteria were acetabular fractures treated non-operatively, fractures requiring primary THA, and periprosthetic acetabular fractures. Data concerning demographics, date of injury, date of surgery, surgical approach, stabilization, and further reconstructive surgery were collected retrospectively. The number of patients who underwent THA and their risk factors were recorded. The minimum follow-up for each patient was 2 years of observation. A total of 77 patients with a mean age of 53 years were included. Results: At a mean follow-up of 2 years, THA was performed in 16 (20.8%) patients due to post-traumatic arthritis. An analysis of the surgical approaches showed that the Kocher–Langenbeck approach increased the risk of THA nearly 12 times compared with the ilioinguinal approach (p = 0.016). Furthermore, the duration of the waiting period for surgery significantly impacted the occurrence of THA, with each additional day leading to an 89% increase in the risk of prosthesis usage (p = 0.001). Conclusions: This study suggests that acetabular fractures may lead to post-traumatic hip osteoarthritis. The surgical approach and the waiting time for surgery are potential factors that may predict secondary hip osteoarthritis and the need for subsequent THA. However, further investigations should be performed to establish predictors for secondary hip osteoarthritis, and especially to determine the impact of the surgical approach. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
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18 pages, 2419 KiB  
Article
Effects of Iliosacral Joint Immobilization on Walking after Iliosacral Screw Fixation in Humans
by Katharina Jäckle, Takashi Yoshida, Kira Neigefink, Marc-Pascal Meier, Mark-Tilmann Seitz, Thelonius Hawellek, Gabriela von Lewinski, Paul Jonathan Roch, Lukas Weiser, Arndt F. Schilling and Wolfgang Lehmann
J. Clin. Med. 2023, 12(20), 6470; https://doi.org/10.3390/jcm12206470 - 11 Oct 2023
Viewed by 783
Abstract
Background: Pelvis fractures are commonly stabilized by surgical implants to facilitate their healing. However, such implants immobilize the iliosacral joint for up to a year until removal. We report how iliosacral joint immobilization affects the walking of patients. Methods: The gaits of patients [...] Read more.
Background: Pelvis fractures are commonly stabilized by surgical implants to facilitate their healing. However, such implants immobilize the iliosacral joint for up to a year until removal. We report how iliosacral joint immobilization affects the walking of patients. Methods: The gaits of patients with immobilized sacroiliac joints after unstable pelvic fracture (n = 8; mean age: 45.63 ± 23.19; five females and three males) and sex- and age-matched healthy control individuals (n = 8; mean age: 46.50 ± 22.91; five females and three males) were recorded and analyzed using a motion capture system. The forces between the tread and feet were also recorded. Standard gait parameters as well as dynamic patterns of joint angles and moments of the lower extremities were analyzed using the simulation software OpenSim. Results: With the exception of hip extensor strength, the monitored joint parameters of the patients showed task-dependent deviations during walking, i.e., plantarflexor force was increased when stepping on an elevated surface, as were hip flexion and extensor moments, knee flexion and extensor moments, as well as ankle dorsiflexion and the associated negative plantarflexor force during stance on the elevated surface. Conclusions: Iliosacral joint fixation causes reduced forward and upward propulsion and requires an extended range of hip motion in the sagittal plane. Patients show significant mobility limitation after iliosacral screw fixation. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
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9 pages, 1619 KiB  
Article
Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring
by Florian Baumann, Stefano Pagano, Volker Alt and Viola Freigang
J. Clin. Med. 2023, 12(12), 4169; https://doi.org/10.3390/jcm12124169 - 20 Jun 2023
Viewed by 845
Abstract
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric [...] Read more.
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
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9 pages, 1244 KiB  
Article
Comparison of Percutaneous Screw Fixation to Open Reduction and Internal Fixation in Acetabular Fractures: A Matched Pair Study Regarding the Short-Term Rate of Conversion to Total Hip Arthroplasty and Functional Outcomes
by Stephanie Einhorn, Andreas Höch, Georg Osterhoff, Christoph Josten, Christian Kleber and Philipp Pieroh
J. Clin. Med. 2023, 12(3), 1163; https://doi.org/10.3390/jcm12031163 - 1 Feb 2023
Viewed by 1210
Abstract
Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were [...] Read more.
Closed reduction and percutaneous internal fixation (CRPIF) for acetabular fractures was introduced as a less invasive alternative to open reduction and internal fixation (ORIF) for moderately displaced fractures. Currently, comparisons of ORIF and CRPIF outcomes are rare. Twenty-three patients treated with CRPIF were matched with patients treated with ORIF based on sex, age, and fracture classification. Surgery-dependent and -independent factors of the in-hospital stay, the conversion rate to total hip arthroplasty (THA), and quality of life were assessed. The ORIF group had a higher preoperative fracture step (p = 0.04) and gull wing sign (p = 0.003) compared with the CRPIF group. Postoperatively, the gap and step size were not significantly different between the groups (p > 0.05). CRPIF required less time (p < 0.0001) and transfusions (p = 0.009) and showed fewer complications (p = 0.0287). Four patients were converted to THA (CRPIF, n = 1; ORIF, n = 3; p = 0.155) because of posttraumatic osteoarthritis. Functional outcomes and pain were similar in both groups (p > 0.05). The present study revealed less blood loss and a lesser extent of reduction in patients treated with CRPIF than in those treated with ORIF. The rates of conversion to THA and functional outcomes did not differ between CRPIF and ORIF. CRPIF appeared to be a valuable treatment option for selected patients. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
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