Acetabular fracture
Introduction
Introduction to acetabular fractures The hip bone is composed of the humerus, the ischial bone and the pubis. The outer side has a large and deep socket called the acetabulum, and the femoral head forms the hip joint. The acetabulum is an important part of the hip joint. Because the hip joint is heavy and has a large degree of activity, it is easy to cause damage. The acetabular fracture can be caused by pubic ischial or tibial fractures in the pelvic fracture and affect the acetabulum. It can also be caused by central dislocation of the hip. basic knowledge Sickness ratio: 5% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock, vascular injury, traumatic arthritis
Cause
Causes of acetabular fractures
Cause:
Mostly caused by indirect violence and violent violence. It is common when the human body falls from a height and a large femur collides with the ground. At this time, the impact of the femoral head on the acetabulum can cause the acetabular non-displacement fracture or the acetabular inner wall fracture block to shift into the pelvic cavity. Violence along the longitudinal axis of the femur can also cause a fracture of the posterior edge of the acetabulum when the hip is bent. If the lower extremity is in the end position, it will be prone to posterior dislocation of the hip joint in addition to the acetabular fracture, and when the lower extremity is abducted, it may cause comminuted fracture of the acetabular top. In addition, crush injuries can also cause acetabular fractures.
Prevention
Acetabular fracture prevention
Joint stiffness Some patients often limit the movement of the affected joint in order to grow the bones in the normal position of the fracture, which makes it easy to cause adhesion between the muscles, tendons and ligaments, which makes the joints stiff. Therefore, patients with fractures should be properly placed in the joints of the gypsum or splint to ensure that the blood vessels are unobstructed. In addition, the muscles of the fixed part should also be properly contracted and relaxed to prevent muscle contracture. Encourage multiple activities: Moderate exercise can strengthen bone strength on the one hand, and maintain muscle strength and good balance on the other, reducing the chance of falls. This is also one of the prevention methods for fractures.
Complication
Complications of acetabular fractures Complications, shock, vascular injury, traumatic arthritis
1. Shock: If the fracture involves other parts of the pelvis, or if the acetabular fracture is part of a multiple fracture of the body, it may cause shock due to pain and massive blood loss.
2. Infection: Most acetabular fractures are accompanied by severe local soft tissue injury or abdominal and pelvic visceral injuries, which will increase the chance of infection. In addition, in order to maintain the blood supply of the fracture piece during surgery, it is often retained as a result of severe contusion. The soft tissue pedicles associated with the fractures, once infected, often become a breeding ground for bacterial growth.
3. Neurovascular injury: the posterior part of the hip joint is adjacent to the sciatic nerve. When the fracture is displaced or the operation is reset, the nerve is vulnerable to injury. When the Kocher-Langenbeck approach is used, the sciatic nerve may mainly affect the sacral branch. The sciatic nerve may also be injured during the approach. The knee joint should be flexed at least 60° during the operation, and the hip joint should be stretched. This is beneficial to reduce the sciatic nerve traction. After the neural crest, the sacral-foot brace should be used. It is expected to recover partially or completely, but it takes a long time. When the fracture involves a large ischial notch, the sciatic nerve, the gluteal nerve and the gluteal blood vessel may be injured during the operation. The latter may be retracted into the pelvic cavity if it is broken at the sciatic notch. It is difficult to stop bleeding, and should be very cautious when exposing and repairing fractures.
4. Heterotopic bone: Kocher-Langenbeck has the highest incidence, followed by the extended patellofemoral approach, while the groin approach rarely occurs. Surgery should minimize muscle trauma. Preoperative and postoperative months. Non-steroidal anti-inflammatory drugs are given to prevent the occurrence and aggravation of heterotopic ossification.
5. Traumatic arthritis: Although the acetabular fracture is restored, it can still lead to incomplete anastomosis of the femoral head and acetabular surface, reduce the contact area between the femoral head and the acetabulum, and increase the local pressure when the weight is loaded, eventually leading to articular cartilage. Wear and traumatic arthritis.
Symptom
Symptoms of acetabular fractures Common symptoms Local tingling of the joints of the hips can be seen on the outside of the hips. The lower limbs are shortened below the thighs or knees... Children's hip pain
The main manifestations are local pain and limited mobility of the hip joint. For example, the dislocation of the femoral head is characterized by corresponding lower limb deformity and elastic fixation. When the central dislocation of the hip occurs, the degree of pain and dysfunction is not as good as before and after the hip joint. Dislocation, physical signs are not obvious, severe dislocation can be manifested as shortened limbs.
In acetabular fractures, pelvic hemorrhage, urethral or nerve damage, and rupture of the pelvic ring and ipsilateral lower extremity fractures should be performed to prevent omission.
The classification of acetabular fractures is generally based on the Letournel classification method. The acetabular fractures are divided into five simple fractures and a composite fracture composed of these simple fractures.
(1) Simple fracture: posterior wall, posterior column, anterior wall, anterior column and transverse fracture.
(2) composite fractures: posterior and posterior, lateral and posterior, "T", anterior and posterior transverse, two-column fractures, in which "T" fractures resemble transverse fractures, just along the tetragonal surface and The acetabular fossa has a vertical rupture that separates the anterior and posterior columns, sometimes accompanied by a subpubic fracture. The so-called posterior semi-horizontal shape refers to a transverse fracture of the posterior column.
Examine
Examination of acetabular fractures
X-ray and CT examination can confirm the diagnosis and displacement of the fracture.
X-ray film: X-ray examination is commonly used in medicine as one of the auxiliary examination methods. Clinically used x-ray examination methods are both fluoroscopy and radiography. The film can clearly display the structure of the examined part on the x-ray film and can be stored as an objective record for a long time, so that it can be studied at any time when needed or compared at the time of review. X-ray special inspections such as tomography, oscillography, and angiography can also be performed when necessary.
Diagnosis
Diagnosis and diagnosis of acetabular fracture
Diagnostic criteria
History of trauma, local pain and activity limitation of the hip. When combined with dislocation, there may be deformities of the lower extremities and elastic fixation. After the fracture is found by the pelvic X-ray anterior slice, the 45° oblique X-ray film of the pelvis can be re-taken. CT examination and three-dimensional reconstruction after scanning to determine the extent of the fracture and the displacement of the fracture piece.
The pelvic X-ray plain film on the sacral line and the sacral line are the radiographic signs of the anterior and posterior columns, respectively. The 45° obturator oblique position is to rotate the injured side acetabulum to the X-ray tube, which can better display the acetabulum. The anterior column and posterior margin, the oblique position of the humerus is the fracture of the acetabulum from the X-ray tube, which can show the large, small ischial notch and the leading edge of the epiphysis.
CT examination is particularly helpful in the determination of certain fractures that are difficult to observe on X-ray films, such as fractures on the quadrilateral surface, acetabular fractures, etc. Three-dimensional reconstruction after CT examination can show the panoramic and precise movement of the fracture. Bit direction.
Differential diagnosis
This disease is generally not confused with other diseases.
