International Orthopaedics

, Volume 36, Issue 12, pp 2559–2563 | Cite as

Acetabular fracture types vary with different acetabular version

  • Clément M. L. Werner
  • Carol E. Copeland
  • Thomas Ruckstuhl
  • Jeff Stromberg
  • Clifford H. Turen
  • Samy Bouaicha
Original Paper
First Online:
Received:
Accepted:

Abstract

Purpose

Acetabular fractures typically occur in high energy trauma. Understanding of the various contributing biomechanical factors and trauma mechanisms is still limited. While several investigations figured out what role femoral position during impact plays in distinct fracture patterns, no data exists on the influence of acetabular version on the fracture type. Our study was carried out to clarify this issue.

Methods

Radiological data sets of 192 patients (145 male, 47 female, age 14–90 years) sustaining acetabular fractures were assessed retrospectively. The crossover ratio of the crossover sign and presence or absence of the posterior wall sign and ischial spine sign were used to determine acetabular retroversion on conventional radiographs. Acetabular version in the axial plane was measured on a computed tomography (CT) scan. Statistics were then performed to analyse the relationship between the acetabular fracture type according to the Letournel classification and acetabular version.

Results

A significant difference (p = 0.029) in acetabular version was found between fractures of the anterior [mean equatorial edge (EE) angle 19.93°] and posterior (mean EE angle 17.53°) acetabulum in the CT scan. No difference was shown on the measurements on conventional radiographs.

Conclusions

Acetabular version in the axial plane has an influence on the acetabular fracture pattern. While more anteverted acetabula were frequently associated with anterior fracture types according to the Letournel classification, retroversion of the acetabulum was associated with posterior fracture types.

Keywords

Fracture Type Acetabular Fracture Generalise Little Square Conventional Radiograph Acetabular Retroversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Laird A, Keating JF (2005) Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg Br 87:969–973PubMedCrossRefGoogle Scholar
  2. 2.
    Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13–S-A20Google Scholar
  3. 3.
    Peltier LF (1965) Complications associated with fractures of the pelvis. J Bone Joint Surg Am 47:1060–1069PubMedGoogle Scholar
  4. 4.
    Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 46:1615–1646PubMedGoogle Scholar
  5. 5.
    Matta JM (1996) 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 78:1632–1645PubMedGoogle Scholar
  6. 6.
    Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br 92:250–257PubMedGoogle Scholar
  7. 7.
    Dakin GJ, Eberhardt AW, Alonso JE, Stannard JP, Mann KA (1999) Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma 47:1063–1071PubMedCrossRefGoogle Scholar
  8. 8.
    Pearson JR, Hargadon EJ (1962) Fractures of the pelvis involving the floor of the acetabulum. J Bone Joint Surg Br 44-B:550–561PubMedGoogle Scholar
  9. 9.
    Urist MR (1948) Fractures of the acetabulum; the nature of the traumatic lesions, treatment, and 2-year end-results. Ann Surg 127:1150–1164CrossRefGoogle Scholar
  10. 10.
    Knight RA, Smith H (1958) Central fractures of the acetabulum. J Bone Joint Surg Am 40-A:1–16, passimPubMedGoogle Scholar
  11. 11.
    Ezoe M, Naito M, Inoue T (2006) The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am 88:372–379PubMedCrossRefGoogle Scholar
  12. 12.
    Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 81:281–288PubMedCrossRefGoogle Scholar
  13. 13.
    Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770PubMedGoogle Scholar
  14. 14.
    Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85-A:278–286PubMedGoogle Scholar
  15. 15.
    Giori NJ, Trousdale RT (2003) Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res 417:263–269PubMedGoogle Scholar
  16. 16.
    Parmar R, Parvizi J (2010) The multifaceted etiology of acetabular labral tears. Surg Technol Int 20:321–327PubMedGoogle Scholar
  17. 17.
    Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res 407:241–248PubMedCrossRefGoogle Scholar
  18. 18.
    Tannast M, Zheng G, Anderegg C et al (2005) Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res 438:182–190PubMedCrossRefGoogle Scholar
  19. 19.
    Werner CM, Copeland CE, Ruckstuhl T, Stromberg J, Seifert B, Turen CH (2008) Prevalence of acetabular dome retroversion in a mixed race adult trauma patient population. Acta Orthop Belg 74:766–772PubMedGoogle Scholar
  20. 20.
    Werner CM, Copeland CE, Stromberg J, Ruckstuhl T (2010) Correlation of the cross-over ratio of the cross-over sign on conventional pelvic radiographs with computed tomography retroversion measurements. Skeletal Radiol 39:655–660PubMedCrossRefGoogle Scholar
  21. 21.
    Werner CM, Copeland CE, Ruckstuhl T et al (2010) Radiographic markers of acetabular retroversion: correlation of the cross-over sign, ischial spine sign and posterior wall sign. Acta Orthop Belg 76:166–173PubMedGoogle Scholar
  22. 22.
    Ozçelik A, Omeroğlu H, Inan U, Ozyurt B, Seber S (2002) Normal values of several acetabular angles on hip radiographs obtained from individuals living in the Eskişehir region. Acta Orthop Traumatol Turc 36:100–105PubMedGoogle Scholar
  23. 23.
    Pinhero J, Bates D, DebRoy S, Sarkar D, the R Core Team. nlme: linear and nonlinear mixed effects models, 1–90Google Scholar
  24. 24.
    Partanen J, Jämsä T, Jalovaara P (2001) Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J Bone Miner Res 16:1540–1546PubMedCrossRefGoogle Scholar
  25. 25.
    Kuhn KM, Riccio AI, Saldua NS, Cassidy J (2010) Acetabular retroversion in military recruits with femoral neck stress fractures. Clin Orthop Relat Res 468:846–851PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Clément M. L. Werner
    • 1
    • 2
    • 3
  • Carol E. Copeland
    • 3
  • Thomas Ruckstuhl
    • 2
  • Jeff Stromberg
    • 3
  • Clifford H. Turen
    • 3
  • Samy Bouaicha
    • 1
    • 2
  1. 1.Division of Trauma SurgeryUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of OrthopaedicsBalgrist University Hospital ZurichZurichSwitzerland
  3. 3.R Adams Cowley Shock Trauma CenterUniversity of Maryland Medical SystemsBaltimoreUSA

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