| Part One Fracture line mapping of pure transverse acetabular fracturesObjectives: To describe and analyze the morphological characteristics,location and frequency of pure transverse acetabular fracture lines through establishing fracture mapping and measuring anatomic parameters.Methods: Forty-nine original CT and clinical data of pure transverse acetabular fractures were retrospectively collected.All cases were divided into62-B1.1(infratectal),62-B1.2(juxtatectal),and 62-B1.3(transtectal)types based on the AO Foundation/Orthopedic Trauma Association(AO/OTA)classification.The Mimics software was used for reconstruction and reduction of fractures.The fracture lines were overlapped onto a standard model to create the fracture map and heatmap.Some anatomic parameters of acetabular fractures were measured and compared in these 3 groups.Results: The study included 19 type 62-B1.1,17 type 62-B1.2,and 13 type 62-B1.3 fractures.The average anterior rim fracture angle of 49 cases was(70.0±11.6)°,and the posterior rim fracture angle was(92.4±28.5)°.The anterior rim fracture angles in 40 cases(40/49,81.6%)fell within a wide range between 63° and 80°.On the heatmap,the hot zones were located on the highest position of the cotyloid fossa and the narrowed region in the junction of ilium and pubis,and the cold zone was on the inferior third of the articular surface.For type 62-B1.3 fractures,the hot zone was located on the posterior area of the acetabular dome.There were no significant differences in anterior rim fracture angle and anterior height among the three groups(P>0.05).Post hoc tests of the posterior rim fracture angle and the posterior height revealed significant differences among three groups(P<0.05).The posterior intra-articular fracture line was significantly longer than the anterior intraarticular fracture line in type 62-B1.1 and type 62-B1.2 fractures(P<0.05).Conclusions: The fracture lines of pure transverse acetabular fractures were concentrated on the narrowed zone in the junction of ilium and pubis,and the posterior fracture lines were diffusely distributed.The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface.The recurrent fracture lines involving the weight-bearing area mainly converged on the posterior region of the roof.Part Two Fracture line and fragment mapping of transverse associated posterior wall acetabular fracturesObjectives: To analyze the morphological characteristics and distribution patterns of transverse fracture line and posterior wall fragment in transverse associated posterior wall acetabular fractures by using computer software and fracture mapping technique.Methods: Sixty-seven imaging data and clinical information of transverse associated posterior wall acetabular fractures were recruited retrospectively.According to AO Foundation/Orthopedic Trauma Association(AO/OTA)classification,67 cases were divided into 62-B1.1(infratectal),62-B1.2(juxtatectal),and 62-B1.3(transtectal)types.Reconstruction and reduction of fractures were operated by using Mimics software.The fracture lines and posterior wall fracture fragments were overlapped onto a standard model to create the fracture line and fragment mapping.The measurements of anatomic parameters related acetabular fracture were also compared in each group.Results: Sixty-seven transverse and posterior wall acetabular fracture cases included 19 type 62-B1.1,17 type 62-B1.2,and 13 type 62-B1.3fractures.All fracture lines were distributed on the superior half and the posterior wall region of acetabulum,and concentrated on the narrowed zone of ilium and pubis.The intra-articular fracture fragments of posterior wall were mainly appeared on the posterior 1/2 of the lunate plane.65(63/65,97.0%)posterior wall fractures involved acetabular dome.There were statistically significant differences in height of transverse fracture and anterior rim fracture angle in type 62-B1.1,type 62-B1.2 and type 62-B1.3(P<0.05).No significant difference was noted in start/end point,range of posterior wall fracture,and intra/extra-articular surface area of posterior wall fracture among three groups(P>0.05).Conclusions: The fracture lines of transverse associated posterior wall acetabular fractures were concentrated on the narrowed zone of ilium and pubis.The posterior wall fracture fragments were mainly appeared on the posterior 1/2 of the lunate plane.Most of posterior wall fractures involved acetabular roof.The locations of intra-articular transverse fracture lines in type62-B1.1,type 62-B1.2 and type 62-B1.3 fractures were diverse,but the characteristics of posterior wall fracture fragments were similar.Part Three Analysis of risk factors for traumatic arthritis after operation of transverse acetabular fracturesObjectives: To count the incidence of traumatic arthritis after open reduction and internal fixation,and to explore risk factors for traumatic arthritis after the operation in transverse acetabular fractures.Methods: A retrospective study was conducted to assess the clinical data of 172 transverse acetabular fracture cases.According to traumatic arthritis occurred or not after operation,all patients were divided into traumatic arthritis group and non-traumatic arthritis group.The demographic characteristics,perioperative information,post-operative follow-up indexes and other combined injuries of the two groups were recorded.Multivariable regression analysis was performed after univariate analysis to investigate independent risk factors for traumatic arthritis after operation for transverse acetabular fractures.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value and calculate the optimal cut-off point.Results: The incidence of post-operated traumatic arthritis in patients with transverse acetabular fracture was 19.2%(33/172).The traumatic arthritis group showed significantly higher ratio of transverse associated posterior wall acetabular fracture,time from injury to surgery,ratio of physical work after surgery,ratio of acetabular roof fracture,and ratio of femoral head injury than those in non-traumatic arthritis group(P < 0.05).Multivariate logistic regression analysis showed that physical work after surgery(OR=6.849,P=0.000),transverse associated posterior wall acetabular fracture(OR=3.122,P=0.040),longer time from injury to surgery(OR=1.117,P=0.039),acetabular roof fracture(OR=3.573,P=0.019)and femoral head injury(OR=4.568,P=0.002)were the independent risk factors for traumatic arthritis after operation of transverse acetabular fractures.The area under the receiver operating characteristic curve(AUC)predicted by time from injury to surgery was 0.651(P=0.007).The optimum critical point was 12.5,the sensitivity and specificity were 55.0% and 75.2%,respectively.Conclusions: Physical work after surgery,transverse associated posterior wall acetabular fracture,longer time from injury to surgery,acetabular roof fracture and femoral head injury were identified as the independent risk factors for traumatic arthritis after operation of transverse acetabular fractures.Increasing attention to the above risk factors and making a targeted assessment of the patient’s condition can help to establish an appropriate planning of treatment and improve the surgical prognosis for patients. |
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