Function Outcome of Impaction Injuries in Acetabular Fractures

Acetabular Fracture Clinical Trial

Official title:

Short-Term Outcome of Surgical Treatment of Osteochondral Impaction in Acetabular Fractures

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03152266
• Other study ID #: OCIA
• Status: Completed
• Start date: June 1, 2017
• Est. completion date: June 30, 2022

Study information

• Verified date: June 2022
• Source: Assiut University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Is the anatomical reduction of osteochondral impaction in the acetabular fractures will improve the functional outcome? Despite the increasing amount of literature related to the management of anteromedial dome impactions and marginal impactions, there are still remaining issues and controversies pertaining mainly to the exact anatomy and location of the lesion, the best method of reduction, the need and type of subchondral void filling, the best method of stabilization, the need of reduction in elderly population and its true value as an outcome prognostic factor.

Description:

The reduction of the impacted fragment done through many ways and techniques , all acetabular approaches can be used to reach to the impacted part or through independent cortical window, The impacted part can be reached through the fracture itself as in marginal impaction through the posterior wall and in anteromedial impaction through the quadrilateral plate. Then using a bone graft as a void filling which can be taken from iliac bone or greater trochanter. Post-operative x-rays and computed tomography scan will be done to all patients , Radiological grading immediate post-operative and at the last follow-up according to Matta , Heterotopic ossification will be classified according to the Brooker classes on an Anteroposterior radiograph, Posttraumatic arthritis will be evaluated according to the method by Kellgren and Lawrence, functional outcome will be assessed according to Merle D'Aubigne and Postel scoring which was modified by Matta, Avascular necrosis of hips will be classified according to Ficat and Arlet classification.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 42
• Est. completion date: June 30, 2022
• Est. primary completion date: June 1, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 15 Years and older

Eligibility

Inclusion Criteria:

• Traumatic Osteochondral impaction injuries of the acetabulum (marginal and dome ).
• Pure impaction without cortical interruption
• Closed fractures.
• Skeletally mature (adults and elderly).

Exclusion Criteria:

• Fractures in skeletally immature patients.
• Pathological fractures .
• Associated proximal Hip fractures.
• Open acetabular Fractures.
• Fractures more than 3 weeks

Related Conditions & MeSH terms

• Acetabular Fracture
• Fractures, Bone

Intervention

Other:
• No intervention. Observational study
Follow up of the function of the hip after reduction of the impacted fragment which associated with acetabular fractures

Locations

Country	Name	City	State
Egypt	Assiut faculty of medicine	Assiut

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

Country where clinical trial is conducted

Egypt, 

References & Publications (21)

Bertrand R, Derancourt J, Kassab R. Molecular movements in the actomyosin complex: F-actin-promoted internal cross-linking of the 25- and 20-kDa heavy chain fragments of skeletal myosin subfragment. Biochemistry. 1992 Dec 8;31(48):12219-26. — View Citation

Bhandari M, Matta J, Ferguson T, Matthys G. Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip. J Bone Joint Surg Br. 2006 Dec;88(12):1618-24. — View Citation

Casstevens C, Archdeacon MT, d'Heurle A, Finnan R. Intrapelvic reduction and buttress screw stabilization of dome impaction of the acetabulum: a technical trick. J Orthop Trauma. 2014 Jun;28(6):e133-7. doi: 10.1097/BOT.0000000000000005. — View Citation

Collinge CA, Lebus GF. Techniques for reduction of the quadrilateral surface and dome impaction when using the anterior intrapelvic (modified Stoppa) approach. J Orthop Trauma. 2015 Feb;29 Suppl 2:S20-4. doi: 10.1097/BOT.0000000000000271. — View Citation

Gänsslen A, Hildebrand F, Kretek C. Transverse + posterior wall fractures of the acetabulum: epidemiology, operative management and long-term results. Acta Chir Orthop Traumatol Cech. 2013;80(1):27-33. — View Citation

Giannoudis PV, Kanakaris NK, Delli Sante E, Morell DJ, Stengel D, Prevezas N. Acetabular fractures with marginal impaction: mid-term results. Bone Joint J. 2013 Feb;95-B(2):230-8. doi: 10.1302/0301-620X.95B2.30548. — View Citation

Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury. 2010 Oct;41(10):986-95. doi: 10.1016/j.injury.2010.08.003. Review. — View Citation

Jeffcoat DM, Carroll EA, Huber FG, Goldman AT, Miller AN, Lorich DG, Helfet DL. Operative treatment of acetabular fractures in an older population through a limited ilioinguinal approach. J Orthop Trauma. 2012 May;26(5):284-9. doi: 10.1097/BOT.0b013e31821e10a2. — View Citation

Kreder HJ, Rozen N, Borkhoff CM, Laflamme YG, McKee MD, Schemitsch EH, Stephen DJ. Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall. J Bone Joint Surg Br. 2006 Jun;88(6):776-82. — View Citation

Laflamme GY, Hebert-Davies J. Direct reduction technique for superomedial dome impaction in geriatric acetabular fractures. J Orthop Trauma. 2014 Feb;28(2):e39-43. doi: 10.1097/BOT.0b013e318298ef0a. — View Citation

Leucht P, Castillo AB, Bellino MJ. Comparison of tricalcium phosphate cement and cancellous autograft as bone void filler in acetabular fractures with marginal impaction. Injury. 2013 Jul;44(7):969-74. doi: 10.1016/j.injury.2013.04.017. Epub 2013 May 14. — View Citation

Lubovsky O, Kreder M, Wright DA, Kiss A, Gallant A, Kreder HJ, Whyne CM. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures. J Orthop Res. 2013 Dec;31(12):1980-5. doi: 10.1002/jor.22458. Epub 2013 Aug 12. — View Citation

Manson T, Schmidt AH. Acetabular Fractures in the Elderly: A Critical Analysis Review. JBJS Rev. 2016 Oct 4;4(10). pii: e1. doi: 10.2106/JBJS.RVW.15.00090. Review. — View Citation

Martins e Souza P, Giordano V, Goldsztajn F, Siciliano AA, Grizendi JA, Dias MV. Marginal impaction in posterior wall fractures of the acetabulum. AJR Am J Roentgenol. 2015 Apr;204(4):W470-4. doi: 10.2214/AJR.14.12451. — View Citation

Moed BR, WillsonCarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am. 2002 May;84(5):752-8. — View Citation

Moed BR, Yu PH, Gruson KI. Functional outcomes of acetabular fractures. J Bone Joint Surg Am. 2003 Oct;85(10):1879-83. — View Citation

Scolaro JA, Routt ML Jr. Reduction of osteoarticular acetabular dome impaction through an independent iliac cortical window. Injury. 2013 Dec;44(12):1959-64. doi: 10.1016/j.injury.2013.07.012. Epub 2013 Aug 2. — View Citation

Tosounidis TH, Stengel D, Giannoudis PV. Anteromedial dome impaction in acetabular fractures: Issues and controversies. Injury. 2016 Aug;47(8):1605-7. doi: 10.1016/j.injury.2016.07.020. — View Citation

Ugino FK, Righetti CM, Alves DP, Guimarães RP, Honda EK, Ono NK. Evaluation of the reliability of the modified Merle d'Aubigné and Postel Method. Acta Ortop Bras. 2012;20(4):213-7. doi: 10.1590/S1413-78522012000400004. — View Citation

Wu XB, Wang MY, Zhu SW, Cao QY, Wu HH. [Marginal impaction in acetabular fractures]. Zhonghua Wai Ke Za Zhi. 2003 Apr;41(4):289-91. Chinese. — View Citation

Zhuang Y, Lei JL, Wei X, Lu DG, Zhang K. Surgical treatment of acetabulum top compression fracture with sea gull sign. Orthop Surg. 2015 May;7(2):146-54. doi: 10.1111/os.12175. — View Citation

* Note: There are 21 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	modified Merle d'Aubigne and Postel scoring	The modified Merle D'Aubigné clinical hip score is the most generally accepted clinical grading system for evaluating the results of acetabular fracture treatment , which evaluates pain, gait and mobility, on a scale.	6th month