At the request of our publishers, I accepted the task of preparing this second edition. I felt this was necessary for several reasons: new imaging technologies such as CT scanning and 3-D reconstructions are now used routinely, the in dications for employing improved approaches are clearer, and reconstructions are facilitated by new internal fixation devices. Above all, I thought it was time to report the long-term results of the 940 acetabular fractures, 90070 of which were treated surgically - a unique series. In spite of the experience acquired from the three previous reviews of cases…mehr
At the request of our publishers, I accepted the task of preparing this second edition. I felt this was necessary for several reasons: new imaging technologies such as CT scanning and 3-D reconstructions are now used routinely, the in dications for employing improved approaches are clearer, and reconstructions are facilitated by new internal fixation devices. Above all, I thought it was time to report the long-term results of the 940 acetabular fractures, 90070 of which were treated surgically - a unique series. In spite of the experience acquired from the three previous reviews of cases (1966, 1971, and 1978), I failed to foresee the amount of time this revision would need. In fact, it took more than 3 years to follow up the larger number of cases, and 159 patients (out of 800, i. e. 22. 7%) were not included as they had moved since their last review and simply could not be located. At a time when it is in fashion to evaluate the cost of health care, it is strange to see how public administrators, so keen on evaluating the immediate cost of our opera tions, do not care about the quality of their long-term results, which appears to us, however, to be the best basis for the choice of the initial treatment.
Introduction: History and Development of Our Methods of Classification and Treatment of Acetabular Fractures.- 1 Anatomy of the Acetabulum.- 1.1 Columns of the Acetabulum.- 1.2 Posterior Column.- 1.3 Anterior Column.- 1.3.1 Iliac Segment.- 1.3.2 Acetabular Segment.- 1.3.3 Pubic Segment.- 1.4 Structure of the Innominate Bone in Relation to Load-Bearing...- 1.5 Vascular Supply.- 1.5.1 Internal Surface.- 1.5.2 External Surface.- 1.5.3 Acetabulum.- 2 Mechanics of Acetabular Fractures.- 2.1 Force Applied to the Greater Trochanter in the Axis of the Femoral Neck.- 2.1.1 Neutral Abduction-Adduction.- 2.1.2 Abduction and Adduction.- 2.2 Force Applied to the Flexed Knee in the Axis of the Femoral Shaft.- 2.2.1 Hip Joint Flexed 90°.- 2.2.2 Different Degrees of Hip Flexion.- 2.3 Force Applied to Foot with Knee Extended.- 2.3.1 Hip Flexed.- 2.3.2 Hip Extended.- 2.4 Force Applied to Lumbo-sacral Region.- 2.5 Comment.- 2.6 Clinical Correlation.- 2.6.1 Blow on Knee or Dashboard Injuries.- 2.6.2 Blow on Greater Trochanter.- 2.6.3 Blow Under Foot.- 2.6.4 Blow on Sacro-iliac Region.- 2.6.5 Antero-posterior Compression.- 3 Radiology of the Normal Acetabulum.- 3.1 Standard Radiography.- 3.1.1 Anterior-posterior Radiograph of Pelvis.- 3.1.2 Anteroposterior Radiograph of Acetabulum.- 3.1.3 Obturator-oblique Radiograph.- 3.1.4 Iliac-oblique Radiograph.- 3.2 Computed Tomography.- 3.2.1 CT of a Normal Acetabulum.- 3.2.2 Special Advantages of CT.- 3.2.3 Disadvantages of CT.- 3.3 Tomography.- 3.4 Stereo-radiography.- 3.5 Interpreting the Radiographs.- 3.5.1 Interpreting the Standard Views.- 3.5.2 Interpreting the CT Sections to Aid or Complete the Diagnosis.- 4 Classification.- 5 Posterior Wall Fractures.- 5.1 Typical Posterior Wall Fractures.- 5.1.1 Morphology.- 5.1.2 Radiology.- 5.2 Postero-superior Fractures.- 5.2.1 Morphology.- 5.2.2 Radiology.- 5.3 Postero-inferior Fractures.- 5.3.1 Morphology.- 5.3.2 Radiology.- 5.4 Special Forms of Posterior Wall Fractures.- 5.4.1 Extended Posterior Wall Fractures.- 5.4.2 Horizontal Extension of Fracture Line.- 5.4.3 Massive Posterior Wall Fractures.- 5.4.4 Posterior Wall and Incomplete Transverse Fractures.- 5.5 CT Study of Posterior Wall Fractures.- 6 Fractures of the Posterior Column.- 6.1 Typical Posterior Column Fractures.- 6.1.1 Morphology.- 6.1.2 Radiology.- 6.2 Extended Posterior Column Fractures.- 6.2.1 Morphology.- 6.2.2 Radiology.- 6.3 Atypical Posterior Column Fractures.- 6.3.1 Other Associated Pelvic Ring Fractures.- 6.3.2 Epiphyseal Injury.- 6.4 Transitional Posterior Column Fractures.- 6.4.1 Partial Superior Fractures.- 6.4.2 Partial Inferior Fractures.- 6.5 CT Study of Posterior Column Fractures.- 7 Anterior Wall Fractures.- 7.1 Morphology.- 7.2 Radiology.- 7.2.1 Antero-posterior View.- 7.2.2 Obturator-oblique View.- 7.2.3 Iliac-oblique View.- 7.3 Atypical Examples.- 7.4 CT Study of Anterior Wall Fractures.- 8 Fractures of the Anterior Column.- 8.1 Morphology.- 8.1.1 Very Low Fractures.- 8.1.2 Low Fractures.- 8.1.3 Intermediate Fractures.- 8.1.4 High Fractures.- 8.1.5 Atypical Examples.- 8.2 Radiology.- 8.2.1 Very Low Fractures.- 8.2.2 Low Fractures.- 8.2.3 Intermediate Fractures.- 8.2.4 High Fractures.- 8.2.5 Atypical Examples.- 8.3 CT Study of Anterior Column Fractures.- 9 Pure Transverse Fractures.- 9.1 Morphology.- 9.1.1 Orientation of Fracture.- 9.1.2 Displacement in Transverse Fractures.- 9.2 Radiology.- 9.2.1 Antero-posterior View.- 9.2.2 Obturator-oblique View.- 9.2.3 Iliac-oblique View.- 9.3 Atypical Cases.- 9.4 CT Scan Study of Transverse Fractures.- 10 T-shaped Fractures.- 10.1 Morphology.- 10.1.1 Transverse Component.- 10.1.2 Stem Component.- 10.1.3 Displacement.- 10.2 Radiology.- 10.2.1 Transverse Component.- 10.2.2 Stem Component.- 10.3 Atypical Examples.- 10.3.1 Additional Vertical Fracture of Obturator Ring.- 10.3.2 Additional Fracture Line in Cotyloid Fossa.- 10.3.3 Association of a Posterior Column and an Anterior Hemitransverse Fracture.- 10.4 CT Study of T-Shaped Fractures.- 1
Introduction: History and Development of Our Methods of Classification and Treatment of Acetabular Fractures.- 1 Anatomy of the Acetabulum.- 1.1 Columns of the Acetabulum.- 1.2 Posterior Column.- 1.3 Anterior Column.- 1.3.1 Iliac Segment.- 1.3.2 Acetabular Segment.- 1.3.3 Pubic Segment.- 1.4 Structure of the Innominate Bone in Relation to Load-Bearing...- 1.5 Vascular Supply.- 1.5.1 Internal Surface.- 1.5.2 External Surface.- 1.5.3 Acetabulum.- 2 Mechanics of Acetabular Fractures.- 2.1 Force Applied to the Greater Trochanter in the Axis of the Femoral Neck.- 2.1.1 Neutral Abduction-Adduction.- 2.1.2 Abduction and Adduction.- 2.2 Force Applied to the Flexed Knee in the Axis of the Femoral Shaft.- 2.2.1 Hip Joint Flexed 90°.- 2.2.2 Different Degrees of Hip Flexion.- 2.3 Force Applied to Foot with Knee Extended.- 2.3.1 Hip Flexed.- 2.3.2 Hip Extended.- 2.4 Force Applied to Lumbo-sacral Region.- 2.5 Comment.- 2.6 Clinical Correlation.- 2.6.1 Blow on Knee or Dashboard Injuries.- 2.6.2 Blow on Greater Trochanter.- 2.6.3 Blow Under Foot.- 2.6.4 Blow on Sacro-iliac Region.- 2.6.5 Antero-posterior Compression.- 3 Radiology of the Normal Acetabulum.- 3.1 Standard Radiography.- 3.1.1 Anterior-posterior Radiograph of Pelvis.- 3.1.2 Anteroposterior Radiograph of Acetabulum.- 3.1.3 Obturator-oblique Radiograph.- 3.1.4 Iliac-oblique Radiograph.- 3.2 Computed Tomography.- 3.2.1 CT of a Normal Acetabulum.- 3.2.2 Special Advantages of CT.- 3.2.3 Disadvantages of CT.- 3.3 Tomography.- 3.4 Stereo-radiography.- 3.5 Interpreting the Radiographs.- 3.5.1 Interpreting the Standard Views.- 3.5.2 Interpreting the CT Sections to Aid or Complete the Diagnosis.- 4 Classification.- 5 Posterior Wall Fractures.- 5.1 Typical Posterior Wall Fractures.- 5.1.1 Morphology.- 5.1.2 Radiology.- 5.2 Postero-superior Fractures.- 5.2.1 Morphology.- 5.2.2 Radiology.- 5.3 Postero-inferior Fractures.- 5.3.1 Morphology.- 5.3.2 Radiology.- 5.4 Special Forms of Posterior Wall Fractures.- 5.4.1 Extended Posterior Wall Fractures.- 5.4.2 Horizontal Extension of Fracture Line.- 5.4.3 Massive Posterior Wall Fractures.- 5.4.4 Posterior Wall and Incomplete Transverse Fractures.- 5.5 CT Study of Posterior Wall Fractures.- 6 Fractures of the Posterior Column.- 6.1 Typical Posterior Column Fractures.- 6.1.1 Morphology.- 6.1.2 Radiology.- 6.2 Extended Posterior Column Fractures.- 6.2.1 Morphology.- 6.2.2 Radiology.- 6.3 Atypical Posterior Column Fractures.- 6.3.1 Other Associated Pelvic Ring Fractures.- 6.3.2 Epiphyseal Injury.- 6.4 Transitional Posterior Column Fractures.- 6.4.1 Partial Superior Fractures.- 6.4.2 Partial Inferior Fractures.- 6.5 CT Study of Posterior Column Fractures.- 7 Anterior Wall Fractures.- 7.1 Morphology.- 7.2 Radiology.- 7.2.1 Antero-posterior View.- 7.2.2 Obturator-oblique View.- 7.2.3 Iliac-oblique View.- 7.3 Atypical Examples.- 7.4 CT Study of Anterior Wall Fractures.- 8 Fractures of the Anterior Column.- 8.1 Morphology.- 8.1.1 Very Low Fractures.- 8.1.2 Low Fractures.- 8.1.3 Intermediate Fractures.- 8.1.4 High Fractures.- 8.1.5 Atypical Examples.- 8.2 Radiology.- 8.2.1 Very Low Fractures.- 8.2.2 Low Fractures.- 8.2.3 Intermediate Fractures.- 8.2.4 High Fractures.- 8.2.5 Atypical Examples.- 8.3 CT Study of Anterior Column Fractures.- 9 Pure Transverse Fractures.- 9.1 Morphology.- 9.1.1 Orientation of Fracture.- 9.1.2 Displacement in Transverse Fractures.- 9.2 Radiology.- 9.2.1 Antero-posterior View.- 9.2.2 Obturator-oblique View.- 9.2.3 Iliac-oblique View.- 9.3 Atypical Cases.- 9.4 CT Scan Study of Transverse Fractures.- 10 T-shaped Fractures.- 10.1 Morphology.- 10.1.1 Transverse Component.- 10.1.2 Stem Component.- 10.1.3 Displacement.- 10.2 Radiology.- 10.2.1 Transverse Component.- 10.2.2 Stem Component.- 10.3 Atypical Examples.- 10.3.1 Additional Vertical Fracture of Obturator Ring.- 10.3.2 Additional Fracture Line in Cotyloid Fossa.- 10.3.3 Association of a Posterior Column and an Anterior Hemitransverse Fracture.- 10.4 CT Study of T-Shaped Fractures.- 1
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