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VOLUME 11 , ISSUE 2 ( August, 2016 ) > List of Articles

Original Article

Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures

Lalit Maini, Sahil Batra, Rajat Gupta, Sumit Arora

Keywords : Avascular necrosis, Femoral head, Acetabular fracture, Obturator externus, Piriformis

Citation Information : Maini L, Batra S, Gupta R, Arora S. Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures. 2016; 11 (2):105-111.

DOI: 10.1007/s11751-016-0253-7

License: CC BY-NC-SA 4.0

Published Online: 01-06-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.


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  1. Tannast M, Krüger A, Mack PW, Powell JN, Hosalkar HS, Siebenrock KA (2010) Surgical dislocation of the hip for the fixation of acetabular fractures. J Bone Joint Surg Br 92:842-852
  2. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within 3 weeks after the injury. J Bone Joint Surg Am 78:1632-1645
  3. Mayo KA (1994) Open reduction and internal fixation of fractures of the acetabulum. Clin Orthop 305:31-37
  4. Giannoudis PV, Grotz MRW, Papakostidis C (2005) Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg Br 87:2-9
  5. Hadjicostas PT, Thielemann FW (2008) The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures. Injury 39:907-913
  6. Siebenrock KA, Gautier E, Woo AKH, Ganz R (2002) Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma 16:543-552
  7. Panagiotis T, Elias P (2007) Long term results in surgically treated acetabular fractures through the posterior approaches. Trauma 62:378-382
  8. Heeg M, Klasen HJ, Visser JD (1990) Operative treatment for acetabular fractures. J Bone Joint Surg Br 72:383-386
  9. Naranje S, Shamshery P, Yadav CS (2010) Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures. Arch Orthop Trauma Surg 130:93-101
  10. Briffa N, Pearce R, Hill AM, Bircher M (2011) Outcomes of acetabular fracture fixation with 10 years follow-up. J Bone Joint Surg Br 93:229-236
  11. Gautier E, Ganz K, Krugel N (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 82:679-683
  12. Rybak LD (2003) Torriani M magnetic resonance imaging of sports related muscle injuries. Top Magn Reson Imaging 14:209-219
  13. Griffin DB, Beaule PE, Matta JM (2005) Safety and efficacy of the extended ilio-femoral approach in the treatment of complex fractures of the acetabulum. J Bone Joint Surg Br 87:1391-1396
  14. Ganz R, Gill TJ, Gautier E (2001) Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83:1119-1124
  15. Tannast M, Pleus F, Bonel H, Galloway H, Siebenrock KA, Anderson SE (2010) Magnetic resonance imaging in traumatic posterior hip dislocation. J Orthop Trauma 24(12):723-731
  16. Jungbluth KH, Sauer HD (1984) The internal fixation of displaced acetabular fractures: a follow study. In: Weller S, Hierholzer G, Hermichen HG (eds) Late results after osteosynthesis. Collective studies of the German section of AO/ASIF International. AO Bulletin, 63-74
  17. Uchida K, Kokubo Y, Yayama T, Nakajima H, Miyazaki T, Negoro K et al (2013) Fracture of the acetabulum: a retrospective review of ninety-one patients treated at a single institution. Eur J Orthop Surg Traumatol 23:155-163
  18. Mitsionis G, Lykissas M, Motsis E, Mitsiou D, Gkiatas I, Xenakis T et al (2012) Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma 26:460-465
  19. Matta JM, Merritt PO (1988) Displaced acetabular fractures. Clin Orthop 230:83-97
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