Department of Orthopaedic Surgery, Davis Medical Center, University of California, Sacramento, CA.
Department of Orthopaedics, Naval Medical Center San Diego, San Diego, CA.
J Orthop Trauma. 2019 May;33(5):229-233. doi: 10.1097/BOT.0000000000001427.
To report the incidence of patients with extra-articular posterosuperior acetabular cortical impaction associated with a posterior wall acetabular fracture-dislocation.
Retrospective case series.
Regional Level 1 trauma center.
PATIENTS/PARTICIPANTS: Ninety-seven patients who sustained an isolated posterior wall acetabular fracture-dislocation from July 2007 until July 2017.
The medical record and the computed tomography (CT) scan of the abdomen and pelvis were reviewed including axial, coronal, and sagittal reconstruction images and 3D surface renderings.
Each pelvic CT scan was evaluated for impaction of the extra-articular posterosuperior acetabular cortical surface associated with posterior wall acetabular fracture-dislocations. The reduction accuracy was assessed for each patient with cortical impaction using postoperative CT scans. The final attending radiology report was reviewed to see whether the cortical impaction was noted.
Four of the 99 patients (4.12%) had identifiable areas of cortical impaction on preoperative CT imaging. Reduction accuracy demonstrated 1 anatomical reduction, 2 imperfect reductions, and 1 poor reduction. The final attending radiologist report did not comment on any patient with cortical impaction.
Our study demonstrates that a small number of patients sustain cortical impaction of the posterosuperior acetabular cortical surface along with their posterior wall acetabular fracture-dislocation. Although uncommon, preoperative imaging should be scrutinized to identify this clinical entity. As part of the preoperative plan, the surgeon can anticipate the cortex available for reduction verification and whether any additional steps or altered surgical approaches are needed to achieve an anatomical reduction.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告与髋臼后侧壁骨折脱位相关的髋臼后上关节外皮质撞击的患者发生率。
回顾性病例系列研究。
区域 1 级创伤中心。
患者/参与者：2007 年 7 月至 2017 年 7 月期间，97 例单独发生髋臼后侧壁骨折脱位的患者。
回顾了病历和腹部及骨盆的计算机断层扫描（CT），包括轴位、冠状位和矢状位重建图像和 3D 表面渲染图。
对每例髋臼 CT 扫描进行评估，以确定与髋臼后侧壁骨折脱位相关的髋臼后上关节外皮质表面的撞击情况。使用术后 CT 扫描评估有皮质撞击的每位患者的复位准确性。对皮质撞击进行了评估。查看最终主治放射科医生的报告，以了解是否注意到皮质撞击。
99 例患者中有 4 例（4.12%）在术前 CT 成像上有可识别的皮质撞击区。复位准确性显示 1 例解剖复位，2 例不完全复位，1 例复位不良。最终主治放射科医生的报告并未对任何有皮质撞击的患者发表评论。
我们的研究表明，一小部分患者在发生髋臼后侧壁骨折脱位的同时伴有髋臼后上关节外皮质撞击。尽管不常见，但术前影像学检查应仔细观察以识别这种临床实体。作为术前计划的一部分，外科医生可以预测可用于复位验证的皮质，并确定是否需要任何额外的步骤或改变手术方法来实现解剖复位。
预后 IV 级。有关证据水平的完整描述，请参见作者说明。
