In a Mexican Hospital, Acetabular Fractures are the Cause of Injury by: Dr. Fernandez

Introduction

The study's goal is to determine the relationship between surgically treated acetabular fractures, associated lesions, and the need for pelvic stabilisation before definitive fixation.

Retrospective review of patients with acetabular fractures treated surgically at the Mexican Red Cross Central Hospital between August 2013 and January 2016. Descriptive statistical analysis in terms of frequency, proportions, and X2 were performed to determine qualitative dependency among variables, with a P value of 0.05 used to determine significance.32 patients were sampled, 26 of whom were males with an average age of 36.3 years. 75% were caused by an accident involving a motor vehicle (P=0.0052). Damage control orthopaedics were performed in 68.7% of cases, with a positive relationship between this and subsequent surgical treatment (P=0.0052). Damage control orthopaedics were performed in 68.7% of cases, with a positive relationship between this and subsequent surgical treatment (P=0.0052). Letournel's classification showed that 28.1% of the fractures were an anterior wall, followed by both columns, anterior columns, and posterior walls tied. Non-orthopaedic associated lesions were present in all cases, with the most common being thoracic abdominal and pelvic contusion (40.6%), head trauma (21.8%), and renal and sciatic nerve injury (both 6.25%). The sacroiliac dislocation was the most common orthopaedic-related injury, with 40.6% being significant (P= 0.0019). 

We discovered a link between these injuries and high-energy mechanisms, as well as the presence of other injuries and the need for some stabilisation due to pelvic ring disruption. Disruption of the pelvic ring as a result of a traumatic event is associated with a high risk of death from haemorrhage and is an indicator of severe trauma. They were previously thought to be extremely rare lesions. In the Iliad, Homer describes Diomedes throwing a stone on Aeneas's thigh "where the hip turns toward the pelvis at the cup joint." Pearson 2800 years later in cadaveric models reproduced a mechanism that is still valid in terms of the direct impact of the femoral head on the joint surface by a vectorial force in the manner of a mediaeval battering ram (the femoral head) against a curved gate (the articular cup). The current increase in motor vehicle accidents, the incidence of falls from great heights, and the general population's improvement in medical services and quality of life have managed to stage these injuries in adults in a bimodal frequency: Patients are typically males in their prime who suffer trauma from a high-energy mechanism, or a mixed elderly population who suffers a low-energy fall. It is extremely rare in the paediatric population and is considered an unequivocal indicator of intra-abdominal haemorrhage. They are also associated as the causal agent with automobile accidents, running over, and sports injuries, as well as a high incidence of accompanying brain, thoracic, or orthopaedic injuries. The anatomical and histological differences between a paediatric and adult pelvis, as well as the anatomical peculiarities of the main joint of the legs, make consensus on the diagnosis, classification, and management of these injuries difficult. A high-energy mechanism is defined as an injury caused by any type of traffic accident, falls from more than one level of height, and industrial and agricultural injuries. A minimum acceleration of 48 km/h (30 mph) is required in a frontal collision to cause a pelvic ring disruption, and the kinetic energy dissipated in the event is responsible for the concomitant injuries that these cases present in the whole body economy.

Summary

Acetabular fractures pose a diagnostic and surgical challenge for the orthopedist. Increased motor vehicle traffic and urbanisation in developing economies such as Mexico will result in an increase in the frequency of these injuries. The diagnosis and management of these lesions are difficult; there is a direct correlation between the surgeon's experience in detecting these lesions radiographically and the results obtained. Because the anatomy and histology of the paediatric pelvis modify the kinematics of the injury in children, and because all classifications of pelvic and acetabular injuries are currently insufficient for the anatomical variability and presentation of these lesions, there is controversy in the staging between paediatric and adult patients. In the last 50 years, the treatment of pelvic injuries has significantly improved, transforming them from entities with a high risk of morbidity and mortality due to internal bleeding and associated injuries to entities with a better prognosis. Because of the extensive amount of resources and personnel required to comprehensively treat these cases and provide follow-up, rehabilitation, and also attend to their sequelae and complications, these injuries disproportionately burden the health system and the patient's environment. The majority of the reported cases had some type of injury to another accompanying organ or system, and the associated orthopaedic injuries were a direct result of the initial injury mechanism and subsequent disruption of the pelvic ring. Although it is not within the scope of the study, several registered patients underwent surgical procedures from other specialities (CAT, LAPE, Diagnostic Peritoneal Lavage, etc.), increasing the patient's metabolic response. Patients' morbidity and mortality are increasing as a result of the second blow. In order to treat these patients as a priority, orthopaedic damage control is required, which in this case consists of pelvic stabilisation via invasive or non-invasive methods in polytraumatized patients with pelvic instability that does not allow fixation. In a 24-hour period, definitive We discovered a direct link between the presence of these injuries and acute pelvic stabilisation for in-hospital and symptomatic control while awaiting definitive surgical treatment in this study. This is because, during the study's scope, the host hospital protocolizes damage control in orthopaedics, and the vast majority of registered files had some type of previous pelvic stabilization, which the literature establishes improves in-hospital management prognosis.

Submission open for Special Issue: https://www.jotsrr.org/

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