Traumatic hernia of the abdominal wall after pelvic and acetabular fracture: a case report.

Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature.

Elysia timida (Risso, 1818) three decades of research

During the last 30 years, studies on Elysia timida (Risso, 1818) have addressed various aspects related to food sources, photosynthetic efficiency of kleptoplasts, population genetics, chemical ecology and reproductive biology, both in the Mediterranean Sea and in the Mar Menor coastal lagoon. E. timida shows a strong specific interaction with Acetabularia acetabulum, retaining functional chloroplasts for at least 45 days and obtaining extra energy in periods when food resources are scarce. It shows control of parapodia, avoiding pigment photodestruction under oversaturated light conditions. The chemical ecological relationships established between E. timida and its potential predator fish, Thalassoma pavo, have also been evaluated, and it has been found that that the extracts of the mollusc contain repellent and unpalatable polypropionate compounds. Population genetics has demonstrated the genetic divergence between populations showing high and significant values of FST and genetic distances, and at least six privative alleles that are not shared with Mediterranean populations have been detected in lagoon populations. This sacoglossan is a poecilogonic species, and its lagoon populations show a greater reproductive output than Mediterranean populations; they produce a greater number of egg masses and embyros per individual, and the capsules have a wider diameter.

Colour morphotypes of Elysia timida (Sacoglossa, Gastropoda) are determined by light acclimation in food algae

Elysia timida (Risso, 1818) colonizing the shallow waters of the Mar Menor Lagoon (Spain) exhibit a brown and a green morph. It was hypothesised that these morphs were the result of feeding preferentially on brown and green algae, respectively. E. timida and its potential food sources, Acetabularia acetabulum (Chlorophyta) and Halopteris filicina (Heterokontophyta) were collected by snorkelling during April 2010. Photosynthetic pigments were analysed by HPLC, photo-physiological parameters were estimated by PAM fluorometry and body colour was characterized by spectral reflectance. Digital photography was used to count the number and area of red spots (small red dots on the slug’s surface) on the parapodia of the 2 morphs. In the laboratory, green E. timida was fed with A. acetabulum cultured under 2 light treatments (high light, 600 µmol E m−2 s−1 and low light, 40 µmol E m−2 s−1), and digital photography was used to monitor colour alterations in E. timida. Spectral reflectance confirmed the colour differences, but both morphs showed a pigment composition similar to the green alga A. acetabulum and showed none of the pigments present in the brown alga H. filicina, neither immediately after collection of the slugs in situ, nor after the feeding experiment. A. acetabulum grown under high light intensity changed from green to brown colour and E. timida changed to brown colour when fed with high-light acclimated A. acetabulum. Thus, E. timida colour differences could not be attributed to feeding on different algae groups but was likely the result of feeding on A. acetabulum growing under different light intensities.

Elysia timida (Risso, 1818) three decades of research

Elysia timida (Risso, 1818) three decades of research.— During the last 30 years, studies on Elysia timida (Risso, 1818) have addressed various aspects related to food sources, photosynthetic efficiency of kleptoplasts, population genetics, chemical ecology and reproductive biology, both in the Mediterranean Sea and in the Mar Menor coastal lagoon. E. timida shows a strong specific interaction with Acetabularia acetabulum, retaining functional chloroplasts for at least 45 days and obtaining extra energy in periods when food resources are scarce. It shows control of parapodia, avoiding pigment photodestruction under oversaturated light conditions. The chemical ecological relationships established between E. timida and its potential predator fish, Thalassoma pavo, have also been evaluated, and it has been found that that the extracts of the mollusc contain repellent and unpalatable polypropionate compounds. Population genetics has demonstrated the genetic divergence between populations showing high and significant values of FST and genetic distances, and at least six privative alleles that are not shared with Mediterranean populations have been detected in lagoon populations. This sacoglossan is a poecilogonic species, and its lagoon populations show a greater reproductive output than Mediterranean populations; they produce a greater number of egg masses and embyros per individual, and the capsules have a wider diameter.

Tomographic index as auxiliary criteria for surgery indication in fracture dislocation of acetabulum posterior wall

There are situations which the tomographic exam is done on the affected hip or situations where the contralateral hip presents abnormalities that make it impossible to compare. In this study we aimed to evaluate a tomographic index that does not require comparison between the both hips. Twenty two patients with unilateral acetabular fracture dislocation with fracture of posterior wall were studied. We established the relationship between the remaining posterior wall and the femoral head diameter (head/wall index-H/W index). We evaluated 45 two-dimensional computed tomography scan in normal hips and established the H/W index. In 45 normal hips we simulated a posterior wall fracture with involvement of 25% and 30% of the posterior wall and calculated the H/W index. We divided into five groups with five different H/W index (fractured group with non surgical treatment; fractured group; normal group; normal group with simulated fracture of 25% and; 30% of the posterior wall). 2.4 was the lowest limit of confidence interval of the group with 25% of the posterior wall fracture. When we analyzed the confidence interval of the 30% fracture group the upper limit of the confidence interval was 2.7, close to the lower limit of the surgical group that was 2.9. Thus, we suggest the 2.4 the H/W index limit as an auxiliary criteria to indicate whether or not to operate. H/W index is helpful to decide whether or not surgery indication in the fracture dislocation of the posterior wall of the acetabulum. © 2012 Fujiki et al.; licensee BioMed Central Ltd.

Gunshot wounds to the acetabulum

To classify the fracture patterns of gunshot wounds to the acetabulum; identify the associated injuries and complications; determine the predictors of poor outcome and deep infection; and propose a treatment algorithm based on the results.

Die operative Behandlung der Azetabulum-T-Fraktur über eine chirurgische Hüftluxation oder einen Stoppa-Zugang. [Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach]

OBJECTIVE: Anatomic reduction and stable fixation by means of tissue- preserving surgical approaches. INDICATIONS Displaced acetabular fractures. Surgical hip dislocation approach with larger displacement of the posterior column in comparison to the anterior column, transtectal fractures, additional intraarticular fragments, marginal impaction. Stoppa approach with larger displacement of the anterior column in comparison to the posterior column. A combined approach might be necessary with difficult reduction. CONTRAINDICATIONS Fractures > 15 days (then ilioinguinal or extended iliofemoral approaches). Suprapubic catheters and abdominal problems (e.g., previous laparotomy due to visceral injuries) with Stoppa approach (then switch to classic ilioinguinal approach). SURGICAL TECHNIQUE: Surgical hip dislocation: lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Reduction and fixation of the posterior column with plate and screws. Fixation of the anterior column with a lag screw in direction of the superior pubic ramus. Stoppa approach: supine position. Incision according to Pfannenstiel. Longitudinal splitting of the anterior portion of the rectus sheet and the rectus abdominis muscle. Blunt dissection of the space of Retzius. Ligation of the corona mortis, if present. Blunt dissection of the quadrilateral plate and the anterior column. Reduction of the anterior column and fixation with a reconstruction plate. Fixation of the posterior column with lag screws. If necessary, the first window of the ilioinguinal approach can be used for reduction and fixation of the posterior column. POSTOPERATIVE MANAGEMENT: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline, if a surgical dislocation was performed. Maximum weight bearing 10-15 kg for 8 weeks. Then, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis for 8 weeks postoperatively. RESULTS: 17 patients with a mean follow-up of 3.2 years. Ten patients were operated via surgical hip dislocation, two patients with a Stoppa approach, and five using a combined or alternative approach. Anatomic reduction was achieved in ten of the twelve patients (83%) without primary total hip arthroplasty. Mean operation time 3.3 h for surgical hip dislocation and 4.2 h for the Stoppa approach. Complications comprised one delayed trochanteric union, one heterotopic ossification, and one loss of reduction. There were no cases of avascular necrosis. In two patients, a total hip arthroplasty was performed due to the development of secondary hip osteoarthritis.

Acetabulum injuries in infancy and childhood

In this article, the anatomical and morphological features of the acetabulum in infancy and childhood are presented. The pathology and treatment of older children and adolescents is deliberately not covered, because the fracture morphology and treatment of patients aged 13 to 15 years is based on the criteria of adult medicine. Especially in the younger child, the anatomical differences are of particular importance. The younger the child is, the more difficult the diagnosis. Therefore today, MRI examinations should be generous used, even if anesthesia is necessary. If the injured child is hemodynamic stable, anesthesia can be electively used for a more complex diagnosis. Acetabular fractures are particularly problematic in infancy because even with optimal treatment and perfect reduction growth disturbances can occur. These manifest as so-called secondary dysplasia. During treatment, care should be taken to ensure that a surgical team having experience with the infant and juvenile skeleton is available and that appropriate implants are available.

Anterior approaches to the acetabulum

Since the 1960s the ilioinguinal approach by Letournel with the three anatomic windows has been successfully established for the treatment of acetabular fractures involving predominantly the anterior column. The previous standard approach, the iliofemoral approach by Smith-Petersen, is still used for the therapy of anterior wall or isolated femoral head fractures. The increase in acetabular fractures in the elderly with lateral compression fractures after lateral falls, characterized by medial displacement of the quadrilateral plate and superomedial dome impaction, led to the use of the intrapelvic modified Stoppa approach with or without the first window of the ilioinguinal approach in the 1990s. To combine the advantages of the second and third windows of the ilioinguinal approach and the medial view of the modified Stoppa approach the Berne research group recently introduced the pararectus approach in acetabular surgery, which can be used as a less invasive acetabular surgical (LIAS) technique especially in the elderly.

Posterior approaches to the acetabulum

Posterior approaches to the hip joint were developed by Langenbeck and Kocher in the nineteenth century. Letournel created the term Kocher-Langenbeck approach which became one of the most important approaches to the hip joint. The further extension of this approach by digastric trochanteric osteotomy and subsequently by surgical hip dislocation enables visualization of the entire hip joint which allows complete evaluation of articular joint damage, quality of reduction and confirmation of extra-articular hardware. With the increasing incidence of acetabular fractures in the elderly there is a concomitant increase of complicating factors, such as multifragmentary posterior wall fractures, dome impaction, marginal impaction and femoral head damage. These factors are negative predictors and compromise a favorable outcome after acetabular surgery. With direct joint visualization these factors can be reliably recognized and corrected as adequately as possible. Surgical hip dislocation thus offers advantages in complex posterior wall, transverse and T-shaped fractures with or without posterior wall involvement. For these fracture types surgical hip dislocation represents a standard approach in our hands.