Ahmed Hazem Abdelazeem

Background: Long-term prospective data on periacetabular osteotomy (PAO) from Middle Eastern populations are limited. This study evaluated ≥ seven year clinical, functional, and radiographic outcomes following PAO and identified predictors of survivorship. Methods: Thirty-six consecutive patients (34.6 ± 7.2 years; 78% female) undergoing PAO (2014–2018) were prospectively followed. Inclusion required symptomatic dysplasia with Tönnis 0–2. Outcomes included HHS, WOMAC, HOS, SF-36, radiographic parameters (LCEA, AI), complications, and THA conversion. Reliability, multivariate regression, and Kaplan–Meier analyses were performed. Results: At 7.8 ± 1.2 years, HHS improved from 63.5 ± 11.2 to 89.6 ± 7.8 ( p < 0.001). LCEA increased from 16.2 ± 4.3° to 31.8 ± 3.9° and AI decreased from 22.8 ± 5.1° to 7.2 ± 3.6°. ICC for measurements was 0.92. Complications occurred in 16.7% (mostly minor). THA conversion was 5.6%, both with preoperative Tönnis 2 and correction < 12°. Magnitude of LCEA correction independently predicted HHS improvement (β = 0.41, p < 0.01). Conclusions: PAO achieved durable correction and sustained functional improvement with low THA conversion at mid- to long-term follow-up. Preoperative cartilage status and adequacy of correction are key determinants of outcome.

Introduction: Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and may lead to femoroacetabular impingement, early osteoarthritis, and long-term functional disability if inadequately treated. While in situ pinning remains the standard treatment for mild slips, it fails to correct the deformity in moderate and severe cases, potentially predisposing to degenerative changes. The modified Dunn procedure (MDP) was developed to restore proximal femoral anatomy through surgical hip dislocation while preserving vascular supply. The aim of the study is to evaluate the long-term radiological and functional outcomes of the MDP in patients with moderate (14 cases) and severe (10 cases) SCFE, and to assess the incidence of avascular necrosis (AVN), osteoarthritis, and other complications. Methods: A prospective case series was conducted between August 2015 and January 2019 at a single tertiary institution. A total of 24 hips with moderate-to-severe SCFE and open physis were treated using the MDP via surgical hip dislocation. Mild and acute-only slips were excluded. MDP was used as a primary procedure, performed early in severe slips and in selected moderate slips after clinical assessment. Patients were followed clinically and radiologically for a mean duration of 84 ± 2.6 months (range 80–88 months). Functional outcomes were assessed using the Harris Hip Score (HHS) and Merle d’Aubigné and Postel score. Radiographic outcomes and complications, including AVN and secondary arthritis, were documented. Fixation was performed using Schanz screws, cannulated screws, or K-wires according to intraoperative findings. Results: The mean preoperative slip angle (48.3° ± 7.2°) significantly improved postoperatively (11.4° ± 3.1°, p < 0.001). HHS improved from a preoperative mean of 70.4 ± 5.8 to 92.9 ± 4.2 at final follow-up ( p < 0.001). The Merle d’Aubigné and Postel score improved from 13.8 ± 1.6 preoperatively to 17.5 ± 0.9 at final follow-up ( p < 0.001). AVN developed in 4 out of 24 hips (16.7%). Arthritis developed in 2 out of 24 hips (8.3%, degenerative OA; no septic arthritis or chondrolysis), representing a total of 6 out of 24 hips (25%) with significant complications when combined with AVN. No cases of postoperative instability or wound infection occurred. Functional scores showed sustained improvement in the majority of patients. Conclusions: MDP offers favorable long-term anatomical correction and functional recovery in moderate-to-severe SCFE. However, the risk of AVN and arthritis, particularly in unstable or severe cases, warrants careful patient selection and technical precision. Extended follow-up is essential to detect late complications and evaluate procedural durability.

Objective: Neglected acetabular fractures, defined as those not addressed surgically within three weeks of injury, pose significant technical and prognostic challenges due to chronic displacement, malunion, and soft tissue contracture. This study aimed to evaluate radiological and functional outcomes of open reduction and internal fixation (ORIF) in a large prospective cohort managed at a tertiary trauma center. Methods: Between 2009 and 2019, patients aged 14 years and older with displaced, neglected acetabular fractures (> 3 weeks post-injury) were enrolled at a high-volume Level I pelvic trauma center. Exclusion criteria included pathological fractures, fresh fractures, unreconstructable articular surfaces, and patients who did not complete the minimum follow-up period. Of the total cohort, 94 patients underwent ORIF and were analyzed. Preoperative evaluation included CT imaging, and fractures were classified using the Letournel–Judet system. Radiological reduction quality was graded by Matta’s criteria, and functional recovery was assessed using the modified Merle d’Aubigné–Postel score. Secondary outcomes included complication rates and conversion to THA. For subgroup analysis, patients were stratified into early-late presenters (3–5 weeks) and very-late presenters (> 5 weeks). Statistical analysis employed chi-square tests for categorical variables, Student’s t-test or Mann–Whitney U test for continuous variables, and multivariate logistic regression to identify predictors of outcome, with significance set at p < 0.05. Results: Among the 94 patients analyzed, anatomical reduction (≤ 1 mm displacement) was achieved in 59.6%, with imperfect and poor reductions in 26.6% and 13.8%, respectively. Quality of reduction (β = 0.44, p < 0.001) and surgical delay (β = − 0.32, p = 0.006) independently predicted functional outcome, while fracture type and femoral head condition were not significant.On subgroup comparison, early-late presenters (3–5 weeks) showed a trend toward better outcomes compared with very-late presenters (> 5 weeks), although differences did not reach statistical significance. Major complications included heterotopic ossification (12.8%), post-traumatic arthritis (14.9%), avascular necrosis (9.6%), and conversion to THA during follow-up (10.6%). Conclusion: This study represents one of the largest prospective series on neglected acetabular fractures with midterm follow-up. Despite delayed presentation, ORIF achieved satisfactory anatomical and functional results in most cases. Early surgical intervention within the neglected window was associated with superior outcomes, while subgroup analysis highlighted a gradual adverse effect of increasing delay. These findings underscore the importance of individualized surgical strategies, meticulous planning, and experienced surgical execution in optimizing results for this challenging patient population.

Mahmoud Fahmy, MD, Mahmoud Abdel Karim, MD, Ahmed Hazem Abdelazeem, MD, Ahmed Magdy Abdelrazek, MSc. Hip Pelvis 2025;37:64-71. https://doi.org/10.5371/hp.2025.37.1.64

Purpose: To assess the reliability of sequential examination under anaesthesia (EUA) to determine pelvic instability and to evaluate radiological and functional outcomes in unstable lateral compression (LC) injuries. Methods: A prospective case series study was conducted from 2020 to 2022 at a university hospital on 43 cases with LC injuries that met the inclusion criteria. Sequential EUA was carried out in three steps. Posterior-only fixation or anterior–posterior fixation was done according to the algorithm. Each patient was followed up for at least 12 months, both radiologically and functionally. Results: Forty cases proved unstable and were fixed. None showed secondary displacement in the anterior–posterior fixation group. However, five cases (19.2%) of the posterior-only fixation group showed secondary displacement with a mean of 5.9 mm. Four cases of them had tetra-ramic injuries. There is a high tendency for secondary displacement at 14.5 mm or more preoperative displacement of the rami. Patients with secondary displacement showed comparable functional outcome scores to patients without secondary displacement. Posterior-only fixation showed shorter operative time, lesser radiological exposure, blood loss and iatrogenic nerve injury than anterior–posterior fixation. Conclusion: EUA is a reliable method to determine pelvic instability and management plan for LC fractures with unilateral anterior ring injury. Anterior–posterior fixation is needed if there is a tetra-ramic fracture or initial anterior ring displacement of 14.5 mm or more, irrespective of EUA.

Purpose Different reduction techniques and tools are described to facilitate anatomical reduction of acetabular fractures. However, maintenance of reduction, plate placement, and fracture fixation remain a challenge owing to the large surface area occupied by the available reduction tools. This study aims at radiological and functional assessment of the effectiveness of a novel reduction technique for the posterior column element in displaced acetabular fractures. Methods A prospective study was conducted for evaluation of a novel reduction technique; the use of the conventional large holding Verbrugge forceps for reduction of posterior column and transverse, with or without posterior wall, fractures. Intra-operative safety and reduction time were evaluated. The immediate postoperative quality of reduction was assessed using Matta radiographic criteria. The functional outcome was evaluated at the latest follow-up visit using the modified Merle d’Aubigne and Postel (MDP) score. Results Thirty patients with a mean follow-up of 18.1 months were included. Fifteen had transverse/posterior wall, ten had transverse, and five had posterior column fractures. All fractures were displaced ≥ 2 mm on anteroposterior and/or Judet views of the pelvis without traction. The average operative time was 100.4 min with 12.5 min reduction time. No intra-operative complications were encountered. Twenty-three patients (76.6%) had anatomical while seven (23.3%) had imperfect reduction. The functional outcome score was excellent in three patients, good in 18, fair in four, and poor in five patients at the latest follow-up. Conclusion The use of the conventional large Verbrugge bone-holding forceps for the reduction of the posterior column element in displaced acetabular fractures using the Kocher–Langenbeck approach is a safe, effective, time-saving, and technically undemanding procedure.

Introduction Failure to neutralize the different physiological forces acting on the inferior as well as the superior regions of the pubic symphysis, the long healing time, is blamed for the repeated failures of conventional superior symphyseal plating. Material and methods A three years prospective case series study between January 2017 and December 2019 was done, to evaluate the radiological and the functional outcomes, using Matta/Tornetta and Majeed criteria respectively, of the combination of trans-symphyseal cross-screws configuration and superior symphyseal plate in Tile-type B1 pelvic injuries. Results Thirty patients, 18 with anteroposterior compression type II and 12 with type III, with a mean follow-up of 20 months ±5 were included. Radiologically, 26 (86.6%) cases showed an excellent, one (3.3%) good and three (10%) fair outcome. Clinically, excellent outcome in 26 (86.6%) cases, good in two (6.6%) cases, and fair in two (6.6%). Intra-operative drill bit breakage occurred in three (10%) cases and was the only reported technical complication. Significant re-displacement was reported in three (10%) cases. Conclusion The open trans-symphyseal cross-screws for fixation of the superior symphyseal plate is a simple, efficient, and safe technique with the biomechanical advantages of an extra-fixation point to the inferior symphysis together with a long and a strong bony anchorage.

Introduction Numerous approaches were described for the management of Pipkin’s type I fracture with no consensus on the “standard of care”. The strategic thinking of the ideal access is through the medial approach. Material and methods Using Ferguson intermuscular interval, prospective study was done (January 2014–2019) to evaluate radiological and functional outcomes using HHS and Thompson-Epstein criteria. Fracture patterns were subclassified: anterior and posterior-inferior (AI/PI) requiring different reduction positions. Results Twenty-one patients (mean FU = 24.3 months (range, 12–48)) were divided into 14 (67.7%) AI and seven PI. Excision was performed in five (23.8%) (AI = 3 (14.3%) and PI = 2) and ORIF in 16 (AI = 11 (52.4%) and PI = 5). At the last follow-up, two (9.5%) were graded as excellent, 11 (52.4%) as good, three (14.3%) as fair, and five as poor. Conclusion Modified Ludloff’s approach provides safe easy direct access to fracture allowing easy excision or direct anatomical reduction, perpendicular compression, and rigid fixation with minimal complications.