Preface

This book is intended to provide a concise, yet comprehensive introduction to some common hip and ankle pathologies and their treatment. Newer concepts continue to evolve and to keep abreast with these one should have a sound basic knowledge of the subject.

Every attempt has been made to narrate the concepts in a simplified manner keeping the originality. Wherever possible illustrations have been used to help the reader to understand the subject. The target audience comprises orthopedic surgeons, either in practice or in training, as well as clinicians, radiologists, and physical therapists.

The text is divided into two sections with short chapters providing a broad overview of the anatomy, pathology, and treatment. Selected references are also provided without the claim of being exhaustive and with the aim of stimulating interest and discussion.

We hope that we have succeeded in providing a useful and practical tool for the identification of some hip and ankle pathologies, and we remain open to any suggestions and criticisms for improvement in the future.

> **Carlos Suarez-Ahedo** Hospital Medica Sur, Mexico City

**Anell Olivos-Meza** Instituto Nacional de Rehabilitación, Mexico

> **Arie M. Rijke** University of Virginia, USA

**1**

Section 1

Hip

Section 1 Hip

**3**

**Chapter 1**

**Abstract**

and Biomechanics

using Modified Harris Hip score.

**1. Introduction**

corona mortis, secondary congruence

*Sachin Kumar Sharma and Hemant Mathur*

Surgical Anatomy of Acetabulum

Both column acetabular fractures are challenging articular injuries. Majority of them are treated operatively. The concept of "secondary congruence" was introduced by Letournel. Despite this, biomechanical data on secondary congruence indicate that nonoperative treatment leads to an increase in peak pressures in the supra-acetabular region with the potential risk of developing posttraumatic degenerative osteoarthritis. Operative management is therefore justified. A cohort of 10 patients having both column (anterior and posterior) acetabular fractures managed using bicolumnar plating between Jan 2016 and Dec 2017 were enrolled in the study and were analyzed during follow-up period. Eighty percent of the patients had excellent to good result. Average postoperative score was 85.7. Assessment was done

**Keywords:** anterior and posterior column fracture, modified Harris Hip score,

Hip arthroscopy requires a thorough knowledge of acetabular and pelvic anatomy. Acetabular and pelvic anatomy is complex yet important for any procedure to be done on hip joint. The articular surface of acetabulum can be visualized as being supported between the limbs of an inverted "Y". These two limbs are considered anterior and posterior columns of acetabulum. On radiographic view, anterior column is represented by iliopectineal line and posterior column by ilioischial line. Discontinuity in any of these lines is considered fracture of anterior or posterior column. The external iliac and internal iliac arteries lie in close relation to these columns. An anomalous connection of these two arteries called circle of death or corona mortis should be identified and ligated properly as injury to this artery can lead to catastrophic results. Lumbar plexus and its various nerve roots traverses the lesser and greater sciatic notches and are vulnerable to injury in portal placement and various other hip surgeries. This chapter mainly focuses on various aspects of surgical anatomy of acetabulum and biomechanics relevant to hip arthroscopy in detail.

Treatment of acetabular fractures requires a deep understanding of pelvic anatomy. With advent of various minimally invasive approaches and fixation methods, knowledge of acetabular anatomy plays a pivotal role in treatment of displaced acetabular

**2. Surgical and applied anatomy of the acetabulum**
