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Acetabular Refracture Through Posterior Wall Malunion Treated with Sciatic Neuroplasty and Open Reduction and Internal FixationA Report of Two Cases
Michael Isiah Sandlin, MD1; Saam Morshed, MD, PhD, MPH2; M.L. Chip Routt, MD3
1 Department of Orthopaedic Surgery, University of California, Los Angeles 10833 Le Conte Avenue, Room 76-143 CHS, Los Angeles, CA 90095
2 Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110. E-mail address: morsheds@orthosurg.ucsf.edu
3 Department of Orthopaedic Surgery, University of Texas Medical School, 6400 Fannin Street, Suite 1700, Houston, Texas 77030
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Investigation performed at Harborview Medical Center, University of Washington, Seattle, Washington

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Apr 10;3(2):e34 1-7. doi: 10.2106/JBJS.CC.L.00173
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Fractures involving the posterior wall are the most common type of acetabular fractures1-3. These injuries are often associated with posterior fracture-dislocations of the hip from high-energy trauma such as motor vehicle collisions4-6. Despite the frequency of these events, repeat acetabular injuries are exceedingly rare and, to our knowledge, have not been previously reported. We present two patients who sustained refracture through malunited, previously stable, nonoperatively treated acetabular fractures of the posterior wall. Challenges including malunited fracture fragment reduction and stabilization, sciatic neuroplasty, and posttraumatic nerve palsy in the setting of this uncommon clinical scenario are discussed. The patient from Case 1 and the patient and her parents from Case 2 were informed that data concerning the cases would be submitted for publication, and they all provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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