Morel‐Lavallée lesion is a closed soft tissue degloving injury usually associated with high‐velocity trauma. It most commonly occurs in the thigh, hip, and pelvis. Because such lesions are prone to a missed or delayed diagnosis, it may present a potential risk of infection at the fracture site once it progresses. Therefore, timely identification and management of Morel‐Lavallée lesion is crucial. Moreover, there are no relevant guidelines for the treatment of Morel‐Lavallée lesion. Based on the above facts, we reviewed the etiology, epidemiology, pathophysiology, clinical presentation, imaging features, treatment, prognosis, and complications of Morel‐Lavallée lesion with the aim of providing a comprehensive overview of Morel‐Lavallée lesion, increasing awareness of this injury among orthopaedic surgeons, and thus providing a management algorithm that can be applied to this injury.

The primary goal of this study was to create a frequency map of a series of surgically treated both-column fractures and to explore its implications on surgical management. We used a consecutive series of 71 both-column fractures to create 3-dimensional reconstruction images, which were superimposed and oriented to fit a model hemipelvis template by aligning specific pelvis landmarks. Fracture lines were identified and traced to create a fracture map of both-column fractures. Then the possible clinical implications of fracture line map were explored. Fracture location is closely related to the distribution of fracture line. Of 71 fractures that met the criteria for inclusion, we found the most common pattern demonstrated by coexisting fracture lines. The anterior column was involved by 66% of the fractures extending obliquely from the anterior superior spine to the ischial spine, while 62% of the fractures involved the anterior column extending approximately vertically from the iliac crest to the acetabular roof. Additionally, 39% of the fractures involved the posterior column traversing posterior wall. Furthermore, the high fracture line intensity (n = 65, 92%) formed a Y-shaped pattern, which highlighted the consistency of the patterns. Surgically treated both-column fractures display very common patterns. The most common pattern is the low anterior column fracture in nearly two thirds of cases, the high anterior column fracture in three fifths of cases and the posterior column fracture with posterior wall involvement in nearly two fifths of cases. These study results may help surgeons to yield insight relevant to surgical approaches, reduction, fixation strategies and even implant design for both-column fractures.

Background: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. Methods: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. Results: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. Conclusions: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.

Background: At present, the choice of surgical approach for both-column fractures is still controversial. The purpose of this study was to explore the efficacy of the Stoppa combined with iliac fossa (S+IF) approach in the treatment of both-column fractures. Methods: In this retrospective case series, 76 patients were included in the study from 2014 to 2018. They were divided into two groups according to the surgical approaches. The differences of intraoperative blood loss, operative time, quality of reduction, clinical outcome, and perioperative complications were compared between the two groups. Results: All patients had undergone the IL approach or the S+IF approach. The average operative time was 156.2 min (110~210 min) in group I and 126.5 min (80~180 min) in group II (P < 0.001). The average blood loss in group I was 784.1 ml, while the average blood loss in group II was 625.3 ml (P = 0.007). According to Matta’s criteria, 28 cases obtained anatomic reduction and 12 cases got imperfect reduction in group I; 21 cases obtained anatomic reduction and 7 cases got imperfect reduction in group II (P > 0.05). The clinical outcome (excellent to good) was 66% in group I versus 69% in group II (P > 0.05). The complication rates were 18.2% in group I and 12.5% in group II (P > 0.05). Conclusions: As a minimally invasive surgical approach, the S+IF approach is a valuable alternative to the IL approach for the treatment of both-column acetabular fractures if these two anterior approaches can achieve fracture exposure, reduction, and fixation.