The use of Verbrugge forceps for reduction of the posterior column element in displaced acetabular fractures: clinical and radiological evaluation

Background. The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. Material and methods. This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta’s criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. Results. D’Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta’s criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. Conclusions. 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langenbeck with or without trochanteric flip osteotomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-operative radiographs, Judet’s views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.

Download Full-text

Oblique-ilioischial Plate Technique: A Novel Method for Acetabular Fractures Involving Low Level Posterior Column

10.21203/rs.3.rs-1003401/v1 ◽

2021 ◽

Author(s):

Zhong Chen ◽

Zhaoxiang Wu ◽

Ge Chen ◽

Yi Ou ◽

Hongjie Wen

Keyword(s):

Blood Loss ◽

Operative Time ◽

Iliac Fossa ◽

Posterior Column ◽

Acetabular Fractures ◽

Intraoperative Blood Loss ◽

Low Level ◽

Plate Technique ◽

Stoppa Approach ◽

Hip Function

Abstract Background: Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low level posterior column. Methods: A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low level posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low level posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded.Results: Out of the 18 patients, 10 were male and 8 were female (mean age: 48.6±10.2 years, range: 45–62 years; mean interval from injury to operation: 7.2±1.4 days, range: 5–19 days; mean operative time: 2.1±0.3 h, range: 1. 0–3.2 hours; mean intraoperative blood loss: 300±58.4 mL, range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion: The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low level posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

Download Full-text

New technique and strategy for posterior column, posterior wall, ischium, and quadrilateral plate fixation from the anterior approach for acetabular fractures

10.21203/rs.3.rs-16869/v1 ◽

2020 ◽

Author(s):

Kunihiro Asanuma ◽

Gaku Miyamura ◽

Yoshiaki Suzuki ◽

Haruhiko Satonaka ◽

Kakunoshin Yoshida ◽

...

Keyword(s):

Anterior Approach ◽

Plate Fixation ◽

Posterior Wall ◽

Ischial Tuberosity ◽

Posterior Column ◽

Joint Surface ◽

Acetabular Fractures ◽

Quadrilateral Plate ◽

Screw Length ◽

Considerable Problem

Abstract BackgroundAcetabular fractures are relatively common, but management of the ischial fragment is a considerable problem when determining whether to use only the anterior approach or to add the posterior approach for anterior column and posterior hemitransverse acetabular fractures, T-type fractures, and both column fractures. This study is the first to demonstrate how to screw or drill around the quadrilateral space, posterior column, posterior wall, and near the ischial tuberosity from the anterior approach by a novel "sleeve guide technique". MethodsFirst, a nozzle, drill, depth gauge, and driver were prepared from DepuySynthes. Periosteum of the internal obturator muscle was detached from the quadrilateral plate to near the ischial tuberosity, while paying attention not to injure Alcock’s canal. The skin was cut about 1.5 cm opposite to the side of the fracture, and the nozzle was inserted as an external sleeve. Drilling, measuring screw length, and screwing were performed through this nozzle. With this technique, the approach angles of drilling and screwing to the posterior wall and ischium were inclined, and plating from the ischium to the ilium could be performed from the anterior approach. ResultsTwo cases are presented. Case 1 was a 63-year-old man who had a left both column fracture with a free bone fragment of the joint surface. After plating a 14-hole plate from the pubis to the ilium, a bent 14-hole plate was placed at the quadrilateral space as a buttress, and a screw was inserted from the posterior wall to the ilium using sleeve guide technique. Case 2 was a 66-year-old man with a quadrilateral fracture. After a 13-hole plate was bent and placed at the quadrilateral space, screws were inserted to the ischium and posterior wall using sleeve guide technique ConclusionsSleeve guide technique is very easy, useful, and safe to drill and insert screws to the quadrilateral space, posterior wall, and near the ischial tuberosity from the anterior approach. This technique can be used for simple drilling and screwing of a small T buttress plate held by a ball spike at the quadrilateral space from the surgical window. We believe that these techniques lead to new strategies for acetabular fractures.

Download Full-text