Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

Introduction: In this study, we aimed to investigate safety and efficacy of the trochanteric flip osteotomy with surgical hip dislocation technique in selected displaced acetabular and femoral head fractures with clinico-radiological outcome and potential complications. Materials and methods: We retrospectively reviewed 32 patients from January 2009 to June 2014. Selected displaced acetabular fractures with comminution and/or cranial extension of posterior wall, marginal impaction, intraarticular fragment, femoral head fractures and hip fracture-dislocations were operated by this modified approach of trochanteric flip osteotomy and surgical hip dislocation. Patients were evaluated for fracture reduction, femoral head viability, trochanteric union, abduction power, and functional evaluation was done by Merle d’Aubigné-Postel scoring system. Minimum follow-up was 24 months. Results: Reduction was judged to be anatomical in 84.38% of cases, and within 1-3 millimetres in 9.38% of cases. All osteotomies healed in an anatomical position. Heterotopic ossification was found in 2 patients limited to Brooker class I. Osteonecrosis developed in 1 patient. 2 patients developed arthritis of the hip as sequelae of poor reduction. Abduction power was MRC 5/5 in all except in 1 patient (4/5). Mean Merle d’Aubigné-Postel score was 16.18; overall good to excellent result was achieved in 87.5% of cases. Conclusions: Trochanteric flip osteotomy with surgical dislocation allows better intraarticular assessment, control of intraarticular fragments, assists accurate reduction and the fixation of complex acetabular and femoral head fractures, without compromising femoral head vascularity and abductor strength. This technique has provided excellent midterm results in the management of complex injuries around the hip.

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The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2016.11.006 ◽

2017 ◽

Vol 20 (3) ◽

pp. 161-165 ◽

Cited By ~ 2

Author(s):

Sandeep Gupta ◽

Jagdeep Singh ◽

Jagandeep Singh Virk

Keyword(s):

Acetabular Fractures ◽

Trochanteric Flip Osteotomy

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Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0015.2364 ◽

2021 ◽

Vol 23 (4) ◽

pp. 271-277

Author(s):

Qazi Waris Manzoor ◽

Asif Sultan ◽

Bashir Ahmed Mir

Keyword(s):

Functional Outcome ◽

Nerve Palsy ◽

Posterior Approach ◽

Case Series ◽

Posterior Wall ◽

Posterior Column ◽

Acetabular Fractures ◽

Single Posterior Approach ◽

Necrosis Of Femoral Head ◽

Trochanteric Flip Osteotomy

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.

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Complete Resection of a Massive Synovial Osteochondromatosis of the Hip Using an Anterior Approach: A Report of Two Cases

Case Reports in Orthopedics ◽

10.1155/2017/9806863 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Masanao Kataoka ◽

Koji Goto ◽

Yutaka Kuroda ◽

Toshiyuki Kawai ◽

Ouki Murata ◽

...

Keyword(s):

Hip Joint ◽

Anterior Approach ◽

Open Surgery ◽

Complete Resection ◽

Synovial Osteochondromatosis ◽

Surgical Dislocation ◽

Arthroscopic Excision ◽

Trochanteric Flip Osteotomy ◽

Dislocation Of The Hip ◽

Surgical Option

Arthroscopic excision of synovial osteochondromatosis of the hip is commonly performed. However, when the lesion extends to the extra-articular space of the hip joint, excision using arthroscopy becomes difficult. Although surgical dislocation of the hip with a trochanteric flip osteotomy is commonly used, manual access to the inferomedial portion of the acetabulum remains difficult. In this case report, we describe arthroscopic resection followed by open surgery using an anterior approach with or without surgical dislocation to excise a synovial osteochondromatosis of the hip that had extended to the extra-articular space and formed a herniation sac. Excision was completed without complications. An anterior approach with or without surgical dislocation should be considered as a surgical option for the treatment of a massive synovial osteochondromatosis of the hip joint.

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