Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

Abstract Objective Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. Methods The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. Results The patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). Conclusions The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.

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Mid-term results of an anterior ilioischial plating for complex acetabular fractures with a combined anterior approach: a retrospective cohort study

10.21203/rs.2.10376/v1 ◽

2019 ◽

Author(s):

Weikun Meng ◽

Yi Ou ◽

Zhaoxiang Wu ◽

Hongchang Yang ◽

Ge Chen ◽

...

Keyword(s):

Blood Loss ◽

Anterior Approach ◽

Operative Time ◽

Fracture Reduction ◽

Acetabular Fractures ◽

Time Interval ◽

Intraoperative Blood Loss ◽

Ilioinguinal Approach ◽

Stoppa Approach ◽

Hip Function

Abstract Background: Bi-columnar plating via combined anterior and posterior approaches is routinely applied treatment for complex acetabular fractures with noteworthy shortcomings. The goal of this study was to evaluate the effectiveness of the anterior plating with an ilioischial plate through the combined anterior approach for complex acetabular fracture treatment. Methods: Patients with complex acetabular fractures treated at our trauma centre between January 2015 and December 2016 were retrospectively reviewed. Fractures were stabilized with an ilioischial plate via a modified Stoppa approach combined with the 1st window of the ilioinguinal approach. Interval between injury and surgery, operative time and intraoperative blood loss were recorded. Fracture reduction was evaluated radiographically with the modified Matta's criteria at 3 days postoperatively. Postoperative hip function was assessed using the modified Merle d'Aubigne and Postel clinical grading system over at least 1 year postoperatively. Results: Twenty patients were included with an average follow-up of 17 months (range, 13-28). The mean time interval between injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 mL (range, 220-450 mL). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and traumatic arthritis in 1 patient (5%). Conclusions: Anterior fixation of complex acetabular fractures with an ilioischial plate via the combined anterior approach yielded clinically satisfactory mid-term outcomes, providing a potentially effective alternative to the conventional treatment algorithm.

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Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

10.21203/rs.2.13759/v1 ◽

2019 ◽

Author(s):

Weikun Meng ◽

Zhong Huang ◽

Haoyang Wang ◽

Duan Wang ◽

Zeyu Luo ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Operation Time ◽

Incision Length ◽

Total Hip ◽

Hip Function

Abstract Background: The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods: Patients with bilateral late-stage ONFH were prospectively recruited from our department during March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within groups. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA groups within 12-month postoperatively. Results: Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded significantly shorter incision length (7.62 vs. 11.12 cm, P = 0.049), longer operation time (103.25 vs. 66.50 min, P = 0.034), more blood loss (1108.50 vs. 843.50 ml, P = 0.023), deficient acetabular cup positioning (abduction angle, 38.75° vs. 44.50°, P = 0.035), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25, P = 0.025) at 12-month postoperatively. However, soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both groups. Conclusions: The SuperPath might not be truly minimal invasive with advantages over the PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches.

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Therapeutic effect of acetabular fractures using the Pararectus approach combined with 3D printing technique

10.21203/rs.2.23813/v1 ◽

2020 ◽

Author(s):

Ruyi Zou ◽

Min Wu ◽

Jianzhong Guan ◽

Yuzhou Xiao ◽

Xiaotian Chen

Keyword(s):

3D Printing ◽

Three Dimensional ◽

Operation Time ◽

Acetabular Fractures ◽

Effective Reduction ◽

Printing Technique ◽

Dimensional Reconstruction ◽

Hip Function ◽

Pararectus Approach ◽

3D Printing Technique

Abstract Background To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial complex acetabular fractures. Methods We retrospectively evaluated 18 (11 males and 7 females) patients with complicated acetabular fractures in the period of June 2017 to December 2018; According to judet-letenneal classification: 11 cases were of double column fracture, 6 fractures were of the anterior column with posterior half transverse, and 1 case was of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures after reduction via the pararectus approach. Results The average time of surgery was 203 min (range:135-245 min)and mean intraoperative blood loss was 1030ml(range:450-1400ml);18 patients were followed up for 12-18 months (average,14 months);One patient (5.6%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics. One patient (5.6%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; all patients underwent pelvic films and pelvic CT+ three-dimensional reconstruction after surgery, suggesting that fractures reduction as well. All the acetabular fractures united after 12 to 16 weeks(average,13 weeks);According to the modified Merle d’Aubigne and Postel scoring system to assess the hip function: excellent in 13 cases (72.2%), good in 3 cases(16.7%) and fair in 2 cases(11.1%). Conclusions In the treatment of partial complex acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and the internal fixation position can be properly adjusted during the operation by looking directly at the model.

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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.

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Mid-term results of an anterior plating via combined anterior approach for complex acetabular fractures: a retrospective cohort study

10.21203/rs.3.rs-40685/v1 ◽

2020 ◽

Author(s):

Weikun Meng ◽

Yi Ou ◽

Zhaoxiang Wu ◽

Hongchang Yang ◽

Ge Chen ◽

...

Keyword(s):

Acetabular Fracture ◽

Anterior Approach ◽

Fracture Reduction ◽

Acetabular Fractures ◽

Stoppa Approach ◽

Hip Function ◽

Bony Healing ◽

Anterior Plating ◽

Simplified Procedure

Abstract Background: Solely anterior plating via the modified Stoppa approach might yield satisfactory outcomes for selected cases of complex acetabular fractures, however, its indications are not practically clear. Methods: Patients with complex acetabular fractures treated with solely anterior plating via the modified Stoppa approach with or without a lateral window at our trauma center between January 2013 and December 2019 were retrospectively reviewed. Fracture type was identified according the newly established three-column classification of acetabular fracture. Perioperative information was recorded, and fracture reduction was evaluated radiographically at 3 days postoperatively. Postoperative hip function was assessed at least 1 year postoperatively. Results: Twenty patients were included with an average 17 months (range, 13-28) follow-up. According to the three-column classification, 2 cases were classified as type B2.2, 8 cases as type B2.3, 3 cases as type C1, and 7 cases as type C3. The mean time from injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 ml (range, 220-450 ml). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and controllable osteoarthritis in 1 patient (5%). Conclusions: Solely anterior plating via the combined anterior approach achieved satisfactory mid-term outcomes for complex acetabular fractures with posterior column detachments. Based on the newly established three-column classification of complex acetabular fracture, the type B, C1, and C3 fractures are possibly the appropriate indications for such a simplified procedure.

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Mid-term Results of an Anterior Plating Via Combined Anterior Approach for complex Acetabular Fractures: A Retrospective Cohort Study

10.21203/rs.3.rs-51697/v1 ◽

2020 ◽

Author(s):

Weikun Meng ◽

Yi Ou ◽

Zhaoxiang Wu ◽

Hongchang Yang ◽

Ge Chen ◽

...

Keyword(s):

Acetabular Fracture ◽

Anterior Approach ◽

Fracture Reduction ◽

Acetabular Fractures ◽

Stoppa Approach ◽

Hip Function ◽

Bony Healing ◽

Anterior Plating ◽

Simplified Procedure

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Therapeutic effect of acetabular fractures using the Pararectus approach combined with 3D printing technique

10.21203/rs.2.23813/v2 ◽

2020 ◽

Author(s):

Ruyi Zou ◽

Min Wu ◽

Jianzhong Guan ◽

Yuzhou Xiao ◽

Xiaotian Chen

Keyword(s):

3D Printing ◽

Operation Time ◽

Anterior Column ◽

Acetabular Fractures ◽

Transverse Fracture ◽

Effective Reduction ◽

Printing Technique ◽

Hip Function ◽

Pararectus Approach ◽

3D Printing Technique

Abstract Objective: To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures.Methods: We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018; According to judet-letenneal classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, 7 fractures were of the anterior column with posterior half transverse,3 fractures were of transverse fracture, and 2 case was of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach. Results : Thirty-three patients were followed up for 12-18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; One patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics; All the acetabular fractures united after 12 to 16 weeks(average,13 weeks);According to the modified Merle d’Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in 7 cases(21.2%) and fair in 4 cases(12.1%).Conclusions: In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and the internal fixation position can be properly adjusted during the operation by looking directly at the model.

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PFNA-II Internal Fixation Helps Hip Joint Recovery and Improves Quality of Life of Patients with Lateral-Wall Dangerous Type of Intertrochanteric Fracture

BioMed Research International ◽

10.1155/2021/5911868 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Weilu Mu ◽

Junlin Zhou

Keyword(s):

Internal Fixation ◽

Hip Joint ◽

Intertrochanteric Fracture ◽

Operation Time ◽

Lateral Wall ◽

Intraoperative Blood Loss ◽

Function Score ◽

Curative Effect ◽

Hip Function

Objective. To analyze the effect of PFNA-II internal fixation on hip joint recovery and quality of life (QOL) in patients with lateral-wall dangerous type of intertrochanteric fracture. Methods. One hundred and twelve patients with lateral-wall dangerous type of intertrochanteric fracture who underwent surgical treatment in our hospital from May 2017 to May 2019 were selected as the participants of the study. Based on the treatment method, all the enrolled patients were divided into two groups: proximal femoral nail antirotation (PFNA group; n = 59 ) who received closed reduction and minimally invasive PFNA internal fixation and dynamic hip screw group (DHS; n = 53 ) who received internal fixation. The clinical indicators, curative effect, hip function score, pain degree, postoperative QOL score, and complications were compared between the two groups. Results. The operation time, intraoperative blood loss, postoperative drainage volume, and the incidence of postoperative complications in PFNA group were statistically lower than those in DHS group ( P < 0.05 ). The curative effect in PFNA group was notably better than that in DHS group. There were no significant differences in scores of hip function, visual analogue scale (VAS), and QOL between the two groups before operation ( P > 0.05 ). However, the hip function score and QOL score increased in both groups after surgery, and the increase was more significant in the PFNA group, while the VAS score decreased in both groups, and the decrease in PFNA group was more significant ( P < 0.05 ). Conclusion. PFNA internal fixation for the treatment of lateral-wall dangerous type of intertrochanteric fracture has the advantages of short operation time, less intraoperative blood loss, effective improvement of hip joint function, and fewer postoperative complications, which is worthy of clinical application.

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Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3023-0 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Weikun Meng ◽

Zhong Huang ◽

Haoyang Wang ◽

Duan Wang ◽

Zeyu Luo ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Length Of Hospital Stay ◽

Operation Time ◽

Short Term ◽

Incision Length ◽

Total Hip ◽

Hip Function

Abstract Background The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively. Results Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches. Conclusion The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches. Trial registration information The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.

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Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191784 ◽

2019 ◽

Vol 5 (3) ◽

pp. 458

Author(s):

Nikil Sanaba Paramesh ◽

Usman Taufiq

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Elderly Patients ◽

Operation Time ◽

Reoperation Rate ◽

Femoral Neck Fractures ◽

Intraoperative Blood Loss ◽

Cerebrovascular Complications ◽

Uncemented Hemiarthroplasty ◽

Hip Function

Background: Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 60 years old.Methods: We searched PUBMED from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.Results: Our control trial involved 132 patients (132 hips) who were eligible for the study. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31–0.76; p = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29–0.64; p<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09–0.26; p<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37–9.49 min; p<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.Conclusions: Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.

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