Determination of Indications to Surgical Treatment and Choice of Surgical Approaches in Complicated Complex Acetabular Fractures

2010 ◽  
Vol 17 (4) ◽  
pp. 30-37
Author(s):  
A V Beletskiy ◽  
A I Voronovich ◽  
Aleksandr Eduardovich Murzich ◽  
A V Beletskiy ◽  
A I Voronovich ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Treatment Results ◽  
Complex Fractures ◽  
Comminuted Fractures ◽  
Simultaneous Use

Experience in surgical treatment of 65 patients with complex fractures of the acetabulum is presented. All patients underwent open reposition with internal fixation of fragments by reconstructive plates. Basic moments of the performance of portals to acetabulum, steps of reposition and fixation in multi-segment comminuted fractures are described. Algorithm for determination of indications to surgical treatment of complex acetabular fractures was determined. Clinical and roentgenologic results were studied at terms from 1 to 9 years. Excellent results were established in 39.5%, good and satisfactory in 34.9%, poor in 25.6% of patients. It was shown that in complex bi-columned fractures the technique of open osteosynthesis was the most effective when used within the first 3 weeks after injury. Simultaneous use of anterior and posterior accesses considerably facilitated the performance of reposition and stabilization of multi-segment comminuted fractures and enabled to achieve favorable treatment results.

scholarly journals Surgical approaches in the treatment of patients with acute acetabular fractures

2021 ◽  
Vol 27 (5) ◽  
pp. 610-619
Author(s):  
N.V. Zagorodny ◽  
◽  
A.I. Kolesnik ◽  
A.F. Lazarev ◽  
E.I. Solod ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Open Reduction ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Online Library

Abstract. Introduction According to the overwhelming majority of Russian and foreign authors, orthopedic traumatologists have been striving to improve the results of surgical treatment of acetabular (AC) fractures over the past decades. First of all, this is due to an increase in the number and severity of this injury, persisting complications and dissatisfaction of researchers with their own results of surgical treatment. Purpose Study of the rationale used by traumatologists for certain surgical approaches in the treatment of acute acetabular fractures. Materials and methods Literature sources were searched for information in the systems and databases Pubmed, Embase, Scopus, Medline, Cochran Library, eLibrary, Wiley Online Library using the keywords: acetabular fractures, surgical treatment, acetabular approach, open reduction and fixation of acetabular fractures, duration and blood loss, hip arthroplasty. Results The incidence of AC fractures, according to different authors, ranges from 2 to 23.4 %. The cause of this injury is road traffic accidents in up to 83 % of all cases. A significant increase in the number of AC fractures was noted. AC fractures in the vast majority of cases are classified according to AO/ASIF. Displaced AC fractures and multiplanar fractures are subject to surgical treatment. Open reduction and internal fixation still remain the standard treatment for AC fractures. The choice of the surgical approach is carried out more often taking into account the classification of AC fractures, and the type of fracture dictates the choice of approach to the acetabulum. It was found that the authors are forced to use surgical approaches taking into account the fractures of the AC columns. Discussion Adherence of traumatologists to the standards regarding indications for the choice of surgical approaches for complex AC fractures was noted. Surgical approaches for the treatment of two-column acetabular fractures are still often extended and traumatic, prolonged and accompanied by blood loss. Conclusion In the surgical treatment of pelvic and AC fractures, most authors adhere to standards in the choice of approach and fixation of columns and AC fragments. There is unanimity in the recognition of the trauma and "expansion" of the approaches used, accompanied by blood loss reaching up to 2000 ml and more, and the duration of the operation is on average 3 hours 50 minutes. For the surgical treatment of acute AC fractures, the researchers used both classical and modified anterior and posterior surgical approaches with the obligatory consideration of the classification of AC fractures. The rationale for choosing an operative approach, as a rule, was the determination of the type of AC fracture according to the AO/ASIF classification. The most effective approach in the surgical treatment of AC fractures is the combined anterior and posterior approach.

scholarly journals Management of Unilateral Zygomaticomaxillary Complex Fracture - A Case Report

2021 ◽  
Vol 10 (35) ◽  
pp. 3070-3073
Author(s):  
Vybhavi M. K. ◽  
Prashanth V. ◽  
Srinivas V.
Keyword(s):  
Surgical Intervention ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Surgical Approaches ◽  
Complex Fracture ◽  
Complex Fractures ◽  
Maxillofacial Fractures ◽  
Zygomaticomaxillary Complex Fracture ◽  
Comminuted Fractures ◽  
Zygomaticomaxillary Complex

Zygomaticomaxillary complex (ZMC) fractures are relatively common. Zygomatic complex fractures with functional or aesthetic impairments often require surgical intervention. Treatment of ZMC fractures consists of reduction and fixation of the dislocated bone fragments to their original location. The zygomaticomaxillary complex functions as a major buttress for the face and because of its prominent convex shape, is frequently involved in facial trauma.1 ZMC fractures are also called tripod, tetrapod, quadripod, malar or trimalar fractures. They account for approximately 15 % - 23.5 % of maxillofacial fractures.2,3 The aetiology of zygomatic complex fractures primarily includes road traffic accidents (RTA), violent assaults, falls and sports injuries. They are the second most common facial fracture after nasal bone fractures.3-6 ZMC fractures are more common in men than women, and most commonly occur in the third decade of life.7-10 The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity, malocclusion and neurosensory disturbances of the infra-orbital nerve.10 The gold standard radiological investigation for evaluation of ZMC fractures is computed tomography (CT) scan. Surgical intervention is effective in cases of displaced and comminuted fractures involving functional and aesthetic defects, whereas a nonsurgical approach is often used for non-displaced fractures.11 Various surgical approaches and treatment strategies have been proposed to obtain a successful treatment outcome. Based on review of literature, it has been observed that the open reduction with internal fixation using mini plates and screws is the most commonly preferred treatment for displaced and comminuted fractures.10-12 Here, we report a clinical case of right zygomaticomaxillary complex fracture and its management.

Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures

2019 ◽  
Author(s):  
Markus Alexander Küper ◽  
Alexander Trulson ◽  
Christian Minarski ◽  
Fabian Stuby ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Impact Energy ◽  
Geriatric Patients ◽  
Pelvic Ring ◽  
Young Patients ◽  
High Energy ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Anatomical Structures ◽  
High Energy Trauma

AbstractInjuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.

scholarly journals Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

2021 ◽  
Vol 27 (2) ◽  
pp. 144-155
Author(s):  
A. I. Kolesnik ◽  
N. V. Zagorodniy ◽  
A. A. Ochkurenko ◽  
A. F. Lazarev ◽  
E. I. Solod ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Femoral Head ◽  
Sciatic Nerve ◽  
Intraoperative Complications ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Aseptic Necrosis ◽  
Superior Gluteal Artery ◽  
Duration Of Surgery

Background.The combination of classical anterior and posterior approaches, as well as their modifications, is recognized as the most effective in acetabular fractures surgical treatment. The use of classical and modified approaches is accompanied by  serious  intra-  and  postoperative  complications  associated  primarily  with  the  duration  of  surgery,  significant  blood loss, tissue trauma, surgical site infection. The aim of review — to determine the main and most frequent complications associated with surgical approaches to the acetabulum. material and methods. Access to literature sources is carried out in the information systems and databases PubMed/Medline, Embase, Scopus, Сochran Library, eLibrary, Wiley Online Library. Keywords: acetabular fractures, surgical treatment, approach to the acetabulum, total hip replacement.Results. The most common intraoperative complications are incorrect fragments reduction, sciatic nerve injury, less often — intraarticular implant position, damage to the superior gluteal artery and other vessels, among the early postoperative complications - wound infection, both superficial and deep, less often — venous thrombosis. Late postoperative complications are mainly represented  by  the  development  of  heterotopic  ossification,  post-traumatic  coxarthrosis,  less  often  revealed  aseptic necrosis of the femoral head, residual protrusion and secondary femoral head lesion. Conclusion. The main approach to the acetabulum are the ileo-inguinal and the Kocher-Langenbeck approach, as well as their combination.Complications were more common using two approaches, especially in cases of simultaneous use. The main intraoperative complications are the sciatic nerve and the superior gluteal artery injury with posterior approaches, the femoral lateral cutaneous nerve with expanded ilio-femoral approach, and the obturator nerve with anterior approaches.

scholarly journals Surgical treatment of displaced acetabular fractures

2011 ◽  
Vol 139 (7-8) ◽  
pp. 496-500 ◽  
Author(s):  
Sasa Milenkovic ◽  
Jordan Saveski ◽  
Mile Radenkovic ◽  
Goran Vidic ◽  
Neda Trajkovska
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Articular Surface ◽  
High Energy ◽  
Acetabular Fractures ◽  
Anatomical Reduction ◽  
Severe Injuries ◽  
Stable Internal Fixation

Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Nis from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d?Aubign? Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

scholarly journals Surgical Treatment of Internal Fixation Failure of Femoral Peritrochanteric Fracture

2021 ◽  
Author(s):  
Gang Zhong ◽  
Lin Teng ◽  
Hai‐bo Li ◽  
Fu‐guo Huang ◽  
Zhou Xiang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Fixation Failure

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

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