scholarly journals The Treatment Advantage of Complex Acetabular Fractures by the Pararectus Approach

2021 ◽  
Author(s):  
Guoming Liu ◽  
Jinli Chen ◽  
Chengzhi Liang ◽  
Chengdong Zhang ◽  
Xuwen Li ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Hip Osteoarthritis ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Orthopedic Surgeons ◽  
Pararectus Approach

Abstract Background: The surgical treatment of complex acetabular fractures is one of the most challenging procedures for orthopedic surgeons. The Pararectus approach, as a reasonable alternative to the existing surgical procedures, was performed for the treatment of complex acetabular fractures involving the anterior column. This study aimed to evaluate outcome using the Pararectus approach for acetabular fractures involving anterior columns. Methods: Thirty-seven with displaced complex acetabular fractures involving anterior columns were treated between July 2016 and October 2019 using the Pararectus approach. The functional outcomes (using the Merle d Aubigné and Postel scoring system, WOMAC and modified Harris scoring), the quality of surgical reduction (using the Matta criteria), and postoperative complications were assessed with about 26 months follow-up.Results: Thirty-seven patients (mean age 53 years, range: 30-71; 28 male) underwent surgery. Mean intraoperative blood loss was 840 ml (rang: 400-2000 ml) and mean operating time was 210 min (rang: 140-500 min). The modified Merle d Aubigné score was excellent and good in 27 cases (73%), fair in 6 cases (16%), and poor in 3 cases (12%). The mean score was 88.5 (range:77-96) for the modified Harris Hip scores, and 22 (range:7-35) for the WOMAC scores after operation. Postoperative functional outcomes were significantly improved compared with preoperative outcomes (P<0.0001). The quality of reduction was anatomical in 21 cases (57%), satisfactory in 9 cases (24%), and unsatisfactory in 7 cases (20%). At follow-up, four patients developed a DVT, and heterotopic bone formation was observed in one patient. The hip osteoarthritis was not observed.Conclusion: The Pararectus approach achieved good functional outcomes and anatomical reduction in the treatment of complex acetabular fractures involving anterior column with minimal access morbidity.

scholarly journals Internal Fixation of Anterior Acetabular Fractures with a Limited Pararectus Approach and the New Anatomical Plates: Preliminary Results

2020 ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Functional Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Invasive Approach ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the new anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with minimally invasive approach and the new anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The new anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the new anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of more minimally invasive and less complications can be an alternative choice for simple anterior acetabular fractures especially involving the quadrilateral plate. The new anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction.

scholarly journals Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Adverse Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Limited Surgery ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

scholarly journals Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

2020 ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Adverse Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Limited Surgery ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

scholarly journals Treatment of Geriatric Acetabular Anterior Fractures: Role of “Frame and Buttress”

2021 ◽  
Author(s):  
Yizhou Wan ◽  
Yan Ma ◽  
Sheng Yao ◽  
Lian Zeng ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Anterior Approach ◽  
Acetabular Fractures ◽  
Rigid Fixation ◽  
Score System ◽  
Age Related ◽  
Buttress Plate ◽  
Anterior Posterior

Abstract Background: As the rate of geriatric acetabular fractures was increasing gradually and accompanied with the quadrilateral surface(QLS) involved resulting by impacting from the head of femur, which usually leaded to the dislocation/subluxation of the head of femur and intra-pelvic medial displacement of the QLS. Traditionally, applying an infra-pectineal buttress plate in the true pelvis to resist the protrusive fragments of the QLS, however, these plates with small contact area could not provide enough buttress effect to age-related fractures. This study was to evaluate the “frame and buttress” fixation strategy for treatment of geriatric acetabular anterior fractures(GAAF).Methods: A cohort of 28 patients with acetabular fractures involving QLS were managed operatively with the “frame and buttress” fixation strategy with a single pelvic anterior approach. 7 cases were transverse, 3 cases were posterior column, 8 cases were associated both columns, 4 cases were anterior posterior hemi-transverse and 6 cases were T-type patterns fracture. The quality of reduction, functional outcomes and complicates were recorded for analyzing.Results: Functional outcomes were 15 cases in excellent; 9 cases were good; 3 cases were fair, and 1 case was poor. The quality of surgical reduction was evaluated by the Matta score system, which was graded as excellent in 17 cases, good in 9 cases and poor in 2 cases, respectively. No loss or failure of internal fixation, no second dislocation/subluxation of femoral head and no complications like infection were observed.Conclusions: The “frame and buttress” fixation strategy provided firm method for treating GAAF, the “frame” formed rigid fixation structure for acetabular fractures and the “buttress” resisted protrusive QLS.

scholarly journals A study on fracture lines of the quadrilateral plate based on fracture mapping

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yun Yang ◽  
Chang Zou ◽  
Yue Fang
Keyword(s):  
Posterior Wall ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Orthopedic Surgeons ◽  
Posterior Wall Fracture ◽  
Quadrilateral Plate ◽  
Fixation Devices ◽  
Different Types ◽  
Ct Data ◽  
Fracture Mapping

Abstract 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.

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

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.

Kocher-Langenbeck Approach in Prone Position

2020 ◽  
Author(s):  
Seyyed Hossein Shafiei ◽  
Babak Siavashi ◽  
Farhad Mahdavi ◽  
Mohammad Heshmati ◽  
Mohammad Reza Sadeghi ◽  
...  
Keyword(s):  
Femoral Head ◽  
Prone Position ◽  
Posterior Approach ◽  
Lateral Position ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Orthopedic Surgeons ◽  
Quadrilateral Plate ◽  
Anatomic Reduction ◽  
Surgical Fixation

Background: The posterior approach for acetabular fractures is the Kocher-Langenbeck (K-L) approach which is performed in lateral and prone positions. Lateral position is a familiar position for most orthopedic surgeons. Prone position yields multiple advantages compared to lateral position. Methods: Between years 2016 and 2019, 18 patients with selected acetabular fractures in which the best decision was surgical fixation using K-L approach were studied. The surgical procedure was done using K-L approach with the patient in prone position and we used Matta scoring system to evaluate post-operative reduction quality. Results: According to the Matta system, the anatomic reduction was observed in 13 patients (86.6%). Imperfect reduction was observed in 2 patients (13.3%), no patient had poor reduction. Avascular necrosis (AVN) of the femoral head was seen in one patient (6.6%) and no infectio and heterotopic ossification (HO) were noted. Conclusions: The advantage of this approach in prone position is believed to be better exposure and greater access to the quadrilateral plate (QLP) and anterior column indirectly. One of the most important advantages is that in prone position, handling the reduction devices to indirectly reduce anterior column or QLP is much easier

scholarly journals Relevance of a simulation model to microsurgery for military surgical residents

2021 ◽  
Author(s):  
Ammar GHABI ◽  
Alexandre SABATE FERRIS ◽  
Georges PFISTER ◽  
Marie Pauline CHAPON ◽  
Josette Legagneux ◽  
...  
Keyword(s):  
Simulation Model ◽  
Operating Time ◽  
Surgery Simulation ◽  
Self Assessment ◽  
Surgical Residents ◽  
Orthopedic Surgeons ◽  
Average Operating ◽  
Average Operating Time ◽  
Assessment Questionnaire

Abstract IntroductionMicrosurgical training is an asset for military orthopedic surgeons who frequently treat hand or nerve injuries in external operations. The objective of this study was to evaluate a microvascular surgery simulation model intended to prepare residents prior to their enrolment in conventional degree training.Materials and MethodsAn experimental study was conducted to evaluate technical progress and satisfaction of military surgical residents using a model based on Japanese noodles with four tests of increasing difficulty. Objective endpoints included: instrument handling, distribution and quality of stitches, duration of anastomoses and responses to the Structured Assesment of MicrosurgerySkill (SAMS) self-assessment questionnaire were also analyzed.ResultsNine residents from different specialties participated in the study. The quality of their anastomoses and their average satisfaction were significantly increased between the first and the last session: respectively 7.2 / 15 versus 10.7 / 15 (p < 0.05) and 37.5 / 70 versus 47.5 / 70 (p < 0.05). Conversely, the average operating time decreased significantly over the sessions (92 min versus 52 min, p < 0.001).ConclusionsThis simulation model seems to constitute a satisfactory initiation to microsurgery which could limit the use of the animal model. It could also be included in the continuing education of military surgeons who perform microsurgery only occasionally in external operations.

scholarly journals Percutaneous fixation of acetabular fractures

2018 ◽  
Vol 3 (5) ◽  
pp. 326-334 ◽  
Author(s):  
Horacio Caviglia ◽  
Adrian Mejail ◽  
Maria Eulalia Landro ◽  
Nosratolah Vatani
Keyword(s):  
Acetabular Fractures ◽  
Percutaneous Technique ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Percutaneous Approach ◽  
Screw Insertion ◽  
Quadrilateral Plate ◽  
Bone Fragments ◽  
Post Traumatic ◽  
Joint Congruence

The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation. Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing. An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure. The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty. We recommend the use of intramedullary cannulated screws. Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture. In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054

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