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 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 Two-Incision Minimally Invasive Approach for the Treatment of Anterior Column Acetabular Fractures

2015 ◽  
Vol 5 (3) ◽  
pp. e13
Author(s):  
Steffen Ruchholtz ◽  
Benjamin Bücking ◽  
Ralph Zettl ◽  
Rene Aigner ◽  
Carsten Mand ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals The pararectus approach for internal fixation of acetabular fractures involving the anterior column: evaluating the functional outcome

2018 ◽  
Vol 43 (6) ◽  
pp. 1487-1493 ◽  
Author(s):  
Christian von Rüden ◽  
Lisa Wenzel ◽  
Johannes Becker ◽  
Andreas Thannheimer ◽  
Peter Augat ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Pararectus Approach

scholarly journals Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Haiyang Wu ◽  
Qipeng Shao ◽  
Ranran Shang ◽  
Chengjing Song ◽  
Ximing Liu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Classification System ◽  
Functional Outcomes ◽  
Open Reduction ◽  
The Elderly ◽  
Acetabular Fractures ◽  
Quadrilateral Plate ◽  
Anatomic Reduction ◽  
Functional Scores

Abstract Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.

scholarly journals Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures

2018 ◽  
Vol 3 (7) ◽  
pp. 418-425 ◽  
Author(s):  
Haroon Majeed ◽  
James Barrie ◽  
Wendy Munro ◽  
Donald McBride
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Internal Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Percutaneous Fixation ◽  
Calcaneal Fractures ◽  
Minimally Invasive Reduction

The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures. Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies. All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF. Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains. Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes. Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043

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