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

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.

Determinants of functional outcome after simple and complex acetabular fractures involving the posterior wall

2006 ◽  
Vol 88-B (6) ◽  
pp. 776-782 ◽  
Author(s):  
H. J. Kreder ◽  
N. Rozen ◽  
C. M. Borkhoff ◽  
Y. G. Laflamme ◽  
M. D. McKee ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Posterior Wall ◽  
Acetabular Fractures

scholarly journals Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

2021 ◽  
Vol 7 (6) ◽  
pp. 1139
Author(s):  
K. Nageswara Rao ◽  
Ronak Dinesh Soni ◽  
C. Nagesh ◽  
P. A. Shravan Kumar ◽  
B. Arvind Kumar
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Posterior Wall ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
P Value ◽  
Radiological Outcome ◽  
Anatomic Reduction ◽  
Joint Reduction

<p class="abstract"><strong>Background:</strong> The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value &lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.</p>

New technique and strategy for posterior column, posterior wall, ischium, and quadrilateral plate fixation from the anterior approach for acetabular fractures

2020 ◽  
Author(s):  
Kunihiro Asanuma ◽  
Gaku Miyamura ◽  
Yoshiaki Suzuki ◽  
Haruhiko Satonaka ◽  
Kakunoshin Yoshida ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Plate Fixation ◽  
Posterior Wall ◽  
Ischial Tuberosity ◽  
Posterior Column ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
Quadrilateral Plate ◽  
Screw Length ◽  
Considerable Problem

Abstract BackgroundAcetabular fractures are relatively common, but management of the ischial fragment is a considerable problem when determining whether to use only the anterior approach or to add the posterior approach for anterior column and posterior hemitransverse acetabular fractures, T-type fractures, and both column fractures. This study is the first to demonstrate how to screw or drill around the quadrilateral space, posterior column, posterior wall, and near the ischial tuberosity from the anterior approach by a novel "sleeve guide technique". MethodsFirst, a nozzle, drill, depth gauge, and driver were prepared from DepuySynthes. Periosteum of the internal obturator muscle was detached from the quadrilateral plate to near the ischial tuberosity, while paying attention not to injure Alcock’s canal. The skin was cut about 1.5 cm opposite to the side of the fracture, and the nozzle was inserted as an external sleeve. Drilling, measuring screw length, and screwing were performed through this nozzle. With this technique, the approach angles of drilling and screwing to the posterior wall and ischium were inclined, and plating from the ischium to the ilium could be performed from the anterior approach. ResultsTwo cases are presented. Case 1 was a 63-year-old man who had a left both column fracture with a free bone fragment of the joint surface. After plating a 14-hole plate from the pubis to the ilium, a bent 14-hole plate was placed at the quadrilateral space as a buttress, and a screw was inserted from the posterior wall to the ilium using sleeve guide technique. Case 2 was a 66-year-old man with a quadrilateral fracture. After a 13-hole plate was bent and placed at the quadrilateral space, screws were inserted to the ischium and posterior wall using sleeve guide technique ConclusionsSleeve guide technique is very easy, useful, and safe to drill and insert screws to the quadrilateral space, posterior wall, and near the ischial tuberosity from the anterior approach. This technique can be used for simple drilling and screwing of a small T buttress plate held by a ball spike at the quadrilateral space from the surgical window. We believe that these techniques lead to new strategies for acetabular fractures.

Midterm results of trochanteric flip osteotomy technique for management of fractures around the hip

2017 ◽  
Vol 28 (2) ◽  
pp. 148-155 ◽  
Author(s):  
Vivek Trikha ◽  
Saubhik Das ◽  
Arkesh Madegowda ◽  
Prabhat Agrawal
Keyword(s):  
Femoral Head ◽  
Excellent Result ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
Acetabular Fractures ◽  
Functional Evaluation ◽  
Midterm Results ◽  
Surgical Hip Dislocation ◽  
Surgical Dislocation ◽  
Trochanteric Flip Osteotomy

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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