A Novel Approach for Treatment of Acetabular Fractures

Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

doi:10.12659/msm.898887

Cited by 3 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been undergoing continued evolution with our better understanding of these complex fractures and advances in instrumentation, imaging techniques, and surgical training. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

Sancheti¹,

Shyam²,

Patil³

et al. 2022

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

A bstract Aim and objective To study the radiological and functional outcomes as well as complications in the management of fractures involving both columns of the acetabulum using a single surgical approach. Design Type IV, prospective clinical study. Setting Level I trauma centre. Materials and methods Inclusion criteria were as follows: (a) patients over 20 year of age and (b) patients suffering from acetabular fractures involving both columns as per Letournel and Judet classification, namely transverse, transverse + posterior wall, T type, anterior column posterior hemi-transverse (ACPHT) and associated both columns. Exclusion criteria were as follows: (a) patient suffering from isolated anterior column, posterior column, anterior wall, posterior wall and posterior wall + column fractures; (b) patient who have undergone surgical procedures of the hip prior to trauma; and (c) compound acetabular fractures. A total of 23 patients having both column acetabulum fractures were included prospectively from June 2016 to December 2018 and followed up till 1 year postoperatively. Open reduction and internal fixation were performed through one of three described approaches, i.e., iliofemoral, Kocher-Langenbeck, and anterior intrapelvic or ilioinguinal. Results Our study population consisted of 30.4% transverse, 39.1% associated both columns, 21.7% T type and 8.7% anterior column + posterior hemi-transverse. Of these, 65.2% were operated using the Kocher-Langenbeck approach, while 30.4% of patients required the anterior intrapelvic approach. The remaining 4.3% of patients were operated by the iliofemoral approach. Anatomic reduction was achieved in 100% of our study population with remaining displacement less than or equal to 1°mm. At 1-year follow-up, all fractures showed a satisfactory union with an excellent Matta index in 100% study subjects. Complications at 1 year included one case of foot drop, which was present preoperatively but failed to improve and one case of post-traumatic arthritis. Average Harris Hip score (HHS) and mean Merle D'Aubigne (MDA) scores suggested good clinical outcomes in the study population. Conclusions A single approach can be used to achieve good functional and radiological outcomes in carefully selected bicolumnar fractures of the acetabulum, with less approach-related morbidity. Clinical significance Traditionally, multiple approaches are used for acetabulum fractures involving both columns, but with proper patient selection, single approach can be used with good functional and surgical outcomes. How to cite this article Patil A, Attarde DS, Haphiz A, et al. A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients. Strategies Trauma Limb Reconstr 2021;16(3):152–160...

show abstract

“…It has been undergoing continued evolution with our better understanding of these complex fractures and advances in instrumentation, imaging techniques, and surgical training. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

Sancheti¹,

Shyam²,

Patil³

et al. 2022

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

show abstract

“…It is obviously difficult to achieve anatomic reduction only through the K-L approach because of the weight of the lower extremity. Although anterior column fractures were satisfactorily exposed by a conventional ilioinguinal approach, extensive soft tissue dissection is unavoidable [ 15 , 16 ]. The modified Stoppa [ 17 – 20 ] and para-rectus approaches [ 21 ] are minimally invasive, but these approaches also have disadvantages of insufficient exposure, as well as difficulty in reducing fractures and maintaining the reductions.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Transverse with or without Posterior Wall Fractures of Acetabulum Using a Modified Smith-Petersen Combined with Kocher-Langenbeck Approach

Jiang

et al. 2017

Med Sci Monit

Self Cite

View full text Add to dashboard Cite

BackgroundThe aim of this study was to explore the surgical treatment of transverse with or without posterior wall fractures of the acetabulum.Material/MethodsWe surgically treated 21 consecutive cases of pure transverse (7 cases) and with posterior wall (14 cases) fractures of the acetabulum. The anterior column fractures were firstly reduced, temporarily fixed through a modified Smith-Petersen small incision, and finally fixed after the fixation of the posterior column and wall fractures, which were reduced and fixed through a Kocher-Langenbeck approach. The operative time, intra-operative blood loss, quality of reduction (Matta criteria), perioperative complications, osseous union, subsequent complications, and hip function evaluation were recorded.ResultsThe mean operative time was 198.1 min and the mean intra-operative blood loss was 938.1 ml. Anatomic reduction of the anterior column was obtained in 20 cases and was imperfect in 1 case. All posterior column and wall fractures were anatomically reduced. We followed up 18 cases for a mean duration of 16.3 (8–30) months. All the fractures achieved osseous union. The mean Harris score was 85.1 points, with an excellent result in 7 cases, good in 8, fair in 2, and poor in 1. According to modified Merle d’ Aubigne and Postel score system, the results were excellent in 2 cases, good in 15, and poor in 1. Avascular necrosis of the femoral head occurred in 1 case, heterotopic ossification in 3 cases, and numbness of the anterolateral thigh in 6 cases.ConclusionsFor transverse with or without posterior wall fractures of the acetabulum, reduction and fixation of anterior and posterior column should be done in sequence, and a modified Smith-Petersen small incision might be a good choice in reduction and fixation of the anterior column because it possesses advantages of direct visualization and minimal invasion.

show abstract

“…Большинство пациентов получили травму в ДТП -184 случая [1,16,17,19,20,22,23,24,25]. Падение с высоты более 3 м послужило причиной перелома у 108 пациентов [1,16,17,19,20,22,23,24,25], с уровня менее 3 м -у 65 пациентов [1,19,23,24,25]. Травма произошла от падения тяжелого предмета у 11 пациентов [21,23].…”

Section: механизм травмы и хирургические доступыunclassified

“…На графике отображены данные из 9 источников, так как в остальных работах механизм травмы не отражен. Перелом передней колонны в сочетании с полупоперечным переломом задней колонны ВВ зафиксирован у 65 пациентов [1,16,19,22,23]. Перелом задней стенки выявлен у 56 пациентов [1,16,17,19,21,25].…”

Section: механизм травмы и хирургические доступыunclassified

“…Применение классических и модифицированных хирургических доступов к ВВ сопровождается серьезными интра-и послеоперационными осложнениями, возникающими в 8-59% случаев [3]. Осложнения связаны, прежде всего, с травматизацией тканей, сосудов, нервов, лимфатических структур, длительностью оперативного вмешательства до трех и более часов и значительной кровопотерей [1,7,8,9,10,11], что становится серьезным сдерживающим фактором широкого применения доступов в остром периоде травмы [12,13,14,15,16].…”

Section: Introductionunclassified

See 1 more Smart Citation

Surgical Approaches for Acetabulum Fracture Treatment: Analytic Review

Kolesnik¹,

Донченко

Surikov

et al. 2022

Traumatology and Orthopedics of Russia

View full text Add to dashboard Cite

Background. The use of classical and modified surgical approaches to acetabulum is accompanied by serious intra- and postoperative complications associated with tissues, vessels, nerves, and lymphatic structures injury. The choice of approach to acetabulum affects the surgical time and the blood loss volume. The aim of the review was to compare the surgical time and blood loss volume using different surgical approaches to the acetabulum based on the relevant literature analysis. Methods. The search was carried out in PubMed/MEDLINE and Scopus databases from 1964 to 2022. When conducting a search for the phrases acetabular fractures, surgical approach to the acetabulum, 4368 articles were found. As a result of the selection, 12 publications containing the most complete information on the studied indicators were included in the quantitative analysis. Results. The data of surgical treatment of 540 patients with acetabulum fractures were analyzed. The average age of the patients was 45.211.6 years. Among the causes of pelvic and acetabulum fractures, road accident (70.4%) and falls from height (21.3%) largely prevailed. The blood loss depended on the use of specific approaches or their combination, and the surgical time. The shortest surgical time (101.027.0 min.) was required using pararectal approach, the longest (26456.4 min.) with the use of ilio-inguinal approach. The largest volume of blood loss was observed with Pfannenstiel approach 1057.1377.9 ml. No statistically significant differences were found when comparing the Kocher-Langenbeck (793328 ml), ilio-inguinal (82864 ml) and pararectal (798322 ml) approach. Performing the Kocher-Langenbeck approach in the patients lateral position reduces the surgical time by 16.8% and reduces blood loss by 12.4% compared to the patients prone position. Conclusion. Comparative clinical studies are required to determine the safest surgical approaches to the acetabulum, depending on the type of fracture, the mechanism of injury and the age of the patient.

show abstract

A Novel Approach for Treatment of Acetabular Fractures

Cited by 3 publications

References 27 publications

A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

Treatment of Transverse with or without Posterior Wall Fractures of Acetabulum Using a Modified Smith-Petersen Combined with Kocher-Langenbeck Approach

Surgical Approaches for Acetabulum Fracture Treatment: Analytic Review

Contact Info

Product

Resources

About