Clinical results of acetabular fracture management with the Pararectus approach

Keel, Marius; Tomagra, Salvatore; Bonél, Harald; Siebenrock, Klaus A.; Bastian, Johannes Dominik

doi:10.1016/j.injury.2014.10.040

Cited by 62 publications

(50 citation statements)

References 36 publications

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“…In this series, only 48.1% of the patients were older than 60 years. The reported mean operation time is higher compared to our case series [23]. Due to different age of the patients’ series, comparison is difficult.…”

Section: Discussioncontrasting

confidence: 63%

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Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty

Resch

Krappinger

Moroder

et al. 2017

Arch Orthop Trauma Surg

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BackgroundFractures of the acetabulum in younger patients are commonly treated by open reduction and internal fixation. For elderly patients, stable primary total hip arthroplasty with the advantage of immediate postoperative mobilization might be the adequate treatment. For this purpose, a sufficiently stable fixation of the acetabular component is required.Materials and MethodsBetween August 2009 and 2014, 30 cases were reported in which all patients underwent total hip arthroplasty additionally to a customized implant designed as an antiprotrusion cage. Inclusion criteria were an acetabular fracture with or without a previous hemiarthroplasty, age above 65 years, and pre-injury mobility dependent on a walking frame at the most. The median age was 79.9 years (65–92), and of 30 fractures, 25 were primary acetabular fractures (83%), four periprosthetic acetabular fractures (14%), and one non-union after a failed ORIF (3%).ResultsThe average time from injury to surgery was 9.4 days (3–23) and 295 days for the non-union case. Mean time of surgery was 154.4 min (range 100 to 303). In 21 cases (70%), mobilization with full weight bearing was possible within the first 10 days. Six patients died before the follow-up examination 3 and 6 months after surgery, while 24 patients underwent radiologic examination showing consolidated fractures in bi-plane radiographs. In 9 patients, additional CT scan was performed which confirmed the radiographical results. 13 had regained their pre-injury level of mobility including the non-union case. Only one patient did not regain independent mobility. Four complications were recognized with necessary surgical revision (one prosthetic head dislocation, one pelvic cement leakage, one femoral shaft fracture, and one infected hematoma).ConclusionThe presented cage provides the possibility of early mobilization with full weight bearing which represents a valuable addition to the treatment spectrum in this challenging patient group.

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Section: Discussioncontrasting

confidence: 63%

“…Thus it is not clear when the patients were allowed for partial or full weight bearing. Another minimal invasive technique also published recently is the Pararectus approach of Keel et al [22, 23]. Also, this procedure showed very promising results.…”

Section: Discussionmentioning

confidence: 99%

Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty

Resch

Krappinger

Moroder

et al. 2017

Arch Orthop Trauma Surg

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“…Die Risiken des Pararectuszugangs sind dieselben wie beim ilioinguinalen Zugang, wobei durch die hervorragende Visualisierung der quadrilateralen Fläche das Risiko von Verletzungen der Vasa obturatoria und des N. obturatorius reduziert ist. Dafür ist die Rate an Blutungen auf bis zu 9 % erhöht [29,31,32] In Bauchlage oder Seitenlage erfolgt die Inzision distal des Trochanter major, beginnend bogenförmig über den Trochanter major bis zur Spina iliaca posterior superior. Nach Durchtrennung der Fascia lata erfolgt die stumpfe Dissektion des M. gluteus maximus bis zu den kurzen Außenrotatoren, die ansatznah am Trochanter major unter zwingender Schonung der A. circumflexa femoris tenotomiert werden (▶ Abb.…”

Section: Pararectuszugang (Nach Keel)unclassified

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

Küper

Trulson²,

Minarski

et al. 2019

Z Orthop Unfall

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Injuries 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.

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“…Surgical access was achieved using the Pararectus approach as described previously [8, 13, 14] with an incision length of approximately 12 cm. The screws for fixation of the suprapectineal plates (screws 1–12, Figure 1) were positioned according to the safe zones for reduction of anterior and posterior column fractures [10–12].…”

Section: Methodsmentioning

confidence: 99%

Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

Egli

Keel

Cullmann

et al. 2017

BioMed Research International

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Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30–45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

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Clinical results of acetabular fracture management with the Pararectus approach

Cited by 62 publications

References 36 publications

Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty

Treatment of acetabular fractures in older patients-introduction of a new implant for primary total hip arthroplasty

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

Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

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