Extraarticular Fractures after Periacetabular Osteotomy

Abstract

Extraarticular fractures of the pelvic ring after periacetabular osteotomy could impair stability of the acetabular fragment and cause poor clinical and radiographic outcomes. We evaluated 17 patients (17 hips) with fractures of either the ipsilateral os pubis (n = 12) or os ischium (n = 5) during the postoperative period after periacetabular osteotomy. Ischial fractures seemed more debilitating with two of five resulting in painful nonunions for which additional surgery was performed. In contrast, only one patient with pubic fracture had additional surgery. Ischial fractures took almost twice as long to achieve resolution of symptoms compared with pubic fractures, and when left untreated, asymptomatic nonunions developed in three of five.

Effects of Curved Periacetabular Osteotomy on the Stress Fields of the Pubic Rami and Ischium: A Finite Element Model Analysis

“…A few reports have described the pubic or ischial fracture as a complication of acetabular osteotomies, including CPO [9][10][11]. In these reports, fractures of the inferior pubic rami and ischial fractures were observed in approximately 3% -20% of patients who had undergone acetabular osteotomies [9][10][11].…”

“…According to several reports [9][10][11], most fractures occurred as early as 3 months after surgery. The osteotomy site of the inferior rami and ischium may become stronger with a gradually increasing load over a long period of time.…”

“…Postoperative pubic or ischial stress fracture has also been referred as a complication in some reports, and discontinuity of superior pubic rami [9,10] and narrowing of the inferior pubic rami [10,11] have been considered as risk factors. However, a detailed analysis with regard to load distribution after CPO has not been reported.…”

“…However, a detailed analysis with regard to load distribution after CPO has not been reported. Moreover, we employ the same rehabilitation program for patients at risk as for those who do not exhibit the risk factors, because the fractures do not significantly influence walking or hospital stay [9,10].…”

A Periacetabular Osteotomy for the Treatment of Severe Dysplastic Hips

“…Although the patients with nonunion of the superior ramus of the pubis were asymptomatic throughout the followup period, continued assessment is required. Stress fractures are thought to arise when the load transmission occurs only through the inferior limb of the pubis and ischium [6]. Fractures of the inferior limbs of the pubis were identified in seven (3.7%) among all the hips.…”