Management of Complex Acetabular Fractures Through Single Nonextensile Exposures

Quadrilateral plate fractures of the acetabulum: An update

“…13,15,72 This is due to the difficulties associated with fixation in osteoporotic bone and risks of surgery. 15 Satisfactory results can be expected with minimally displaced (<2 mm) fractures, 2,13,17,21,22 those with apparent congruence of the hip with a both column fracture, an acetabulum which is intact superiorly as documented by roof arc measurements and congruence of the femoral head with the roof on the three standard radiographs (AP pelvis and obturator and iliac oblique Judet views) out of traction. 8,13,18,41 However, a high proportion of unacceptable results have been found with non-operative treatment of elderly fractures.…”

“…The aim is to anatomically restore the joint surface as it has been clearly shown as a key factor for its future prognosis. 7,18,[20][21][22]43,46,72,[74][75][76] Several other factors have also been correlated with outcome. They include fracture type, with the worst outcomes associated with complex fractures, especially those with marked displacement and comminution; chondral and osseous lesions of the femoral head and ipsilateral femoral neck fractures.…”

“…3,4 There has been a move away from extensile approaches such as the extended iliofemoral, triradiate and dual approaches due to an increased rate of complications especially in the elderly. 3,4,18,21,29,42,47,78,79 The ilioinguinal approach, first described by Letournel, has been the most widely used intrapelvic approach to access fractures of the quadrilateral plate. It has a relatively low complication rate but it can be associated with injury to the iliac vessels and lymphatics, lateral femoral cutaneous nerve and disruption of the inguinal ligament resulting in post-operative hernia.…”

“…3,20,22 Rates of heterotopic ossification range from 3% to 59%. 3,[18][19][20][21][22]29,79,80 Risk factors include the extensile approaches, high Injury Severity Score, delay in fixation and associated head injury. 20 In a metaanalysis of 3639 patients treated with ORIF 26.5% went on to develop osteoarthritis and 5.6% went on to develop avascular necrosis of the femoral head.…”

“…[11][12][13][14][15][16][17] These fractures of mainly the elderly population, also pose several specific treatment challenges compared to those of young high-energy trauma patients who are traditionally associated with acetabular fractures. 7,12,13,[18][19][20][21][22][23] Until the 1960s most acetabular fractures were treated nonoperatively. Traction was first recommended by Cottloda in 1922 and represented the mainstay of management.…”