Results of 167 consecutive cases of acetabular fractures using the Kocher-Langenbeck approach: a case series

Abstract

BackgroundAcetabular fractures are quite challenging injuries for the orthopedic surgeon because of their low incidence and their deep and complex anatomy. The objective of this study was to evaluate surgeon-independent parameters that might influence radiographic outcome and early complication rates of high-energy acetabular fractures treated by open reduction and internal fixation via the Kocher-Langenbeck approach, the golden standard for posterior access.MethodsOne hundred sixty-seven consecutive patients (111 males and 56 females) with a mean age of 41.8 years and a mean follow-up period of 10 months were surgically treated by one experienced surgeon at a level I trauma center within 10 years. To quantify the radiographic outcome, the Matta, Brooker, and Epstein grades were used. Posttraumatic arthritis and avascular necrosis of the femoral head (defined as Helfet grades 3 or 4 and Ficat/Arlet stages 3 or 4, respectively) were evaluated. Furthermore, subgroup analyses according to fracture type, age, and gender were performed for each outcome measure and complication (infection, hemorrhagic shock, revision surgery, nerve damage, and need of a total hip arthroplasty).Results65 A1, 34 A2, 51 B1, and 17 B2 fractures were identified according to the AO/ASIF classification. Of all patients, reduction was rated anatomic in 63.5%, imperfect in 22.2%, and poor in 14.4%. Degenerative changes were observed in 49.7%; 37.9% were affected by heterotopic ossification, 21.6% by posttraumatic arthritis, and 5.4% by avascular necrosis of the femoral head. Fifteen percent were diagnosed with a nerve damage, and 4.8% sustained an infection. Total hip arthroplasty was performed in 10.2%. Revision surgery due to secondary loss of reduction, seroma/hematoma, and wound infection was indicated in 6.0%.ConclusionsFracture type, age, and gender are prognostic factors for the surgical outcome after ORIF of high-energy acetabular fractures.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0563-6) contains supplementary material, which is available to authorized users.

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

“…Post-traumatic osteoarthritis is the most common complication of femoral head fracture, and its incidence is directly related to the quality of fracture reduction. 32 , 33 , 35 In our study, three patients developed post-traumatic osteoarthritis, resulting in a lower incidence than the 21.6% reported in the literature. 33 …”

“…Lukas et al. 33 drew a similar conclusion. After anatomic reduction has been achieved, internal fixation should be performed.…”

Outcome after Surgical Management of Acetabular Fractures: A 7-Year Experience

“…As mentioned by Matta et al, [24] the main complication following a fracture of the acetabulum is post-traumatic osteoarthritis. The incidence of osteoarthritis in our series was 60.8%, which is considerably higher than that reported by Isaacson et al, [30] 52% and the 21.6% reported by Negrin et al, [31]. Iatrogenic nerve injury included sciatic nerve, femoral nerve and lateral cutaneous nerve of thigh are possible complication during acetabular surgery.…”

Surgically Treated Posterior Acetabular Fractures Via Iselin’s Modified Approach with A Short-Term Follow-Up

“…In our study, the mean interval between injury and the surgical procedure was found to be 3.2 days with a mean surgical time of 79.8 minutes, and blood loss of 179.15cc. The time of surgery and amount of bleeding are lower than the average of the standard and modified approaches specified in the literature, in particular (Negrin, 2017). Complications such as DVT and PE, which were reported as 8% in the literature, were not detected in any of our cases (Negrin, 2017).…”

“…The time of surgery and amount of bleeding are lower than the average of the standard and modified approaches specified in the literature, in particular (Negrin, 2017). Complications such as DVT and PE, which were reported as 8% in the literature, were not detected in any of our cases (Negrin, 2017). In 2 patients, superficial wound infections were observed and the mean duration of surgery and total blood loss were up to the average (Magu,2011).…”