Less Invasive Surgeries in the Management of Acetabular Fractures in Adults

Abstract Acetabular fractures are rapidly increasing in the present scenario of the practice of orthopedic surgery due to ever increasing high velocity injuries especially the road traffic accidents (RTAs). Acetabular fractures still are among the most challenging fractures to treat because of complex three dimensional anatomy, involved surgical access to fracture sites and the siginificant risk of neurovascular and visceral injuries. The aim of this study as to evaluate the clinical and radiological results of patients presented by fracture acetabulum and treated by less invasive methods of reduction and fixations. !The study included "# patients ith acetabular fractures all operated at Tanta $niversity %ospital. The age of patients ranged from &# to '( years ith an average of)).* years. There ere )* males and &( females. The right side as affected in &+ patients hile left side as affected in (+ patients. The causative injury as motor vehicle accidents in (" patients, motor cycle in &) patients, pedestrian in , patients and falling from height in " patients. The fractures ere classified according to letoumel &++) ()-).

Surgical treatment of complex Acetabular fractures

Abstract Acetabular fractures are not uncommon injuries in .gypt. The aim of surgical treatment is to preserve hip mobility and to avoid of post/ traumatic arthritis. Any factor that interfere ith this goal may jeopardi0e the function of the hip The aim of this study as to evaluate the clinical and radiological results of patients presented by displaced complex acetabular fractures and treated by open reduction and internal fixation. The study included '' patients ith complex acetabular fractures. 1nitial assessment and treatment as directed to ards the patient!s general condition .2osterior hip dislocation as reduced as fast as possible. 3tandard x/ray vie s and 4T cuts as done for every patient to classify the fracture and to define its personality. The definite surgery as done through an ilioinguinal, a 5ocher /6angenbeck or combined approaches. 2ostoperatively, the residual displacement as recorded together ith the head roof relationship. $sing 7atta radiological grades and his modified clinical grading a correlation bet een radiological and clinical results as made. 8actors affecting the outcome ere defined. The mean follo /up period as (+.*( 9,.&+ months ith a minimum of &( months and a maximum of ") months. .xcellent to good results ere achieved in ()# case : *#.&;), hile fair to poor results ere the end result in (&, case : )-.+;).

Anatomical reduction and <or restoration of perfect head<roof congruency ere strongly associated ith better outcome. =eside this there as significant relation bet een good clinical outcome and the utili0ation of the anterior approach. >n the other hand bad outcome as associated ith these factors (&) associated pelvic ring injury.(()posterior all involvement .()) articular surface comminution (") intra/articular fragments.

Surgical Treatment of Acetabular Fractures

Acetabular fractures represent an injury to the articular surface of a major eight bearing joint and should be treated in according ith the same criteria used for other intraarticular fractures. The surgical management of displaced acetabular fractures is indicated for an unstable and an incongruous hip joint. The acetabulum is formed by t o columns of bone, anterior and posterior. These columns converge and meet in a thick and compact portion of bone situated infront of and belo the iliac reticular surface of the sacroiliac joint. The majority of patients ith acetabular fractures have been involved in a motor vehicle accident, either in a car or on a motorcycle. ?udet and 6etournel, divided acetabular fracture into t o major types, elementary and associated or complex@ each has its subgroup. They considered the acetabulum to be an arch formed by t o columns of bone, one anterior and the other is posterior. The most definitive indication for surgery is instability of the hip joint. The type of fracture mainly determines the choice of incision, but other factors also influence the choice. The general trend is to ards more limited exposures to avoid the complications of the more extensile ones. Aisplaced acetabular fractures are usually associated ith significant morbidity and mortality. &+, 3ummary A number of the complications, ho ever, are secondary to surgical treatment@ including either immediate post/surgical complications such as infection, nerve injuries thromboembolism and malreduction, and late complications such as heterotopic ossification, avascular necrosis of the femoral head or acetabular fracture fragment, posttraumatic osteoarthritis and implant failure. The aim of this ork is to assess the results of surgical treatment of fractures of the acetabulum. from ?anuary (--) to 7arch (--', thirty patients ith displaced acetabular fractures ere treated by open reduction and internal fixation in >rthopaedic department, 8aculty of 7edicine, 7enoufiya $niversity. The average patient age at time of acetabular fracture surgery as )) years, ith a range of &# to ''years. All ere ambulatory at the time of injury. There ere (* male patients and " females. The right side as affected in &" patients and the left side in &* patients.

The mechanisms of the injury ere a traffic accident for (" patients ((dashboard injuries and " pedestrian injuries) and a fall for * patients. The follo up period ranges from t elve months to )* months. =ased on the ?udet and 6etournel classification, there ere fourteen elemental patterns (six posterior all, three posterior column and five transverse) and sixteen associated fractures (five T/type, six both column, three T/shaped B posterior all and t o transverse B posterior all). 3ix patients sustained a fracture ith dislocation@ five posterior and one central. Co cases ith anterior dislocation. >ne patient had a &+# 3ummary fracture of the femoral head (2ipkin type 1D). The follo up period ranges from t elve months to )* months. 3even cases of near perfect reduction (().);), sixteen cases ith good reduction (').";) and seven cases ith poor reduction (().);). All cases ere evaluated radiologically and functionally. Radiological evaluation includes early and late radiological evaluation. .arly radiological results ere seven cases of near perfect reduction (().);), sixteen cases ith good reduction (').";) and seven cases ith poor reduction (().);). 6ate radiological results ere excellent in four cases (&).);), good in fifteen cases ('-;), fair in five cases (&*.,;) and poor in six cases ((-;). 8unctional results ere excellent in four cases (&).)), good in fourteen cases ("*.,;), fair in six cases ((-;) and poor in another six cases ((-;). 1ntraarticular fragments and acetabular impaction ere found in four cases. T o ('-;) cases gave good results hile the other t o ('-;) gave fair and poor results. The difference bet een patients ho had intraarticular fragments and acetabular impaction and those ithout these findings as found to be significant. 5ocher/6angenbeck appeared the most popular approach used in acetabular fractures treatment as it as used in seventeen cases ('*.,;). Transtrochanteric approach as used in ten cases ()).);), 4ombined approach in t o cases (*.,;) and .xtensile Triradiate approach in only one case ().);). T enty/four (#-;) cases ere fixed ith reconstruction plates hile six ((-;) cases ere fixed ith scre s alone. &++ 3ummary The average length of hospitali0ation as (&.( days, ranged from ' to "' days. The mean as (-.' days. .arly complications included, deep venous thrombosis in three cases (&-;), t o cases (*.,;) developed sciatic nerve injury, failure of fixation occurred in t o cases (*.,;) and infection in three cases (&-;). 6ate complications included, heterotopic ossification in t o cases (*.,;), osteoarthritis occurred in three cases (&-;), t o cases (*.,;) developed avascular necrosis of the femoral head.