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 Отправлено Harpreet S Gill 13 Июнь 2005, 12:36
Dear All, The patient came to us for opinion regarding this # of pelvis which he sustained 5 months back.
He gives history of being on skin traction for 3,5months. After that he was advised partial weight bearing to be graduated to full weight bearing. Now the patient has difficulty in weight bearing as it is painful. He can walk a few steps only with the help of a walker. Hip movements are restricted and painful. Fl-90* ER-10* IR-0, shortening-4cm. He also had # of humerus and radius/ulna, which were plated and have united. The serial x-rays of the pelvis/Hip during these 5 months show that the hip joint has been in the same position. I have the CT pictures also but not digitalized as yet.
He is 47 years old, Class-1 officer.What are the options? Expert comments please.1. # Pelvis stabilization - Is it possible at 6 mths? And subsequently THR.
2. THR in this position- Cup positioning in a deformed pelvis?
3. Can't be left as such
Regards
Harpreet S Gill
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Re: Neglected # Pelvis
Alampallam Krishnamoorthy 13 Июнь 2005, 18:34
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Dear Dr.Harpreet,
It is a displaced and ununited fracture of the acetabulum, probably type C (AO). The pelvis is not fractured from what one can see of the sacro iliac joint.
That is why the hip movements are restricted.
I thin the only option at the movement is a THR with a mesh to reconstruct the acetabulum and a cage.
Regards
Dr.Venkatachalam
Consultant Orthopaedic surgeon
Chennai.
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Re: Neglected # Pelvis
Alampallam Krishnamoorthy 13 Июнь 2005, 18:35
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Dear Harpreet,
Sorry missed the wide open pubic diastasis.
You could tryan open reduction of the pubis through a Pfannensteil inscision and get some closure done. An external fixator may help preoperatively to get some compression.
Regards
Dr.Venkatachalam
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Re: Neglected # Pelvis
Andrew Ragozin 19 Июнь 2005, 23:41
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I think, if symphysis is unstable at first you must open and stabilize symphysis by plate or
external fixator or may be use both together.
Our experience showes, that reposition and stabilization pelvis in zone of old acetabular fractures with bone grafting are very traumatic and not effective due head AVN and hip arthrosis.
In such cases we use hip arthroplasty with "Octopus" acetabular system (De Puy). This system consist of acetabular ring and cementless cup.
It`s allow you to fix the reinforcement ring in proper position, then bone grafting of the defects of the acetabulum walls and floor.
Then you fix the cup to the ring.
I will show some cases.
--
Best regards,
Ragozin Andrew
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Neglected # Pelvis
