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Re: Нелеченный перелом вертлужной впадины
Frederic B. Wilson, M.D. 25 Март 2007, 00:17
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Chip, et al.,
While not claiming to have the best 3D brain around, it appears to me from the limited images available, that the caudal segment is stable from the symphysis to the SI joint on the fracture side. I would love to see the rest of the transverse CT images to see where the fracture line actually exits posteriorly on both the inner and outer tables of the ilium. In my hands,
assuming that the femoral head has followed the cephalad (dome) fragment, I would use an ilioinguinal approach and take down the fracture line from anterior to posterior, distracting with a lamina spreader, if necessary, to clean out and inspect the joint. I would then reduce the cephalad fragment to the caudal fragment using jungbluth or farabeuf clamp and screws and then apply a plate and screws. If the fracture exits posteriorly would you then favor an additional posterior approach to clean out and reduce from that side?
My concept is that what I am after is restoring the anterior portion of the acetabular ring to the superior dome portion to re-establish the containment of the femoral head in an intact "horseshoe". Is this accurate?
Best regards,
Fred
Frederic B. Wilson, M.D.
Assistant Professor
Trauma and Adult Reconstruction
Department of Orthopaedic Surgery
Louisiana State University Health Sciences Center
2020 Gravier St., #728
New Orleans, Louisiana, 70112
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