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Acetabular fracture
Ортопедия и травматология Отправлено Yordan Andonov 30 Ноябрь 2008, 23:07
Dear All,
I would like to present a case of a young (22 yo) male who suffered a car crush. He has combined transverse and posterior wall fracture of the right acetabulum as well as a nondisplaced fracture of the left acetabulum and bimalleolar fracture of the left ankle.
Initially we did a combined lateral and axial traction to the right leg . The patient is stable now (6 day after the accident), so I would like to ask for your opinion for the best course of treatment of the right acetabulum.
Best regards,
Yordan Andonov MD
Ruse, Bulgaria

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    Re: Acetabular fracture
    Alexander Chelnokov 01 Декабрь 2008, 12:45
    Dear Yordan

    > bimalleolar fracture of the left ankle. Initially we did a combined
    > lateral and axial traction to the right leg . The patient is stable now ( 6


    See http://www.wheelessonline.com/ortho/transverse_frx_of_acetabulum Lateral traction is rather harmful than useful because pin tract infection close to further surgical wound increases risk.
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    Re: Acetabular fracture
    Milton L. Routt 01 Декабрь 2008, 12:50
    The details of the fracture are not so clear from the images sent...would you be able to send along an AP and Judet images as well as some additional axial images above and below the joint?

    I’m not so sure that your patient has a Tr+PW pattern based on the images sent...maybe the fracture’s exact name won’t matter in the long run, but it’d be great to see enough images to make an accurate comment.

    Thanks-

    Chip
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    Re: Acetabular fracture
    Tom Toal 01 Декабрь 2008, 12:51
    Without complete CT images and/or oblique radiographs, it's difficult to answer your question definitively, but it appears that there may not be a posterior wall fracture that requires a posterior approach. A successful reduction through an ilio-inguinal approach will have a faster recovery, and not risk SGN injury or heterotopic ossification.

    Tom Toal
    Portland, Oregon
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    Re: Acetabular fracture
    Yordan Andonov 02 Декабрь 2008, 03:13



    Here are some more axial images. What is your opinion as for the timing of the operative treatment?


    Best regards,

    Yordan Andonov
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    Re: Acetabular fracture
    Maxim Agalakov 02 Декабрь 2008, 17:21
    posterior approach, ORIF
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    Re: Acetabular fracture
    Andrey Ragozin 05 Декабрь 2008, 22:05
    Yordan! In this case position of bone fragments is quite good. We
    prefer to use miniinvasive technique. We fix posterior column by can. screw and put 3mm pin with distal thread to the anterior column. Next day after the surgery he may start walking with crutches. 3 month after the surgery we remove the pin. In cases of maleolar fractures we use
    angle stable plates to lat. mal. and pins or screws and if syndesmosis is intact - full loading is not forbidden.
    Sending exampl pict.




    Best regards
    Andrey Ragozin
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    Re: Acetabular fracture
    Анатолий Канзюба 05 Декабрь 2008, 22:08


    Dear dr Yordan ! I would do internal fixation as soon as possible. I sent to you one of my case with using of anterior iliofemoral approach - 5-th day after the accident. Best regards. Anatoliy Kanzyuba, MD. Donetsk Ukraine


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    • Re: Acetabular fracture
      Отправитель: Maxim Agalakov 08 Декабрь 2008, 20:12
      а какой смысл в подвздошно-бедренном доступе в свежем случае, перелом выглядит как простой поперечный, вроде бы одно из показаний к заднему доступу K-L, чего-то не уловил?

      Maxim Agalakov

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