[Ortho] Acetabulum with imperfect reduction

[Abdelsalam EID]

Dear Friends

  This is a 20 year old man who had an irreducible fracture
dislocation of the left acetabulum, associated transverse +
posterior wall type, operated nearly 2 weeks following the trauma.


  Open reduction and internal fixation was performed through posterior
approach with trochanteric osteotomy. Extraction of the incarcerated
fragment was very difficult, and then reduction of the femoral head
also felt less easy than usual. After plate fixation, the head was
found to subluxe on maximum internal rotation. However, it became more
or less stable after fixation of the trochanteric osteotomy and
reattachment of the rotators. Xray showed lateral displacement of the
femoral head. CT was also performed and it confirmed the lateral
displacement although I don't know if it could be termed subluxation.
The flexion- extension  ROM is 0-45  with some internal-external
rotation, but the limitation is mostly by pain. I cannot explain this
situation and would you like to hear your suggestions.
  I am confident that I left no intraarticular fragments. Could the
comminution in the anterior wall visible on CT be responsible for this?
  I am planning to fix his concomitant tibia fracture within 3 days,
and in the process perform an examination under anaesthesia. If the
ROM is good, I may leave him alone. What do you think? I am sending
the x ray and CT.
If anyone would like better quality but larger images of the X ray and
CT I can send them to their personal addresses.


Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University, Egypt.
Abdelsalam EID
----------- следущая часть -----------
Вложение не в текстовом формате было извлечено…
Имя     : pre-xray.jpg
Тип     : image/pjpeg
Размер  : 14471 байтов
Описание: отсутствует
Url     : http://weborto.net:8080/pipermail/ortho/attachments/20070627/a86ddac6/attachment-0003.bin 
----------- следущая часть -----------
Вложение не в текстовом формате было извлечено…
Имя     : post-ct-2.jpg
Тип     : image/pjpeg
Размер  : 48614 байтов
Описание: отсутствует
Url     : http://weborto.net:8080/pipermail/ortho/attachments/20070627/a86ddac6/attachment-0004.bin 
----------- следущая часть -----------
Вложение не в текстовом формате было извлечено…
Имя     : post-xray.jpg
Тип     : image/pjpeg
Размер  : 21224 байтов
Описание: отсутствует
Url     : http://weborto.net:8080/pipermail/ortho/attachments/20070627/a86ddac6/attachment-0005.bin