[Ortho]Re: Нелеченный перелом вертлужной впадины

[Chip Routt]

The joint is non-concentric as the head appears to be either
"following the caudal segment", or the dome component is displaced
from the tethered head... or so it seems... and he's young... so, many
fracture surgeons would recommend reduction and fixation.   

So we must decide preoperatively which part is the displaced segment?

It's difficult to know from these few selected images which component
of the injury (was before and now) should be deemed the "soon to be
mobile" segment. It's my best guess that it is the caudal portion and
there exists a healing fracture line somewhere thru the posterior
column... one image suggests it. If true, its early healing/union
should be disrupted, and the resultant fragment mobility then allows
accurate reduction. 

Such work is not always possible using a single exposure... it's not
unreasonable to first access the healed zone and osteotomize it using
one direct exposure, then turning the patient if necessary to use
another opposite exposure to further mobilize the fracture, reduce,
clamp, and fix it.    

On the other hand, some surgeons advocate an extended iliofemoral
exposure for these scenarios. For a variety of reasons, I've never
been much of a fan.  

In summary, reduction and fixation would be good. If you have an
excellent 3D brain, a quality OR fluoroscopy unit, and are slick with
an osteotome and clamps thru the ilioinguinal exposure then you've
made your best choice.   
Remember that the symphysis is the caudal segment's "hinge" and may
need destabilizing as well if it's affecting the reduction adversely.

If you have other images which cause you to decide to destabilize the
posterior column fracture component using a direct or EIF exposure,
then you have better info than we can see.

Or you can just leave it... he has good dome coverage and it may be a
durable hip for some time... maybe. 

Chip

M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499