[Ortho]Re: Нелеченный перелом вертлужной впадины

[Frederic B. Wilson, M.D.]

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