scholarly journals Surgical treatment of displaced acetabular fractures

2011 ◽  
Vol 139 (7-8) ◽  
pp. 496-500 ◽  
Author(s):  
Sasa Milenkovic ◽  
Jordan Saveski ◽  
Mile Radenkovic ◽  
Goran Vidic ◽  
Neda Trajkovska
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Articular Surface ◽  
High Energy ◽  
Acetabular Fractures ◽  
Anatomical Reduction ◽  
Severe Injuries ◽  
Stable Internal Fixation

Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Nis from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d?Aubign? Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

scholarly journals Surgical treatment of the unstable type C pelvic injury

2013 ◽  
Vol 60 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Jordan Saveski ◽  
Ivan Micic ◽  
Milan Mitkovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries ◽  
Ring Complex ◽  
Type C ◽  
Stable Internal Fixation

Rotationally and vertically unstable injuries to the pelvic ring (Type C) require stabilisation of the anterior and posterior pelvic ring complex. Inadequate treatment of these injuries leads to chronic instability of the pelvic ring, which can finally cause permanent disability. Open reduction and stable internal fixation of the anterior and posterior complex of unstable pelvic ring injuries are standard procedures in the treatment of hemodynamically stable patients with (Type C) pelvic injuries. Our aim is to show that this type of treatment achieves excellent and good results. All patients were operated on using the method of open reduction and anterior plate fixation of sacroiliac complex as well as fixation of the pubic symphisis. We present a retrospective study of the results concerning the treatment of 19 patients with (Type C ) unstable pelvic injuries. The average age of the patients was 43,21 years old. The final functional results, 2 years post-surgery according to the Majeed scoring system and the results were excellent in 11 (57.89%) and good in 8 (42.1%) patients. There were no bad results to report. Type C pelvic ring injuries are unstable and unless they are adequately treated, they can lead to permanent consequences. Surgical treatment that includes open reduction and stable internal fixation of the anterior and posterior pelvic ring complex leads to excellent and good results. The patients that were treated surgically by fixation of the anterior and posterior pelvic ring complex return to their everyday lives and work activities.

scholarly journals Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-89
Author(s):  
Rayan Ahmed ◽  
Kotb Ahmed ◽  
M. Elmoatasem Elhussein ◽  
Samir Shady ◽  
Tamer A. El-Sobky ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Articular Surface ◽  
High Energy ◽  
Complication Rates ◽  
Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

scholarly journals Ilioinguinal versus modified Stoppa approach for open reduction and internal fixation of displaced acetabular fractures: A Protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Amit Srivastava ◽  
Rajesh Kumar Rajnish ◽  
Prasoon Kumar ◽  
Rehan Ul Haq ◽  
Ish Kumar Dhammi
Keyword(s):  
Systematic Review ◽  
Internal Fixation ◽  
Open Reduction ◽  
English Language ◽  
Case Reports ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Acetabular Fractures ◽  
Anatomical Reduction ◽  
Stoppa Approach

Background: The fracture of the acetabulum is one of the most challenging fractures to manage and operate for orthopaedic surgeons, to get a good surgical outcome, anatomical reduction of fractures and reconstruction of the joint is of utmost importance. To achieve a good postoperative outcome an appropriate surgical approach is necessary to achieve an anatomical reduction of fractures and fewer complications. Objective: The current review aims to compare the outcomes of the ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures by analyzing the evidence from the current literature. Methods: A systematic review of the literature will be conducted in accordance with the PRISMA guidelines. The primary searches will be conducted on the Medline (PubMed), Embase, Scopus, and Cochrane Library databases, using a pre-defined search strategy. The studies of any design in the English language will be included which compared the outcomes of the ilioinguinal and modified Stoppa approach for ORIF of displaced acetabular fractures and reported at least one outcome of interest. Studies that do not compare the outcomes of the ilioinguinal and modified Stoppa approach for the treatment of displaced acetabular fractures in adults (>18 years of age), case reports, conference abstracts, posters, book chapters, review articles, biomechanical studies, technical tips, cadaveric studies, and articles not in the English language will be excluded. Both qualitative and quantitative analyses will be done. Qualitative analysis will be done using appropriate tables and diagrams. Wherever feasible, quantitative analysis to be done with the appropriate software. The risk-of-bias assessment will be done using the MINORS tool for the non-randomized comparative studies, and The Cochrane Collaboration risk-of-bias tool will be used for randomized control trials.

scholarly journals Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

2017 ◽  
Vol 3 (6) ◽  
pp. 1223
Author(s):  
Namdev Gorgile ◽  
Vinod Jagtap ◽  
Yash Shah ◽  
Vikas Rokade ◽  
Girish Bartakke
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
High Energy ◽  
Early Mobilisation ◽  
Anatomical Reduction ◽  
Plating Technique ◽  
Knee Stiffness ◽  
Articular Fractures ◽  
Buttress Plate ◽  
Stable Internal Fixation

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement.</span></p>

Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures

2019 ◽  
Author(s):  
Markus Alexander Küper ◽  
Alexander Trulson ◽  
Christian Minarski ◽  
Fabian Stuby ◽  
Ulrich Stöckle ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Impact Energy ◽  
Geriatric Patients ◽  
Pelvic Ring ◽  
Young Patients ◽  
High Energy ◽  
Surgical Approaches ◽  
Acetabular Fractures ◽  
Anatomical Structures ◽  
High Energy Trauma

AbstractInjuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.

scholarly journals Open reduction and internal fixation of acetabular fractures in patients of old age

2020 ◽  
Vol 44 (10) ◽  
pp. 2123-2130 ◽  
Author(s):  
Pol Maria Rommens ◽  
Roland Schwab ◽  
Kristin Handrich ◽  
Charlotte Arand ◽  
Daniel Wagner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Internal Fixation ◽  
Old Age ◽  
Predictive Factors ◽  
Open Reduction ◽  
Rating Scale ◽  
Acetabular Fractures ◽  
Anatomical Reduction

Abstract Material and methods There is an ongoing debate on which treatment for acetabular fractures in elderly patients is the most appropriate. This study was set up to identify the role of open reduction and internal fixation of acetabular fractures in persons of old age. We retrospectively reviewed the medical charts and radiological data of all patients older than 65 years, who suffered an isolated acetabular fracture and were admitted in our Department between 2010 and 2014 (5-year period). Complications, outcome and mortality were recorded. Of all surviving patients, quality of life (QoL), mobility and independence were graded with European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L), European Quality of Life 5 Dimensions Visual Analogue Scale (EQ-5D-VAS), Numeric Rating Scale (NRS), Elderly Mobility Scale (EMS) and Tinetti Mobility Test (TMT). Results Seventy patients could be identified. There were 52 men (74%) and 18 women (26%) with a median age of 79.0 years (range: 65–104 years). Forty-six patients (66%) had been treated with open reduction and internal fixation (ORIF), 24 (34%) conservatively. There were negative predictive factors—subchondral impaction, damage to the femoral head and multiple fragments—in 54% of the operative group. With ORIF, an anatomical reduction could be achieved in 27 patients (59%), an acceptable in 18 (39%) and a poor in one (2%). At follow-up, 18 patients (26%) had died and 23 (33%) were not able to participate. The follow-up rate of the surviving operatively treated patients was 77%. Eleven of 46 operated patients (24%) needed a conversion to a total hip arthroplasty (THA). All patients undergoing conversion had imperfect reduction after surgery. No patient in the non-operative group underwent conversion to THA during follow-up. The median follow-up time of operatively treated patients without conversion (n = 17) was 30 months (range, 16–73 months), of patients with THA (n = 9) 30 months after conversion (range, 17–55 months). Quality of reduction correlated to QoL, mobility and independence in all recorded parameters. Patients with secondary THA had similar good outcomes as patients after ORIF without later conversion. Men had better outcome than women. Conclusion ORIF of acetabular fractures in patients of old age results in excellent outcomes at short-term follow-up when anatomical reduction can be achieved. In case of negative predictive factors, ORIF cannot be regarded as a definitive solution, rather as the construction of a stable socket for secondary THA. The decision of therapy should be made dependent on pre-operative radiographic parameters.

Functional Outcome of Open Reduction and Internal Fixation for Completely Unstable Pelvic Ring Fractures (Type C)

2003 ◽  
Vol 17 (8) ◽  
pp. 555-562 ◽  
Author(s):  
Sevki Kabak ◽  
Mehmet Halici ◽  
Mehmet Tuncel ◽  
Levent Avsarogullar ◽  
Ali Baktir ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Pelvic Ring ◽  
Pelvic Ring Fractures ◽  
Type C

Monitoring of Somatosensory and Motor Evoked Potentials During Open Reduction and Internal Fixation of Pelvis and Acetabular Fractures

Orthopedics ◽  
2000 ◽  
Vol 23 (10) ◽  
pp. 1081-1083
Author(s):  
Edward D Arrington ◽  
David P Hochschild ◽  
Timothy J Steinagle ◽  
Paul D Mongan ◽  
Steven L Martin
Keyword(s):  
Evoked Potentials ◽  
Internal Fixation ◽  
Open Reduction ◽  
Motor Evoked Potentials ◽  
Acetabular Fractures
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